hospital_name,last_updated_on,version,location_name,hospital_address,license_number|TX,type_2_npi,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.",attester_name,,,,,,,,,,,,,,,,,,,
Longview Rehabilitation Hospital,2026-03-16,3.0.0,Longview Rehabilitation Hospital,701 E Loop 281 Longview  TX 75601,100593,1659079903,TRUE,Ashley Robinson,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,modifiers,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|methodology,standard_charge|min,standard_charge|max,additional_generic_notes
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,AETNA,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,COM,880,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,COM,880,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,COM,1100,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,COM,880,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,BCBS,COM,935,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,CIGNA,COM,1450,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,TRICARE,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,UNITED HEALTHCARE,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,UNITED HEALTHCARE,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,VA,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,VA TRICARE,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,WELLMED,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,HUMANA,MGD,1440,,,,,,,per diem,880,13384.0302,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,A0101,HIPPS,,,,,,,,Inpatient,,,13384.0302,13384.0302,HUMANA CHOICE PLUS,MGD,13384.0302,,,,,,,case rate,880,13384.0302,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,AETNA,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,COM,880,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,COM,880,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,COM,1100,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,COM,880,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,BCBS,COM,935,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,CIGNA,COM,1450,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,TRICARE,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,UNITED HEALTHCARE,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,UNITED HEALTHCARE,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,VA,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,VA TRICARE,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,WELLMED,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,HUMANA,MGD,1440,,,,,,,per diem,880,17537.6322,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,B0101,HIPPS,,,,,,,,Inpatient,,,17537.6322,17537.6322,HUMANA CHOICE PLUS,MGD,17537.6322,,,,,,,case rate,880,17537.6322,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,AETNA,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,COM,880,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,COM,880,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,COM,1100,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,COM,880,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,BCBS,COM,935,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,CIGNA,COM,1450,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,TRICARE,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,UNITED HEALTHCARE,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,UNITED HEALTHCARE,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,VA,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,VA TRICARE,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,WELLMED,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,HUMANA,MGD,1440,,,,,,,per diem,880,15573.2868,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,C0101,HIPPS,,,,,,,,Inpatient,,,15573.2868,15573.2868,HUMANA CHOICE PLUS,MGD,15573.2868,,,,,,,case rate,880,15573.2868,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,AETNA,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,COM,880,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,COM,880,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,COM,1100,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,COM,880,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,BCBS,COM,935,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,CIGNA,COM,1450,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,TRICARE,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,UNITED HEALTHCARE,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,UNITED HEALTHCARE,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,VA,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,VA TRICARE,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,WELLMED,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,HUMANA,MGD,1440,,,,,,,per diem,880,14109.5502,"Per diem rate, all codes are bundled into service package"
Stroke M >=72.50,D0101,HIPPS,,,,,,,,Inpatient,,,14109.5502,14109.5502,HUMANA CHOICE PLUS,MGD,14109.5502,,,,,,,case rate,880,14109.5502,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,AETNA,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,COM,880,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,COM,880,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,COM,1100,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,COM,880,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,BCBS,COM,935,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,CIGNA,COM,1450,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,TRICARE,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,UNITED HEALTHCARE,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,UNITED HEALTHCARE,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,VA,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,VA TRICARE,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,WELLMED,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,HUMANA,MGD,1440,,,,,,,per diem,880,17035.2096,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,A0102,HIPPS,,,,,,,,Inpatient,,,17035.2096,17035.2096,HUMANA CHOICE PLUS,MGD,17035.2096,,,,,,,case rate,880,17035.2096,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,AETNA,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,COM,880,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,COM,880,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,COM,1100,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,COM,880,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,BCBS,COM,935,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,CIGNA,COM,1450,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,TRICARE,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,UNITED HEALTHCARE,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,UNITED HEALTHCARE,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,VA,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,VA TRICARE,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,WELLMED,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,HUMANA,MGD,1440,,,,,,,per diem,880,22320.6228,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,B0102,HIPPS,,,,,,,,Inpatient,,,22320.6228,22320.6228,HUMANA CHOICE PLUS,MGD,22320.6228,,,,,,,case rate,880,22320.6228,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,AETNA,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,COM,880,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,COM,880,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,COM,1100,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,COM,880,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,BCBS,COM,935,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,CIGNA,COM,1450,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,TRICARE,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,UNITED HEALTHCARE,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,UNITED HEALTHCARE,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,VA,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,VA TRICARE,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,WELLMED,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,HUMANA,MGD,1440,,,,,,,per diem,880,19821.2064,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,C0102,HIPPS,,,,,,,,Inpatient,,,19821.2064,19821.2064,HUMANA CHOICE PLUS,MGD,19821.2064,,,,,,,case rate,880,19821.2064,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,AETNA,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,COM,880,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,COM,880,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,COM,1100,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,COM,880,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,BCBS,COM,935,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,CIGNA,COM,1450,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,TRICARE,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,UNITED HEALTHCARE,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,UNITED HEALTHCARE,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,VA,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,VA TRICARE,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,WELLMED,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,HUMANA,MGD,1440,,,,,,,per diem,880,17958.4338,"Per diem rate, all codes are bundled into service package"
Stroke M >=63.50 and M <72.50,D0102,HIPPS,,,,,,,,Inpatient,,,17958.4338,17958.4338,HUMANA CHOICE PLUS,MGD,17958.4338,,,,,,,case rate,880,17958.4338,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,AETNA,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,COM,880,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,COM,880,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,COM,1100,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,COM,880,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,BCBS,COM,935,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,CIGNA,COM,1450,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,TRICARE,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,UNITED HEALTHCARE,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,UNITED HEALTHCARE,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,VA,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,VA TRICARE,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,WELLMED,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,HUMANA,MGD,1440,,,,,,,per diem,880,21867.1728,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,A0103,HIPPS,,,,,,,,Inpatient,,,21867.1728,21867.1728,HUMANA CHOICE PLUS,MGD,21867.1728,,,,,,,case rate,880,21867.1728,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,AETNA,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,COM,880,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,COM,880,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,COM,1100,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,COM,880,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,BCBS,COM,935,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,CIGNA,COM,1450,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,TRICARE,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,UNITED HEALTHCARE,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,UNITED HEALTHCARE,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,VA,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,VA TRICARE,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,WELLMED,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,HUMANA,MGD,1440,,,,,,,per diem,880,28654.4124,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,B0103,HIPPS,,,,,,,,Inpatient,,,28654.4124,28654.4124,HUMANA CHOICE PLUS,MGD,28654.4124,,,,,,,case rate,880,28654.4124,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,AETNA,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,COM,880,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,COM,880,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,COM,1100,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,COM,880,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,BCBS,COM,935,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,CIGNA,COM,1450,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,TRICARE,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,UNITED HEALTHCARE,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,UNITED HEALTHCARE,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,VA,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,VA TRICARE,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,WELLMED,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,HUMANA,MGD,1440,,,,,,,per diem,880,25445.8002,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,C0103,HIPPS,,,,,,,,Inpatient,,,25445.8002,25445.8002,HUMANA CHOICE PLUS,MGD,25445.8002,,,,,,,case rate,880,25445.8002,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,AETNA,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,COM,880,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,COM,880,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,COM,1100,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,COM,880,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,BCBS,COM,935,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,CIGNA,COM,1450,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,TRICARE,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,UNITED HEALTHCARE,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,UNITED HEALTHCARE,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,VA,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,VA TRICARE,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,WELLMED,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,HUMANA,MGD,1440,,,,,,,per diem,880,23053.398,"Per diem rate, all codes are bundled into service package"
Stroke M >=50.50 and M <63.50,D0103,HIPPS,,,,,,,,Inpatient,,,23053.398,23053.398,HUMANA CHOICE PLUS,MGD,23053.398,,,,,,,case rate,880,23053.398,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,AETNA,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,COM,880,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,COM,880,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,COM,1100,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,COM,880,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,BCBS,COM,935,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,CIGNA,COM,1450,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,TRICARE,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,UNITED HEALTHCARE,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,UNITED HEALTHCARE,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,VA,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,VA TRICARE,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,WELLMED,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,HUMANA,MGD,1440,,,,,,,per diem,880,27928.8924,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,A0104,HIPPS,,,,,,,,Inpatient,,,27928.8924,27928.8924,HUMANA CHOICE PLUS,MGD,27928.8924,,,,,,,case rate,880,27928.8924,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,AETNA,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,COM,880,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,COM,880,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,COM,1100,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,COM,880,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,BCBS,COM,935,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,CIGNA,COM,1450,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,TRICARE,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,UNITED HEALTHCARE,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,UNITED HEALTHCARE,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,VA,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,VA TRICARE,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,WELLMED,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,HUMANA,MGD,1440,,,,,,,per diem,880,36597.0426,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,B0104,HIPPS,,,,,,,,Inpatient,,,36597.0426,36597.0426,HUMANA CHOICE PLUS,MGD,36597.0426,,,,,,,case rate,880,36597.0426,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,AETNA,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,COM,880,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,COM,880,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,COM,1100,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,COM,880,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,BCBS,COM,935,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,CIGNA,COM,1450,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,TRICARE,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,UNITED HEALTHCARE,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,UNITED HEALTHCARE,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,VA,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,VA TRICARE,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,WELLMED,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,HUMANA,MGD,1440,,,,,,,per diem,880,32499.6684,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,C0104,HIPPS,,,,,,,,Inpatient,,,32499.6684,32499.6684,HUMANA CHOICE PLUS,MGD,32499.6684,,,,,,,case rate,880,32499.6684,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,AETNA,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,COM,880,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,COM,880,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,COM,1100,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,COM,880,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,BCBS,COM,935,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,CIGNA,COM,1450,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,TRICARE,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,UNITED HEALTHCARE,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,UNITED HEALTHCARE,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,VA,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,VA TRICARE,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,WELLMED,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,HUMANA,MGD,1440,,,,,,,per diem,880,29445.2292,"Per diem rate, all codes are bundled into service package"
Stroke M >=41.50 and M <50.50,D0104,HIPPS,,,,,,,,Inpatient,,,29445.2292,29445.2292,HUMANA CHOICE PLUS,MGD,29445.2292,,,,,,,case rate,880,29445.2292,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,AETNA,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,COM,880,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,COM,880,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,COM,1100,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,COM,880,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,BCBS,COM,935,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,CIGNA,COM,1450,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,TRICARE,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,UNITED HEALTHCARE,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,UNITED HEALTHCARE,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,VA,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,VA TRICARE,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,WELLMED,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,HUMANA,MGD,1440,,,,,,,per diem,880,34806.822,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,A0105,HIPPS,,,,,,,,Inpatient,,,34806.822,34806.822,HUMANA CHOICE PLUS,MGD,34806.822,,,,,,,case rate,880,34806.822,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,AETNA,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,COM,880,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,COM,880,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,COM,1100,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,COM,880,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,BCBS,COM,935,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,CIGNA,COM,1450,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,TRICARE,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,UNITED HEALTHCARE,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,UNITED HEALTHCARE,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,VA,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,VA TRICARE,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,WELLMED,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,HUMANA,MGD,1440,,,,,,,per diem,880,45609.8148,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,B0105,HIPPS,,,,,,,,Inpatient,,,45609.8148,45609.8148,HUMANA CHOICE PLUS,MGD,45609.8148,,,,,,,case rate,880,45609.8148,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,AETNA,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,COM,880,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,COM,880,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,COM,1100,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,COM,880,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,BCBS,COM,935,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,CIGNA,COM,1450,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,TRICARE,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,UNITED HEALTHCARE,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,UNITED HEALTHCARE,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,VA,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,VA TRICARE,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,WELLMED,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,HUMANA,MGD,1440,,,,,,,per diem,880,40502.154,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,C0105,HIPPS,,,,,,,,Inpatient,,,40502.154,40502.154,HUMANA CHOICE PLUS,MGD,40502.154,,,,,,,case rate,880,40502.154,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,AETNA,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,COM,880,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,COM,880,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,COM,1100,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,COM,880,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,BCBS,COM,935,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,CIGNA,COM,1450,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,TRICARE,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,UNITED HEALTHCARE,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,UNITED HEALTHCARE,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,VA,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,VA TRICARE,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,WELLMED,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,HUMANA,MGD,1440,,,,,,,per diem,880,36694.9878,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A >=84.50,D0105,HIPPS,,,,,,,,Inpatient,,,36694.9878,36694.9878,HUMANA CHOICE PLUS,MGD,36694.9878,,,,,,,case rate,880,36694.9878,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,AETNA,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,COM,880,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,COM,880,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,COM,1100,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,COM,880,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,BCBS,COM,935,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,CIGNA,COM,1450,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,TRICARE,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,UNITED HEALTHCARE,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,UNITED HEALTHCARE,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,VA,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,VA TRICARE,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,WELLMED,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,HUMANA,MGD,1440,,,,,,,per diem,880,39207.1008,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,A0106,HIPPS,,,,,,,,Inpatient,,,39207.1008,39207.1008,HUMANA CHOICE PLUS,MGD,39207.1008,,,,,,,case rate,880,39207.1008,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,AETNA,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,COM,880,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,COM,880,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,COM,1100,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,COM,880,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,BCBS,COM,935,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,CIGNA,COM,1450,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,TRICARE,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,UNITED HEALTHCARE,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,UNITED HEALTHCARE,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,VA,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,VA TRICARE,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,WELLMED,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,HUMANA,MGD,1440,,,,,,,per diem,880,51375.885,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,B0106,HIPPS,,,,,,,,Inpatient,,,51375.885,51375.885,HUMANA CHOICE PLUS,MGD,51375.885,,,,,,,case rate,880,51375.885,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,AETNA,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,COM,880,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,COM,880,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,COM,1100,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,COM,880,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,BCBS,COM,935,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,CIGNA,COM,1450,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,TRICARE,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,UNITED HEALTHCARE,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,UNITED HEALTHCARE,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,VA,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,VA TRICARE,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,WELLMED,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,HUMANA,MGD,1440,,,,,,,per diem,880,45622.5114,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,C0106,HIPPS,,,,,,,,Inpatient,,,45622.5114,45622.5114,HUMANA CHOICE PLUS,MGD,45622.5114,,,,,,,case rate,880,45622.5114,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,AETNA,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,COM,880,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,COM,880,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,COM,1100,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,COM,880,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,BCBS,COM,935,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,CIGNA,COM,1450,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,TRICARE,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,UNITED HEALTHCARE,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,UNITED HEALTHCARE,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,VA,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,VA TRICARE,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,WELLMED,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,HUMANA,MGD,1440,,,,,,,per diem,880,41334.6882,"Per diem rate, all codes are bundled into service package"
Stroke M <41.50 and A <84.50,D0106,HIPPS,,,,,,,,Inpatient,,,41334.6882,41334.6882,HUMANA CHOICE PLUS,MGD,41334.6882,,,,,,,case rate,880,41334.6882,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,AETNA,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,COM,880,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,COM,880,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,COM,1100,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,COM,880,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,BCBS,COM,935,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,CIGNA,COM,1450,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,TRICARE,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,UNITED HEALTHCARE,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,UNITED HEALTHCARE,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,VA,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,VA TRICARE,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,WELLMED,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,HUMANA,MGD,1440,,,,,,,per diem,880,13139.1672,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,A0201,HIPPS,,,,,,,,Inpatient,,,13139.1672,13139.1672,HUMANA CHOICE PLUS,MGD,13139.1672,,,,,,,case rate,880,13139.1672,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,AETNA,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,COM,880,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,COM,880,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,COM,1100,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,COM,880,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,BCBS,COM,935,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,CIGNA,COM,1450,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,TRICARE,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,UNITED HEALTHCARE,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,UNITED HEALTHCARE,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,VA,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,VA TRICARE,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,WELLMED,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,HUMANA,MGD,1440,,,,,,,per diem,880,19251.6732,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,B0201,HIPPS,,,,,,,,Inpatient,,,19251.6732,19251.6732,HUMANA CHOICE PLUS,MGD,19251.6732,,,,,,,case rate,880,19251.6732,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,AETNA,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,COM,880,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,COM,880,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,COM,1100,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,COM,880,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,BCBS,COM,935,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,CIGNA,COM,1450,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,TRICARE,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,UNITED HEALTHCARE,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,UNITED HEALTHCARE,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,VA,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,VA TRICARE,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,WELLMED,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,HUMANA,MGD,1440,,,,,,,per diem,880,15308.472,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,C0201,HIPPS,,,,,,,,Inpatient,,,15308.472,15308.472,HUMANA CHOICE PLUS,MGD,15308.472,,,,,,,case rate,880,15308.472,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,AETNA,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,COM,880,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,COM,880,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,COM,1100,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,COM,880,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,BCBS,COM,935,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,CIGNA,COM,1450,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,TRICARE,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,UNITED HEALTHCARE,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,UNITED HEALTHCARE,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,VA,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,VA TRICARE,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,WELLMED,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,HUMANA,MGD,1440,,,,,,,per diem,880,13984.398,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=73.50,D0201,HIPPS,,,,,,,,Inpatient,,,13984.398,13984.398,HUMANA CHOICE PLUS,MGD,13984.398,,,,,,,case rate,880,13984.398,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,AETNA,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,COM,880,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,COM,880,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,COM,1100,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,COM,880,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,BCBS,COM,935,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,CIGNA,COM,1450,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,TRICARE,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,UNITED HEALTHCARE,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,UNITED HEALTHCARE,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,VA,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,VA TRICARE,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,WELLMED,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,HUMANA,MGD,1440,,,,,,,per diem,880,17158.548,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,A0202,HIPPS,,,,,,,,Inpatient,,,17158.548,17158.548,HUMANA CHOICE PLUS,MGD,17158.548,,,,,,,case rate,880,17158.548,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,AETNA,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,1100,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,935,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,CIGNA,COM,1450,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,TRICARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,UNITED HEALTHCARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,UNITED HEALTHCARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,VA,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,VA TRICARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,WELLMED,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,HUMANA,MGD,1440,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,B0202,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,HUMANA CHOICE PLUS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,AETNA,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,COM,880,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,COM,880,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,COM,1100,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,COM,880,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,BCBS,COM,935,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,CIGNA,COM,1450,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,TRICARE,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,UNITED HEALTHCARE,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,UNITED HEALTHCARE,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,VA,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,VA TRICARE,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,WELLMED,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,HUMANA,MGD,1440,,,,,,,per diem,880,19989.8898,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,C0202,HIPPS,,,,,,,,Inpatient,,,19989.8898,19989.8898,HUMANA CHOICE PLUS,MGD,19989.8898,,,,,,,case rate,880,19989.8898,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,AETNA,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,COM,880,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,COM,880,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,COM,1100,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,COM,880,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,BCBS,COM,935,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,CIGNA,COM,1450,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,TRICARE,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,UNITED HEALTHCARE,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,UNITED HEALTHCARE,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,VA,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,VA TRICARE,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,WELLMED,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,HUMANA,MGD,1440,,,,,,,per diem,880,18263.1522,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=61.50 and M <73.50,D0202,HIPPS,,,,,,,,Inpatient,,,18263.1522,18263.1522,HUMANA CHOICE PLUS,MGD,18263.1522,,,,,,,case rate,880,18263.1522,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,AETNA,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,COM,880,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,COM,880,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,COM,1100,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,COM,880,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,BCBS,COM,935,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,CIGNA,COM,1450,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,TRICARE,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,UNITED HEALTHCARE,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,UNITED HEALTHCARE,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,VA,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,VA TRICARE,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,WELLMED,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,HUMANA,MGD,1440,,,,,,,per diem,880,21332.1018,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,A0203,HIPPS,,,,,,,,Inpatient,,,21332.1018,21332.1018,HUMANA CHOICE PLUS,MGD,21332.1018,,,,,,,case rate,880,21332.1018,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,AETNA,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,COM,880,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,COM,880,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,COM,1100,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,COM,880,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,BCBS,COM,935,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,CIGNA,COM,1450,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,TRICARE,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,UNITED HEALTHCARE,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,UNITED HEALTHCARE,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,VA,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,VA TRICARE,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,WELLMED,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,HUMANA,MGD,1440,,,,,,,per diem,880,31257.2154,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,B0203,HIPPS,,,,,,,,Inpatient,,,31257.2154,31257.2154,HUMANA CHOICE PLUS,MGD,31257.2154,,,,,,,case rate,880,31257.2154,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,AETNA,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,COM,880,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,COM,880,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,COM,1100,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,COM,880,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,BCBS,COM,935,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,CIGNA,COM,1450,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,TRICARE,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,UNITED HEALTHCARE,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,UNITED HEALTHCARE,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,VA,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,VA TRICARE,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,WELLMED,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,HUMANA,MGD,1440,,,,,,,per diem,880,24852.6876,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,C0203,HIPPS,,,,,,,,Inpatient,,,24852.6876,24852.6876,HUMANA CHOICE PLUS,MGD,24852.6876,,,,,,,case rate,880,24852.6876,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,AETNA,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,COM,880,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,COM,880,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,COM,1100,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,COM,880,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,BCBS,COM,935,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,CIGNA,COM,1450,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,TRICARE,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,UNITED HEALTHCARE,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,UNITED HEALTHCARE,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,VA,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,VA TRICARE,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,WELLMED,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,HUMANA,MGD,1440,,,,,,,per diem,880,22705.1484,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=49.50 and M <61.50,D0203,HIPPS,,,,,,,,Inpatient,,,22705.1484,22705.1484,HUMANA CHOICE PLUS,MGD,22705.1484,,,,,,,case rate,880,22705.1484,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,AETNA,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,COM,880,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,COM,880,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,COM,1100,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,COM,880,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,BCBS,COM,935,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,CIGNA,COM,1450,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,TRICARE,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,UNITED HEALTHCARE,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,UNITED HEALTHCARE,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,VA,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,VA TRICARE,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,WELLMED,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,HUMANA,MGD,1440,,,,,,,per diem,880,26291.031,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,A0204,HIPPS,,,,,,,,Inpatient,,,26291.031,26291.031,HUMANA CHOICE PLUS,MGD,26291.031,,,,,,,case rate,880,26291.031,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,AETNA,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,COM,880,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,COM,880,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,COM,1100,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,COM,880,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,BCBS,COM,935,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,CIGNA,COM,1450,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,TRICARE,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,UNITED HEALTHCARE,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,UNITED HEALTHCARE,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,VA,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,VA TRICARE,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,WELLMED,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,HUMANA,MGD,1440,,,,,,,per diem,880,38523.2982,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,B0204,HIPPS,,,,,,,,Inpatient,,,38523.2982,38523.2982,HUMANA CHOICE PLUS,MGD,38523.2982,,,,,,,case rate,880,38523.2982,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,AETNA,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,COM,880,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,COM,880,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,COM,1100,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,COM,880,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,BCBS,COM,935,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,CIGNA,COM,1450,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,TRICARE,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,UNITED HEALTHCARE,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,UNITED HEALTHCARE,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,VA,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,VA TRICARE,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,WELLMED,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,HUMANA,MGD,1440,,,,,,,per diem,880,30629.6406,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,C0204,HIPPS,,,,,,,,Inpatient,,,30629.6406,30629.6406,HUMANA CHOICE PLUS,MGD,30629.6406,,,,,,,case rate,880,30629.6406,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,AETNA,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,COM,880,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,COM,880,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,COM,1100,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,COM,880,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,BCBS,COM,935,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,CIGNA,COM,1450,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,TRICARE,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,UNITED HEALTHCARE,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,UNITED HEALTHCARE,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,VA,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,VA TRICARE,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,WELLMED,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,HUMANA,MGD,1440,,,,,,,per diem,880,27983.3064,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M >=35.50 and M <49.50,D0204,HIPPS,,,,,,,,Inpatient,,,27983.3064,27983.3064,HUMANA CHOICE PLUS,MGD,27983.3064,,,,,,,case rate,880,27983.3064,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,AETNA,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,COM,880,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,COM,880,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,COM,1100,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,COM,880,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,BCBS,COM,935,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,CIGNA,COM,1450,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,TRICARE,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,UNITED HEALTHCARE,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,UNITED HEALTHCARE,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,VA,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,VA TRICARE,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,WELLMED,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,HUMANA,MGD,1440,,,,,,,per diem,880,33729.4248,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,A0205,HIPPS,,,,,,,,Inpatient,,,33729.4248,33729.4248,HUMANA CHOICE PLUS,MGD,33729.4248,,,,,,,case rate,880,33729.4248,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,AETNA,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,COM,880,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,COM,880,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,COM,1100,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,COM,880,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,BCBS,COM,935,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,CIGNA,COM,1450,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,TRICARE,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,UNITED HEALTHCARE,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,UNITED HEALTHCARE,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,VA,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,VA TRICARE,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,WELLMED,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,HUMANA,MGD,1440,,,,,,,per diem,880,49422.4224,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,B0205,HIPPS,,,,,,,,Inpatient,,,49422.4224,49422.4224,HUMANA CHOICE PLUS,MGD,49422.4224,,,,,,,case rate,880,49422.4224,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,AETNA,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,COM,880,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,COM,880,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,COM,1100,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,COM,880,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,BCBS,COM,935,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,CIGNA,COM,1450,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,TRICARE,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,UNITED HEALTHCARE,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,UNITED HEALTHCARE,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,VA,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,VA TRICARE,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,WELLMED,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,HUMANA,MGD,1440,,,,,,,per diem,880,39295.977,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,C0205,HIPPS,,,,,,,,Inpatient,,,39295.977,39295.977,HUMANA CHOICE PLUS,MGD,39295.977,,,,,,,case rate,880,39295.977,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,AETNA,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,COM,880,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,COM,880,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,COM,1100,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,COM,880,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,BCBS,COM,935,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,CIGNA,COM,1450,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,TRICARE,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,UNITED HEALTHCARE,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,UNITED HEALTHCARE,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,VA,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,VA TRICARE,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,WELLMED,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,HUMANA,MGD,1440,,,,,,,per diem,880,35900.5434,"Per diem rate, all codes are bundled into service package"
Traumatic brain injury M <35.50,D0205,HIPPS,,,,,,,,Inpatient,,,35900.5434,35900.5434,HUMANA CHOICE PLUS,MGD,35900.5434,,,,,,,case rate,880,35900.5434,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,AETNA,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,COM,880,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,COM,880,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,COM,1100,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,COM,880,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,BCBS,COM,935,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,CIGNA,COM,1450,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,TRICARE,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,UNITED HEALTHCARE,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,UNITED HEALTHCARE,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,VA,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,VA TRICARE,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,WELLMED,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,HUMANA,MGD,1440,,,,,,,per diem,880,14980.1742,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,A0301,HIPPS,,,,,,,,Inpatient,,,14980.1742,14980.1742,HUMANA CHOICE PLUS,MGD,14980.1742,,,,,,,case rate,880,14980.1742,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,AETNA,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,COM,880,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,COM,880,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,COM,1100,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,COM,880,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,BCBS,COM,935,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,CIGNA,COM,1450,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,TRICARE,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,UNITED HEALTHCARE,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,UNITED HEALTHCARE,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,VA,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,VA TRICARE,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,WELLMED,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,HUMANA,MGD,1440,,,,,,,per diem,880,21654.9582,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,B0301,HIPPS,,,,,,,,Inpatient,,,21654.9582,21654.9582,HUMANA CHOICE PLUS,MGD,21654.9582,,,,,,,case rate,880,21654.9582,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,AETNA,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,COM,880,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,COM,880,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,COM,1100,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,COM,880,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,BCBS,COM,935,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,CIGNA,COM,1450,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,TRICARE,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,UNITED HEALTHCARE,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,UNITED HEALTHCARE,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,VA,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,VA TRICARE,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,WELLMED,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,HUMANA,MGD,1440,,,,,,,per diem,880,17162.1756,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,C0301,HIPPS,,,,,,,,Inpatient,,,17162.1756,17162.1756,HUMANA CHOICE PLUS,MGD,17162.1756,,,,,,,case rate,880,17162.1756,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,AETNA,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,COM,880,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,COM,880,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,COM,1100,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,COM,880,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,BCBS,COM,935,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,CIGNA,COM,1450,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,TRICARE,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,UNITED HEALTHCARE,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,UNITED HEALTHCARE,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,VA,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,VA TRICARE,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,WELLMED,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,HUMANA,MGD,1440,,,,,,,per diem,880,16001.3436,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=65.50,D0301,HIPPS,,,,,,,,Inpatient,,,16001.3436,16001.3436,HUMANA CHOICE PLUS,MGD,16001.3436,,,,,,,case rate,880,16001.3436,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,AETNA,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,COM,880,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,COM,880,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,COM,1100,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,COM,880,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,BCBS,COM,935,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,CIGNA,COM,1450,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,TRICARE,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,UNITED HEALTHCARE,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,UNITED HEALTHCARE,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,VA,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,VA TRICARE,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,WELLMED,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,HUMANA,MGD,1440,,,,,,,per diem,880,19376.8254,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,A0302,HIPPS,,,,,,,,Inpatient,,,19376.8254,19376.8254,HUMANA CHOICE PLUS,MGD,19376.8254,,,,,,,case rate,880,19376.8254,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,AETNA,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,COM,880,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,COM,880,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,COM,1100,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,COM,880,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,BCBS,COM,935,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,CIGNA,COM,1450,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,TRICARE,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,UNITED HEALTHCARE,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,UNITED HEALTHCARE,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,VA,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,VA TRICARE,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,WELLMED,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,HUMANA,MGD,1440,,,,,,,per diem,880,28014.141,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,B0302,HIPPS,,,,,,,,Inpatient,,,28014.141,28014.141,HUMANA CHOICE PLUS,MGD,28014.141,,,,,,,case rate,880,28014.141,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,AETNA,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,COM,880,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,COM,880,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,COM,1100,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,COM,880,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,BCBS,COM,935,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,CIGNA,COM,1450,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,TRICARE,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,UNITED HEALTHCARE,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,UNITED HEALTHCARE,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,VA,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,VA TRICARE,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,WELLMED,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,HUMANA,MGD,1440,,,,,,,per diem,880,22202.7258,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,C0302,HIPPS,,,,,,,,Inpatient,,,22202.7258,22202.7258,HUMANA CHOICE PLUS,MGD,22202.7258,,,,,,,case rate,880,22202.7258,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,AETNA,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,COM,880,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,COM,880,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,COM,1100,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,COM,880,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,BCBS,COM,935,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,CIGNA,COM,1450,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,TRICARE,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,UNITED HEALTHCARE,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,UNITED HEALTHCARE,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,VA,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,VA TRICARE,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,WELLMED,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,HUMANA,MGD,1440,,,,,,,per diem,880,20699.0856,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=52.50 and M <65.50,D0302,HIPPS,,,,,,,,Inpatient,,,20699.0856,20699.0856,HUMANA CHOICE PLUS,MGD,20699.0856,,,,,,,case rate,880,20699.0856,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,AETNA,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,COM,880,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,COM,880,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,COM,1100,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,COM,880,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,BCBS,COM,935,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,CIGNA,COM,1450,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,TRICARE,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,UNITED HEALTHCARE,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,UNITED HEALTHCARE,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,VA,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,VA TRICARE,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,WELLMED,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,HUMANA,MGD,1440,,,,,,,per diem,880,22913.7354,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,A0303,HIPPS,,,,,,,,Inpatient,,,22913.7354,22913.7354,HUMANA CHOICE PLUS,MGD,22913.7354,,,,,,,case rate,880,22913.7354,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,AETNA,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,COM,880,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,COM,880,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,COM,1100,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,COM,880,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,BCBS,COM,935,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,CIGNA,COM,1450,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,TRICARE,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,UNITED HEALTHCARE,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,UNITED HEALTHCARE,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,VA,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,VA TRICARE,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,WELLMED,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,HUMANA,MGD,1440,,,,,,,per diem,880,33123.6156,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,B0303,HIPPS,,,,,,,,Inpatient,,,33123.6156,33123.6156,HUMANA CHOICE PLUS,MGD,33123.6156,,,,,,,case rate,880,33123.6156,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,AETNA,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,COM,880,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,COM,880,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,COM,1100,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,COM,880,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,BCBS,COM,935,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,CIGNA,COM,1450,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,TRICARE,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,UNITED HEALTHCARE,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,UNITED HEALTHCARE,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,VA,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,VA TRICARE,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,WELLMED,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,HUMANA,MGD,1440,,,,,,,per diem,880,26252.9412,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,C0303,HIPPS,,,,,,,,Inpatient,,,26252.9412,26252.9412,HUMANA CHOICE PLUS,MGD,26252.9412,,,,,,,case rate,880,26252.9412,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,AETNA,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,COM,880,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,COM,880,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,COM,1100,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,COM,880,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,BCBS,COM,935,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,CIGNA,COM,1450,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,TRICARE,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,UNITED HEALTHCARE,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,UNITED HEALTHCARE,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,VA,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,VA TRICARE,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,WELLMED,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,HUMANA,MGD,1440,,,,,,,per diem,880,24475.4172,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M >=42.50 and M <52.50,D0303,HIPPS,,,,,,,,Inpatient,,,24475.4172,24475.4172,HUMANA CHOICE PLUS,MGD,24475.4172,,,,,,,case rate,880,24475.4172,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,AETNA,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,COM,880,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,COM,880,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,COM,1100,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,COM,880,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,BCBS,COM,935,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,CIGNA,COM,1450,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,TRICARE,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,UNITED HEALTHCARE,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,UNITED HEALTHCARE,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,VA,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,VA TRICARE,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,WELLMED,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,HUMANA,MGD,1440,,,,,,,per diem,880,27143.517,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,A0304,HIPPS,,,,,,,,Inpatient,,,27143.517,27143.517,HUMANA CHOICE PLUS,MGD,27143.517,,,,,,,case rate,880,27143.517,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,AETNA,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,COM,880,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,COM,880,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,COM,1100,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,COM,880,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,BCBS,COM,935,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,CIGNA,COM,1450,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,TRICARE,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,UNITED HEALTHCARE,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,UNITED HEALTHCARE,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,VA,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,VA TRICARE,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,WELLMED,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,HUMANA,MGD,1440,,,,,,,per diem,880,39241.563,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,B0304,HIPPS,,,,,,,,Inpatient,,,39241.563,39241.563,HUMANA CHOICE PLUS,MGD,39241.563,,,,,,,case rate,880,39241.563,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,AETNA,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,COM,880,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,COM,880,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,COM,1100,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,COM,880,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,BCBS,COM,935,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,CIGNA,COM,1450,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,TRICARE,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,UNITED HEALTHCARE,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,UNITED HEALTHCARE,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,VA,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,VA TRICARE,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,WELLMED,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,HUMANA,MGD,1440,,,,,,,per diem,880,31101.2286,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,C0304,HIPPS,,,,,,,,Inpatient,,,31101.2286,31101.2286,HUMANA CHOICE PLUS,MGD,31101.2286,,,,,,,case rate,880,31101.2286,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,AETNA,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,COM,880,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,COM,880,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,COM,1100,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,COM,880,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,BCBS,COM,935,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,CIGNA,COM,1450,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,TRICARE,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,UNITED HEALTHCARE,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,UNITED HEALTHCARE,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,VA,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,VA TRICARE,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,WELLMED,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,HUMANA,MGD,1440,,,,,,,per diem,880,28993.593,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A >=78.50,D0304,HIPPS,,,,,,,,Inpatient,,,28993.593,28993.593,HUMANA CHOICE PLUS,MGD,28993.593,,,,,,,case rate,880,28993.593,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,AETNA,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,COM,880,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,COM,880,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,COM,1100,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,COM,880,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,BCBS,COM,935,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,CIGNA,COM,1450,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,TRICARE,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,UNITED HEALTHCARE,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,UNITED HEALTHCARE,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,VA,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,VA TRICARE,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,WELLMED,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,HUMANA,MGD,1440,,,,,,,per diem,880,29733.6234,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,A0305,HIPPS,,,,,,,,Inpatient,,,29733.6234,29733.6234,HUMANA CHOICE PLUS,MGD,29733.6234,,,,,,,case rate,880,29733.6234,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,AETNA,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,COM,880,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,COM,880,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,COM,1100,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,COM,880,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,BCBS,COM,935,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,CIGNA,COM,1450,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,TRICARE,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,UNITED HEALTHCARE,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,UNITED HEALTHCARE,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,VA,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,VA TRICARE,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,WELLMED,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,HUMANA,MGD,1440,,,,,,,per diem,880,42985.2462,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,B0305,HIPPS,,,,,,,,Inpatient,,,42985.2462,42985.2462,HUMANA CHOICE PLUS,MGD,42985.2462,,,,,,,case rate,880,42985.2462,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,AETNA,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,COM,880,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,COM,880,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,COM,1100,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,COM,880,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,BCBS,COM,935,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,CIGNA,COM,1450,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,TRICARE,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,UNITED HEALTHCARE,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,UNITED HEALTHCARE,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,VA,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,VA TRICARE,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,WELLMED,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,HUMANA,MGD,1440,,,,,,,per diem,880,34068.6054,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,C0305,HIPPS,,,,,,,,Inpatient,,,34068.6054,34068.6054,HUMANA CHOICE PLUS,MGD,34068.6054,,,,,,,case rate,880,34068.6054,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,AETNA,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,COM,880,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,COM,880,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,COM,1100,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,COM,880,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,BCBS,COM,935,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,CIGNA,COM,1450,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,TRICARE,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,UNITED HEALTHCARE,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,UNITED HEALTHCARE,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,VA,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,VA TRICARE,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,WELLMED,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,HUMANA,MGD,1440,,,,,,,per diem,880,31761.4518,"Per diem rate, all codes are bundled into service package"
Non-traumatic brain injury M <42.50 and A <78.50,D0305,HIPPS,,,,,,,,Inpatient,,,31761.4518,31761.4518,HUMANA CHOICE PLUS,MGD,31761.4518,,,,,,,case rate,880,31761.4518,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,AETNA,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,COM,880,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,COM,880,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,COM,1100,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,COM,880,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,BCBS,COM,935,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,CIGNA,COM,1450,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,TRICARE,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,UNITED HEALTHCARE,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,UNITED HEALTHCARE,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,VA,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,VA TRICARE,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,WELLMED,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,HUMANA,MGD,1440,,,,,,,per diem,880,17697.2466,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,A0401,HIPPS,,,,,,,,Inpatient,,,17697.2466,17697.2466,HUMANA CHOICE PLUS,MGD,17697.2466,,,,,,,case rate,880,17697.2466,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,AETNA,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,COM,880,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,COM,880,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,COM,1100,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,COM,880,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,BCBS,COM,935,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,CIGNA,COM,1450,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,TRICARE,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,UNITED HEALTHCARE,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,UNITED HEALTHCARE,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,VA,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,VA TRICARE,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,WELLMED,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,HUMANA,MGD,1440,,,,,,,per diem,880,24573.3624,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,B0401,HIPPS,,,,,,,,Inpatient,,,24573.3624,24573.3624,HUMANA CHOICE PLUS,MGD,24573.3624,,,,,,,case rate,880,24573.3624,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,AETNA,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,COM,880,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,COM,880,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,COM,1100,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,COM,880,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,BCBS,COM,935,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,CIGNA,COM,1450,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,TRICARE,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,UNITED HEALTHCARE,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,UNITED HEALTHCARE,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,VA,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,VA TRICARE,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,WELLMED,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,HUMANA,MGD,1440,,,,,,,per diem,880,20086.0212,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,C0401,HIPPS,,,,,,,,Inpatient,,,20086.0212,20086.0212,HUMANA CHOICE PLUS,MGD,20086.0212,,,,,,,case rate,880,20086.0212,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,AETNA,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,COM,880,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,COM,880,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,COM,1100,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,COM,880,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,BCBS,COM,935,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,CIGNA,COM,1450,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,TRICARE,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,UNITED HEALTHCARE,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,UNITED HEALTHCARE,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,VA,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,VA TRICARE,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,WELLMED,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,HUMANA,MGD,1440,,,,,,,per diem,880,19558.2054,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=56.50,D0401,HIPPS,,,,,,,,Inpatient,,,19558.2054,19558.2054,HUMANA CHOICE PLUS,MGD,19558.2054,,,,,,,case rate,880,19558.2054,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,AETNA,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,COM,880,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,COM,880,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,COM,1100,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,COM,880,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,BCBS,COM,935,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,CIGNA,COM,1450,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,TRICARE,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,UNITED HEALTHCARE,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,UNITED HEALTHCARE,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,VA,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,VA TRICARE,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,WELLMED,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,HUMANA,MGD,1440,,,,,,,per diem,880,22186.4016,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,A0402,HIPPS,,,,,,,,Inpatient,,,22186.4016,22186.4016,HUMANA CHOICE PLUS,MGD,22186.4016,,,,,,,case rate,880,22186.4016,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,AETNA,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,COM,880,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,COM,880,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,COM,1100,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,COM,880,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,BCBS,COM,935,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,CIGNA,COM,1450,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,TRICARE,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,UNITED HEALTHCARE,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,UNITED HEALTHCARE,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,VA,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,VA TRICARE,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,WELLMED,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,HUMANA,MGD,1440,,,,,,,per diem,880,30807.393,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,B0402,HIPPS,,,,,,,,Inpatient,,,30807.393,30807.393,HUMANA CHOICE PLUS,MGD,30807.393,,,,,,,case rate,880,30807.393,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,AETNA,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,COM,880,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,COM,880,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,COM,1100,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,COM,880,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,BCBS,COM,935,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,CIGNA,COM,1450,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,TRICARE,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,UNITED HEALTHCARE,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,UNITED HEALTHCARE,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,VA,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,VA TRICARE,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,WELLMED,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,HUMANA,MGD,1440,,,,,,,per diem,880,25180.9854,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,C0402,HIPPS,,,,,,,,Inpatient,,,25180.9854,25180.9854,HUMANA CHOICE PLUS,MGD,25180.9854,,,,,,,case rate,880,25180.9854,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,AETNA,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,COM,880,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,COM,880,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,COM,1100,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,COM,880,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,BCBS,COM,935,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,CIGNA,COM,1450,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,TRICARE,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,UNITED HEALTHCARE,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,UNITED HEALTHCARE,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,VA,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,VA TRICARE,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,WELLMED,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,HUMANA,MGD,1440,,,,,,,per diem,880,24518.9484,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=47.50 and M <56.50,D0402,HIPPS,,,,,,,,Inpatient,,,24518.9484,24518.9484,HUMANA CHOICE PLUS,MGD,24518.9484,,,,,,,case rate,880,24518.9484,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,AETNA,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,COM,880,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,COM,880,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,COM,1100,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,COM,880,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,BCBS,COM,935,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,CIGNA,COM,1450,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,TRICARE,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,UNITED HEALTHCARE,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,UNITED HEALTHCARE,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,VA,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,VA TRICARE,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,WELLMED,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,HUMANA,MGD,1440,,,,,,,per diem,880,25607.2284,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,A0403,HIPPS,,,,,,,,Inpatient,,,25607.2284,25607.2284,HUMANA CHOICE PLUS,MGD,25607.2284,,,,,,,case rate,880,25607.2284,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,AETNA,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,COM,880,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,COM,880,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,COM,1100,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,COM,880,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,BCBS,COM,935,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,CIGNA,COM,1450,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,TRICARE,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,UNITED HEALTHCARE,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,UNITED HEALTHCARE,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,VA,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,VA TRICARE,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,WELLMED,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,HUMANA,MGD,1440,,,,,,,per diem,880,35557.7352,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,B0403,HIPPS,,,,,,,,Inpatient,,,35557.7352,35557.7352,HUMANA CHOICE PLUS,MGD,35557.7352,,,,,,,case rate,880,35557.7352,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,AETNA,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,COM,880,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,COM,880,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,COM,1100,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,COM,880,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,BCBS,COM,935,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,CIGNA,COM,1450,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,TRICARE,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,UNITED HEALTHCARE,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,UNITED HEALTHCARE,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,VA,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,VA TRICARE,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,WELLMED,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,HUMANA,MGD,1440,,,,,,,per diem,880,29064.3312,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,C0403,HIPPS,,,,,,,,Inpatient,,,29064.3312,29064.3312,HUMANA CHOICE PLUS,MGD,29064.3312,,,,,,,case rate,880,29064.3312,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,AETNA,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,COM,880,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,COM,880,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,COM,1100,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,COM,880,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,BCBS,COM,935,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,CIGNA,COM,1450,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,TRICARE,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,UNITED HEALTHCARE,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,UNITED HEALTHCARE,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,VA,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,VA TRICARE,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,WELLMED,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,HUMANA,MGD,1440,,,,,,,per diem,880,28298.9076,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=41.50 and M <47.50,D0403,HIPPS,,,,,,,,Inpatient,,,28298.9076,28298.9076,HUMANA CHOICE PLUS,MGD,28298.9076,,,,,,,case rate,880,28298.9076,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,AETNA,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,COM,880,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,COM,880,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,COM,1100,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,COM,880,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,BCBS,COM,935,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,CIGNA,COM,1450,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,TRICARE,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,UNITED HEALTHCARE,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,UNITED HEALTHCARE,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,VA,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,VA TRICARE,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,WELLMED,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,HUMANA,MGD,1440,,,,,,,per diem,880,41494.3026,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,A0404,HIPPS,,,,,,,,Inpatient,,,41494.3026,41494.3026,HUMANA CHOICE PLUS,MGD,41494.3026,,,,,,,case rate,880,41494.3026,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,AETNA,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,COM,880,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,COM,880,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,COM,1100,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,COM,880,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,BCBS,COM,935,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,CIGNA,COM,1450,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,TRICARE,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,UNITED HEALTHCARE,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,UNITED HEALTHCARE,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,VA,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,VA TRICARE,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,WELLMED,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,HUMANA,MGD,1440,,,,,,,per diem,880,57615.357,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,B0404,HIPPS,,,,,,,,Inpatient,,,57615.357,57615.357,HUMANA CHOICE PLUS,MGD,57615.357,,,,,,,case rate,880,57615.357,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,AETNA,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,COM,880,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,COM,880,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,COM,1100,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,COM,880,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,BCBS,COM,935,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,CIGNA,COM,1450,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,TRICARE,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,UNITED HEALTHCARE,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,UNITED HEALTHCARE,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,VA,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,VA TRICARE,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,WELLMED,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,HUMANA,MGD,1440,,,,,,,per diem,880,47093.5032,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,C0404,HIPPS,,,,,,,,Inpatient,,,47093.5032,47093.5032,HUMANA CHOICE PLUS,MGD,47093.5032,,,,,,,case rate,880,47093.5032,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,AETNA,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,COM,880,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,COM,880,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,COM,1100,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,COM,880,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,BCBS,COM,935,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,CIGNA,COM,1450,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,TRICARE,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,UNITED HEALTHCARE,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,UNITED HEALTHCARE,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,VA,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,VA TRICARE,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,WELLMED,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,HUMANA,MGD,1440,,,,,,,per diem,880,45854.6778,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <31.50 and A <61.50,D0404,HIPPS,,,,,,,,Inpatient,,,45854.6778,45854.6778,HUMANA CHOICE PLUS,MGD,45854.6778,,,,,,,case rate,880,45854.6778,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,AETNA,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,COM,880,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,COM,880,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,COM,1100,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,COM,880,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,BCBS,COM,935,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,CIGNA,COM,1450,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,TRICARE,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,UNITED HEALTHCARE,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,UNITED HEALTHCARE,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,VA,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,VA TRICARE,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,WELLMED,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,HUMANA,MGD,1440,,,,,,,per diem,880,32867.8698,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,A0405,HIPPS,,,,,,,,Inpatient,,,32867.8698,32867.8698,HUMANA CHOICE PLUS,MGD,32867.8698,,,,,,,case rate,880,32867.8698,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,AETNA,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,COM,880,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,COM,880,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,COM,1100,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,COM,880,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,BCBS,COM,935,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,CIGNA,COM,1450,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,TRICARE,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,UNITED HEALTHCARE,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,UNITED HEALTHCARE,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,VA,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,VA TRICARE,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,WELLMED,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,HUMANA,MGD,1440,,,,,,,per diem,880,45637.0218,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,B0405,HIPPS,,,,,,,,Inpatient,,,45637.0218,45637.0218,HUMANA CHOICE PLUS,MGD,45637.0218,,,,,,,case rate,880,45637.0218,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,AETNA,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,COM,880,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,COM,880,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,COM,1100,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,COM,880,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,BCBS,COM,935,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,CIGNA,COM,1450,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,TRICARE,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,UNITED HEALTHCARE,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,UNITED HEALTHCARE,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,VA,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,VA TRICARE,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,WELLMED,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,HUMANA,MGD,1440,,,,,,,per diem,880,37302.6108,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,C0405,HIPPS,,,,,,,,Inpatient,,,37302.6108,37302.6108,HUMANA CHOICE PLUS,MGD,37302.6108,,,,,,,case rate,880,37302.6108,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,AETNA,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,COM,880,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,COM,880,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,COM,1100,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,COM,880,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,BCBS,COM,935,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,CIGNA,COM,1450,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,TRICARE,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,UNITED HEALTHCARE,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,UNITED HEALTHCARE,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,VA,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,VA TRICARE,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,WELLMED,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,HUMANA,MGD,1440,,,,,,,per diem,880,36321.345,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=31.50 and M <41.50,D0405,HIPPS,,,,,,,,Inpatient,,,36321.345,36321.345,HUMANA CHOICE PLUS,MGD,36321.345,,,,,,,case rate,880,36321.345,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,AETNA,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,COM,880,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,COM,880,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,COM,1100,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,COM,880,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,BCBS,COM,935,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,CIGNA,COM,1450,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,TRICARE,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,UNITED HEALTHCARE,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,UNITED HEALTHCARE,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,VA,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,VA TRICARE,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,WELLMED,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,HUMANA,MGD,1440,,,,,,,per diem,880,43237.3644,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,A0406,HIPPS,,,,,,,,Inpatient,,,43237.3644,43237.3644,HUMANA CHOICE PLUS,MGD,43237.3644,,,,,,,case rate,880,43237.3644,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,AETNA,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,COM,880,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,COM,880,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,COM,1100,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,COM,880,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,BCBS,COM,935,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,CIGNA,COM,1450,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,TRICARE,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,UNITED HEALTHCARE,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,UNITED HEALTHCARE,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,VA,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,VA TRICARE,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,WELLMED,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,HUMANA,MGD,1440,,,,,,,per diem,880,60036.78,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,B0406,HIPPS,,,,,,,,Inpatient,,,60036.78,60036.78,HUMANA CHOICE PLUS,MGD,60036.78,,,,,,,case rate,880,60036.78,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,AETNA,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,COM,880,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,COM,880,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,COM,1100,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,COM,880,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,BCBS,COM,935,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,CIGNA,COM,1450,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,TRICARE,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,UNITED HEALTHCARE,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,UNITED HEALTHCARE,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,VA,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,VA TRICARE,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,WELLMED,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,HUMANA,MGD,1440,,,,,,,per diem,880,49072.359,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,C0406,HIPPS,,,,,,,,Inpatient,,,49072.359,49072.359,HUMANA CHOICE PLUS,MGD,49072.359,,,,,,,case rate,880,49072.359,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,AETNA,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,COM,880,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,COM,880,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,COM,1100,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,COM,880,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,BCBS,COM,935,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,CIGNA,COM,1450,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,TRICARE,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,UNITED HEALTHCARE,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,UNITED HEALTHCARE,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,VA,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,VA TRICARE,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,WELLMED,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,HUMANA,MGD,1440,,,,,,,per diem,880,47780.9334,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M >=24.50 and M <31.50 and A >=61.50,D0406,HIPPS,,,,,,,,Inpatient,,,47780.9334,47780.9334,HUMANA CHOICE PLUS,MGD,47780.9334,,,,,,,case rate,880,47780.9334,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,AETNA,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,COM,880,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,COM,880,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,COM,1100,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,COM,880,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,BCBS,COM,935,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,CIGNA,COM,1450,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,TRICARE,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,UNITED HEALTHCARE,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,UNITED HEALTHCARE,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,VA,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,VA TRICARE,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,WELLMED,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,HUMANA,MGD,1440,,,,,,,per diem,880,59209.6872,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,A0407,HIPPS,,,,,,,,Inpatient,,,59209.6872,59209.6872,HUMANA CHOICE PLUS,MGD,59209.6872,,,,,,,case rate,880,59209.6872,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,AETNA,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,COM,880,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,COM,880,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,COM,1100,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,COM,880,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,BCBS,COM,935,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,CIGNA,COM,1450,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,TRICARE,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,UNITED HEALTHCARE,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,UNITED HEALTHCARE,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,VA,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,VA TRICARE,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,WELLMED,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,HUMANA,MGD,1440,,,,,,,per diem,880,82215.9264,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,B0407,HIPPS,,,,,,,,Inpatient,,,82215.9264,82215.9264,HUMANA CHOICE PLUS,MGD,82215.9264,,,,,,,case rate,880,82215.9264,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,AETNA,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,COM,880,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,COM,880,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,COM,1100,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,COM,880,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,BCBS,COM,935,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,CIGNA,COM,1450,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,TRICARE,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,UNITED HEALTHCARE,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,UNITED HEALTHCARE,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,VA,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,VA TRICARE,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,WELLMED,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,HUMANA,MGD,1440,,,,,,,per diem,880,67201.29,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,C0407,HIPPS,,,,,,,,Inpatient,,,67201.29,67201.29,HUMANA CHOICE PLUS,MGD,67201.29,,,,,,,case rate,880,67201.29,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,AETNA,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,COM,880,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,COM,880,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,COM,1100,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,COM,880,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,BCBS,COM,935,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,CIGNA,COM,1450,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,TRICARE,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,UNITED HEALTHCARE,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,UNITED HEALTHCARE,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,VA,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,VA TRICARE,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,WELLMED,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,HUMANA,MGD,1440,,,,,,,per diem,880,65432.835,"Per diem rate, all codes are bundled into service package"
Traumatic spinal cord injury M <24.50 and A >=61.50,D0407,HIPPS,,,,,,,,Inpatient,,,65432.835,65432.835,HUMANA CHOICE PLUS,MGD,65432.835,,,,,,,case rate,880,65432.835,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,AETNA,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,COM,880,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,COM,880,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,COM,1100,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,COM,880,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,BCBS,COM,935,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,CIGNA,COM,1450,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,TRICARE,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,UNITED HEALTHCARE,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,UNITED HEALTHCARE,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,VA,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,VA TRICARE,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,WELLMED,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,HUMANA,MGD,1440,,,,,,,per diem,880,15644.025,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,A0501,HIPPS,,,,,,,,Inpatient,,,15644.025,15644.025,HUMANA CHOICE PLUS,MGD,15644.025,,,,,,,case rate,880,15644.025,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,AETNA,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,COM,880,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,COM,880,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,COM,1100,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,COM,880,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,BCBS,COM,935,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,CIGNA,COM,1450,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,TRICARE,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,UNITED HEALTHCARE,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,UNITED HEALTHCARE,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,VA,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,VA TRICARE,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,WELLMED,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,HUMANA,MGD,1440,,,,,,,per diem,880,23742.642,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,B0501,HIPPS,,,,,,,,Inpatient,,,23742.642,23742.642,HUMANA CHOICE PLUS,MGD,23742.642,,,,,,,case rate,880,23742.642,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,AETNA,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,COM,880,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,COM,880,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,COM,1100,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,COM,880,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,BCBS,COM,935,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,CIGNA,COM,1450,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,TRICARE,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,UNITED HEALTHCARE,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,UNITED HEALTHCARE,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,VA,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,VA TRICARE,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,WELLMED,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,HUMANA,MGD,1440,,,,,,,per diem,880,18246.828,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,C0501,HIPPS,,,,,,,,Inpatient,,,18246.828,18246.828,HUMANA CHOICE PLUS,MGD,18246.828,,,,,,,case rate,880,18246.828,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,AETNA,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,COM,880,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,COM,880,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,COM,1100,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,COM,880,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,BCBS,COM,935,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,CIGNA,COM,1450,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,TRICARE,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,UNITED HEALTHCARE,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,UNITED HEALTHCARE,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,VA,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,VA TRICARE,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,WELLMED,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,HUMANA,MGD,1440,,,,,,,per diem,880,16975.3542,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=60.50,D0501,HIPPS,,,,,,,,Inpatient,,,16975.3542,16975.3542,HUMANA CHOICE PLUS,MGD,16975.3542,,,,,,,case rate,880,16975.3542,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,AETNA,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,COM,880,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,COM,880,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,COM,1100,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,COM,880,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,BCBS,COM,935,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,CIGNA,COM,1450,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,TRICARE,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,UNITED HEALTHCARE,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,UNITED HEALTHCARE,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,VA,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,VA TRICARE,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,WELLMED,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,HUMANA,MGD,1440,,,,,,,per diem,880,19420.3566,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,A0502,HIPPS,,,,,,,,Inpatient,,,19420.3566,19420.3566,HUMANA CHOICE PLUS,MGD,19420.3566,,,,,,,case rate,880,19420.3566,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,AETNA,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,COM,880,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,COM,880,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,COM,1100,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,COM,880,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,BCBS,COM,935,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,CIGNA,COM,1450,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,TRICARE,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,UNITED HEALTHCARE,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,UNITED HEALTHCARE,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,VA,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,VA TRICARE,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,WELLMED,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,HUMANA,MGD,1440,,,,,,,per diem,880,29476.0638,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,B0502,HIPPS,,,,,,,,Inpatient,,,29476.0638,29476.0638,HUMANA CHOICE PLUS,MGD,29476.0638,,,,,,,case rate,880,29476.0638,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,AETNA,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,COM,880,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,COM,880,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,COM,1100,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,COM,880,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,BCBS,COM,935,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,CIGNA,COM,1450,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,TRICARE,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,UNITED HEALTHCARE,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,UNITED HEALTHCARE,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,VA,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,VA TRICARE,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,WELLMED,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,HUMANA,MGD,1440,,,,,,,per diem,880,22652.5482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,C0502,HIPPS,,,,,,,,Inpatient,,,22652.5482,22652.5482,HUMANA CHOICE PLUS,MGD,22652.5482,,,,,,,case rate,880,22652.5482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,AETNA,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,COM,880,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,COM,880,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,COM,1100,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,COM,880,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,BCBS,COM,935,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,CIGNA,COM,1450,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,TRICARE,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,UNITED HEALTHCARE,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,UNITED HEALTHCARE,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,VA,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,VA TRICARE,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,WELLMED,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,HUMANA,MGD,1440,,,,,,,per diem,880,21072.7284,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=53.50 and M <60.50,D0502,HIPPS,,,,,,,,Inpatient,,,21072.7284,21072.7284,HUMANA CHOICE PLUS,MGD,21072.7284,,,,,,,case rate,880,21072.7284,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,AETNA,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,COM,880,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,COM,880,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,COM,1100,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,COM,880,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,BCBS,COM,935,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,CIGNA,COM,1450,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,TRICARE,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,UNITED HEALTHCARE,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,UNITED HEALTHCARE,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,VA,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,VA TRICARE,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,WELLMED,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,HUMANA,MGD,1440,,,,,,,per diem,880,21990.5112,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,A0503,HIPPS,,,,,,,,Inpatient,,,21990.5112,21990.5112,HUMANA CHOICE PLUS,MGD,21990.5112,,,,,,,case rate,880,21990.5112,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,AETNA,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,COM,880,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,COM,880,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,COM,1100,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,COM,880,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,BCBS,COM,935,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,CIGNA,COM,1450,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,TRICARE,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,UNITED HEALTHCARE,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,UNITED HEALTHCARE,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,VA,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,VA TRICARE,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,WELLMED,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,HUMANA,MGD,1440,,,,,,,per diem,880,33377.5476,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,B0503,HIPPS,,,,,,,,Inpatient,,,33377.5476,33377.5476,HUMANA CHOICE PLUS,MGD,33377.5476,,,,,,,case rate,880,33377.5476,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,AETNA,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,COM,880,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,COM,880,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,COM,1100,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,COM,880,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,BCBS,COM,935,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,CIGNA,COM,1450,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,TRICARE,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,UNITED HEALTHCARE,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,UNITED HEALTHCARE,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,VA,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,VA TRICARE,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,WELLMED,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,HUMANA,MGD,1440,,,,,,,per diem,880,25650.7596,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,C0503,HIPPS,,,,,,,,Inpatient,,,25650.7596,25650.7596,HUMANA CHOICE PLUS,MGD,25650.7596,,,,,,,case rate,880,25650.7596,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,AETNA,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,COM,880,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,COM,880,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,COM,1100,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,COM,880,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,BCBS,COM,935,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,CIGNA,COM,1450,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,TRICARE,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,UNITED HEALTHCARE,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,UNITED HEALTHCARE,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,VA,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,VA TRICARE,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,WELLMED,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,HUMANA,MGD,1440,,,,,,,per diem,880,23862.3528,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=48.50 and M <53.50,D0503,HIPPS,,,,,,,,Inpatient,,,23862.3528,23862.3528,HUMANA CHOICE PLUS,MGD,23862.3528,,,,,,,case rate,880,23862.3528,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,AETNA,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,COM,880,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,COM,880,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,COM,1100,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,COM,880,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,BCBS,COM,935,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,CIGNA,COM,1450,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,TRICARE,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,UNITED HEALTHCARE,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,UNITED HEALTHCARE,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,VA,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,VA TRICARE,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,WELLMED,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,HUMANA,MGD,1440,,,,,,,per diem,880,26276.5206,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,A0504,HIPPS,,,,,,,,Inpatient,,,26276.5206,26276.5206,HUMANA CHOICE PLUS,MGD,26276.5206,,,,,,,case rate,880,26276.5206,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,AETNA,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,COM,880,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,COM,880,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,COM,1100,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,COM,880,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,BCBS,COM,935,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,CIGNA,COM,1450,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,TRICARE,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,UNITED HEALTHCARE,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,UNITED HEALTHCARE,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,VA,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,VA TRICARE,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,WELLMED,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,HUMANA,MGD,1440,,,,,,,per diem,880,39883.6482,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,B0504,HIPPS,,,,,,,,Inpatient,,,39883.6482,39883.6482,HUMANA CHOICE PLUS,MGD,39883.6482,,,,,,,case rate,880,39883.6482,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,AETNA,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,COM,880,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,COM,880,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,COM,1100,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,COM,880,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,BCBS,COM,935,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,CIGNA,COM,1450,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,TRICARE,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,UNITED HEALTHCARE,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,UNITED HEALTHCARE,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,VA,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,VA TRICARE,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,WELLMED,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,HUMANA,MGD,1440,,,,,,,per diem,880,30649.5924,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,C0504,HIPPS,,,,,,,,Inpatient,,,30649.5924,30649.5924,HUMANA CHOICE PLUS,MGD,30649.5924,,,,,,,case rate,880,30649.5924,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,AETNA,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,COM,880,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,COM,880,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,COM,1100,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,COM,880,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,BCBS,COM,935,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,CIGNA,COM,1450,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,TRICARE,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,UNITED HEALTHCARE,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,UNITED HEALTHCARE,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,VA,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,VA TRICARE,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,WELLMED,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,HUMANA,MGD,1440,,,,,,,per diem,880,28512.936,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M >=39.50 and M <48.50,D0504,HIPPS,,,,,,,,Inpatient,,,28512.936,28512.936,HUMANA CHOICE PLUS,MGD,28512.936,,,,,,,case rate,880,28512.936,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,AETNA,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,COM,880,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,COM,880,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,COM,1100,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,COM,880,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,BCBS,COM,935,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,CIGNA,COM,1450,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,TRICARE,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,UNITED HEALTHCARE,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,UNITED HEALTHCARE,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,VA,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,VA TRICARE,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,WELLMED,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,HUMANA,MGD,1440,,,,,,,per diem,880,37335.2592,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,A0505,HIPPS,,,,,,,,Inpatient,,,37335.2592,37335.2592,HUMANA CHOICE PLUS,MGD,37335.2592,,,,,,,case rate,880,37335.2592,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,AETNA,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,COM,880,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,COM,880,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,COM,1100,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,COM,880,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,BCBS,COM,935,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,CIGNA,COM,1450,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,TRICARE,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,UNITED HEALTHCARE,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,UNITED HEALTHCARE,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,VA,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,VA TRICARE,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,WELLMED,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,HUMANA,MGD,1440,,,,,,,per diem,880,56666.7396,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,B0505,HIPPS,,,,,,,,Inpatient,,,56666.7396,56666.7396,HUMANA CHOICE PLUS,MGD,56666.7396,,,,,,,case rate,880,56666.7396,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,AETNA,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,COM,880,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,COM,880,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,COM,1100,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,COM,880,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,BCBS,COM,935,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,CIGNA,COM,1450,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,TRICARE,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,UNITED HEALTHCARE,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,UNITED HEALTHCARE,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,VA,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,VA TRICARE,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,WELLMED,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,HUMANA,MGD,1440,,,,,,,per diem,880,43547.5242,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,C0505,HIPPS,,,,,,,,Inpatient,,,43547.5242,43547.5242,HUMANA CHOICE PLUS,MGD,43547.5242,,,,,,,case rate,880,43547.5242,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,AETNA,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,COM,880,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,COM,880,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,COM,1100,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,COM,880,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,BCBS,COM,935,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,CIGNA,COM,1450,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,TRICARE,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,UNITED HEALTHCARE,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,UNITED HEALTHCARE,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,VA,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,VA TRICARE,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,WELLMED,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,HUMANA,MGD,1440,,,,,,,per diem,880,40513.0368,"Per diem rate, all codes are bundled into service package"
Non-traumatic spinal cord injury M <39.50,D0505,HIPPS,,,,,,,,Inpatient,,,40513.0368,40513.0368,HUMANA CHOICE PLUS,MGD,40513.0368,,,,,,,case rate,880,40513.0368,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,AETNA,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,COM,880,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,COM,880,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,COM,1100,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,COM,880,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,BCBS,COM,935,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,CIGNA,COM,1450,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,TRICARE,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,UNITED HEALTHCARE,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,UNITED HEALTHCARE,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,VA,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,VA TRICARE,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,WELLMED,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,HUMANA,MGD,1440,,,,,,,per diem,880,15217.782,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,A0601,HIPPS,,,,,,,,Inpatient,,,15217.782,15217.782,HUMANA CHOICE PLUS,MGD,15217.782,,,,,,,case rate,880,15217.782,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,AETNA,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,COM,880,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,COM,880,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,COM,1100,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,COM,880,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,BCBS,COM,935,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,CIGNA,COM,1450,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,TRICARE,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,UNITED HEALTHCARE,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,UNITED HEALTHCARE,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,VA,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,VA TRICARE,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,WELLMED,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,HUMANA,MGD,1440,,,,,,,per diem,880,23751.711,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,B0601,HIPPS,,,,,,,,Inpatient,,,23751.711,23751.711,HUMANA CHOICE PLUS,MGD,23751.711,,,,,,,case rate,880,23751.711,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,AETNA,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,COM,880,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,COM,880,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,COM,1100,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,COM,880,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,BCBS,COM,935,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,CIGNA,COM,1450,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,TRICARE,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,UNITED HEALTHCARE,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,UNITED HEALTHCARE,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,VA,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,VA TRICARE,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,WELLMED,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,HUMANA,MGD,1440,,,,,,,per diem,880,17989.2684,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,C0601,HIPPS,,,,,,,,Inpatient,,,17989.2684,17989.2684,HUMANA CHOICE PLUS,MGD,17989.2684,,,,,,,case rate,880,17989.2684,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,AETNA,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,COM,880,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,COM,880,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,COM,1100,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,COM,880,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,BCBS,COM,935,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,CIGNA,COM,1450,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,TRICARE,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,UNITED HEALTHCARE,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,UNITED HEALTHCARE,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,VA,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,VA TRICARE,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,WELLMED,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,HUMANA,MGD,1440,,,,,,,per diem,880,16942.7058,"Per diem rate, all codes are bundled into service package"
Neurological M >=64.50,D0601,HIPPS,,,,,,,,Inpatient,,,16942.7058,16942.7058,HUMANA CHOICE PLUS,MGD,16942.7058,,,,,,,case rate,880,16942.7058,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,AETNA,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,COM,880,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,COM,880,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,COM,1100,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,COM,880,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,BCBS,COM,935,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,CIGNA,COM,1450,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,TRICARE,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,UNITED HEALTHCARE,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,UNITED HEALTHCARE,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,VA,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,VA TRICARE,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,WELLMED,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,HUMANA,MGD,1440,,,,,,,per diem,880,18930.6306,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,A0602,HIPPS,,,,,,,,Inpatient,,,18930.6306,18930.6306,HUMANA CHOICE PLUS,MGD,18930.6306,,,,,,,case rate,880,18930.6306,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,AETNA,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,COM,880,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,COM,880,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,COM,1100,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,COM,880,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,BCBS,COM,935,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,CIGNA,COM,1450,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,TRICARE,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,UNITED HEALTHCARE,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,UNITED HEALTHCARE,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,VA,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,VA TRICARE,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,WELLMED,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,HUMANA,MGD,1440,,,,,,,per diem,880,29544.9882,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,B0602,HIPPS,,,,,,,,Inpatient,,,29544.9882,29544.9882,HUMANA CHOICE PLUS,MGD,29544.9882,,,,,,,case rate,880,29544.9882,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,AETNA,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,COM,880,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,COM,880,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,COM,1100,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,COM,880,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,BCBS,COM,935,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,CIGNA,COM,1450,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,TRICARE,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,UNITED HEALTHCARE,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,UNITED HEALTHCARE,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,VA,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,VA TRICARE,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,WELLMED,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,HUMANA,MGD,1440,,,,,,,per diem,880,22376.8506,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,C0602,HIPPS,,,,,,,,Inpatient,,,22376.8506,22376.8506,HUMANA CHOICE PLUS,MGD,22376.8506,,,,,,,case rate,880,22376.8506,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,AETNA,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,COM,880,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,COM,880,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,COM,1100,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,COM,880,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,BCBS,COM,935,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,CIGNA,COM,1450,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,TRICARE,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,UNITED HEALTHCARE,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,UNITED HEALTHCARE,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,VA,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,VA TRICARE,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,WELLMED,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,HUMANA,MGD,1440,,,,,,,per diem,880,21074.5422,"Per diem rate, all codes are bundled into service package"
Neurological M >=52.50 and M <64.50,D0602,HIPPS,,,,,,,,Inpatient,,,21074.5422,21074.5422,HUMANA CHOICE PLUS,MGD,21074.5422,,,,,,,case rate,880,21074.5422,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,AETNA,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,COM,880,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,COM,880,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,COM,1100,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,COM,880,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,BCBS,COM,935,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,CIGNA,COM,1450,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,TRICARE,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,UNITED HEALTHCARE,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,UNITED HEALTHCARE,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,VA,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,VA TRICARE,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,WELLMED,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,HUMANA,MGD,1440,,,,,,,per diem,880,22511.0718,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,A0603,HIPPS,,,,,,,,Inpatient,,,22511.0718,22511.0718,HUMANA CHOICE PLUS,MGD,22511.0718,,,,,,,case rate,880,22511.0718,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,AETNA,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,COM,880,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,COM,880,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,COM,1100,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,COM,880,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,BCBS,COM,935,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,CIGNA,COM,1450,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,TRICARE,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,UNITED HEALTHCARE,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,UNITED HEALTHCARE,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,VA,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,VA TRICARE,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,WELLMED,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,HUMANA,MGD,1440,,,,,,,per diem,880,35133.306,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,B0603,HIPPS,,,,,,,,Inpatient,,,35133.306,35133.306,HUMANA CHOICE PLUS,MGD,35133.306,,,,,,,case rate,880,35133.306,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,AETNA,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,COM,880,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,COM,880,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,COM,1100,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,COM,880,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,BCBS,COM,935,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,CIGNA,COM,1450,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,TRICARE,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,UNITED HEALTHCARE,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,UNITED HEALTHCARE,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,VA,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,VA TRICARE,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,WELLMED,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,HUMANA,MGD,1440,,,,,,,per diem,880,26608.446,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,C0603,HIPPS,,,,,,,,Inpatient,,,26608.446,26608.446,HUMANA CHOICE PLUS,MGD,26608.446,,,,,,,case rate,880,26608.446,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,AETNA,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,COM,880,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,COM,880,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,COM,1100,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,COM,880,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,BCBS,COM,935,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,CIGNA,COM,1450,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,TRICARE,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,UNITED HEALTHCARE,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,UNITED HEALTHCARE,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,VA,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,VA TRICARE,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,WELLMED,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,HUMANA,MGD,1440,,,,,,,per diem,880,25061.2746,"Per diem rate, all codes are bundled into service package"
Neurological M >=43.50 and M <52.50,D0603,HIPPS,,,,,,,,Inpatient,,,25061.2746,25061.2746,HUMANA CHOICE PLUS,MGD,25061.2746,,,,,,,case rate,880,25061.2746,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,AETNA,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,COM,880,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,COM,880,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,COM,1100,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,COM,880,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,BCBS,COM,935,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,CIGNA,COM,1450,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,TRICARE,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,UNITED HEALTHCARE,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,UNITED HEALTHCARE,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,VA,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,VA TRICARE,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,WELLMED,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,HUMANA,MGD,1440,,,,,,,per diem,880,28469.4048,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,A0604,HIPPS,,,,,,,,Inpatient,,,28469.4048,28469.4048,HUMANA CHOICE PLUS,MGD,28469.4048,,,,,,,case rate,880,28469.4048,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,AETNA,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,COM,880,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,COM,880,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,COM,1100,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,COM,880,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,BCBS,COM,935,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,CIGNA,COM,1450,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,TRICARE,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,UNITED HEALTHCARE,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,UNITED HEALTHCARE,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,VA,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,VA TRICARE,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,WELLMED,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,HUMANA,MGD,1440,,,,,,,per diem,880,44434.4724,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,B0604,HIPPS,,,,,,,,Inpatient,,,44434.4724,44434.4724,HUMANA CHOICE PLUS,MGD,44434.4724,,,,,,,case rate,880,44434.4724,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,AETNA,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,COM,880,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,COM,880,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,COM,1100,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,COM,880,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,BCBS,COM,935,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,CIGNA,COM,1450,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,TRICARE,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,UNITED HEALTHCARE,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,UNITED HEALTHCARE,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,VA,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,VA TRICARE,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,WELLMED,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,HUMANA,MGD,1440,,,,,,,per diem,880,33651.4314,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,C0604,HIPPS,,,,,,,,Inpatient,,,33651.4314,33651.4314,HUMANA CHOICE PLUS,MGD,33651.4314,,,,,,,case rate,880,33651.4314,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,AETNA,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,COM,880,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,COM,880,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,COM,1100,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,COM,880,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,BCBS,COM,935,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,CIGNA,COM,1450,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,TRICARE,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,UNITED HEALTHCARE,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,UNITED HEALTHCARE,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,VA,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,VA TRICARE,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,WELLMED,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,HUMANA,MGD,1440,,,,,,,per diem,880,31696.155,"Per diem rate, all codes are bundled into service package"
Neurological M <43.50,D0604,HIPPS,,,,,,,,Inpatient,,,31696.155,31696.155,HUMANA CHOICE PLUS,MGD,31696.155,,,,,,,case rate,880,31696.155,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,AETNA,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,COM,880,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,COM,880,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,COM,1100,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,COM,880,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,BCBS,COM,935,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,CIGNA,COM,1450,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,TRICARE,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,UNITED HEALTHCARE,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,UNITED HEALTHCARE,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,VA,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,VA TRICARE,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,WELLMED,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,HUMANA,MGD,1440,,,,,,,per diem,880,15440.8794,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,A0701,HIPPS,,,,,,,,Inpatient,,,15440.8794,15440.8794,HUMANA CHOICE PLUS,MGD,15440.8794,,,,,,,case rate,880,15440.8794,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,AETNA,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,COM,880,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,COM,880,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,COM,1100,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,COM,880,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,BCBS,COM,935,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,CIGNA,COM,1450,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,TRICARE,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,UNITED HEALTHCARE,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,UNITED HEALTHCARE,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,VA,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,VA TRICARE,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,WELLMED,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,HUMANA,MGD,1440,,,,,,,per diem,880,22253.5122,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,B0701,HIPPS,,,,,,,,Inpatient,,,22253.5122,22253.5122,HUMANA CHOICE PLUS,MGD,22253.5122,,,,,,,case rate,880,22253.5122,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,AETNA,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,COM,880,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,COM,880,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,COM,1100,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,COM,880,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,BCBS,COM,935,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,CIGNA,COM,1450,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,TRICARE,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,UNITED HEALTHCARE,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,UNITED HEALTHCARE,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,VA,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,VA TRICARE,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,WELLMED,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,HUMANA,MGD,1440,,,,,,,per diem,880,17791.5642,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,C0701,HIPPS,,,,,,,,Inpatient,,,17791.5642,17791.5642,HUMANA CHOICE PLUS,MGD,17791.5642,,,,,,,case rate,880,17791.5642,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,AETNA,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,COM,880,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,COM,880,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,COM,1100,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,COM,880,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,BCBS,COM,935,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,CIGNA,COM,1450,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,TRICARE,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,UNITED HEALTHCARE,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,UNITED HEALTHCARE,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,VA,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,VA TRICARE,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,WELLMED,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,HUMANA,MGD,1440,,,,,,,per diem,880,16897.3608,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=61.50,D0701,HIPPS,,,,,,,,Inpatient,,,16897.3608,16897.3608,HUMANA CHOICE PLUS,MGD,16897.3608,,,,,,,case rate,880,16897.3608,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,AETNA,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,COM,880,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,COM,880,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,COM,1100,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,COM,880,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,BCBS,COM,935,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,CIGNA,COM,1450,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,TRICARE,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,UNITED HEALTHCARE,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,UNITED HEALTHCARE,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,VA,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,VA TRICARE,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,WELLMED,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,HUMANA,MGD,1440,,,,,,,per diem,880,19086.6174,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,A0702,HIPPS,,,,,,,,Inpatient,,,19086.6174,19086.6174,HUMANA CHOICE PLUS,MGD,19086.6174,,,,,,,case rate,880,19086.6174,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,AETNA,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,COM,880,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,COM,880,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,COM,1100,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,COM,880,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,BCBS,COM,935,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,CIGNA,COM,1450,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,TRICARE,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,UNITED HEALTHCARE,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,UNITED HEALTHCARE,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,VA,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,VA TRICARE,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,WELLMED,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,HUMANA,MGD,1440,,,,,,,per diem,880,27506.277,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,B0702,HIPPS,,,,,,,,Inpatient,,,27506.277,27506.277,HUMANA CHOICE PLUS,MGD,27506.277,,,,,,,case rate,880,27506.277,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,AETNA,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,COM,880,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,COM,880,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,COM,1100,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,COM,880,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,BCBS,COM,935,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,CIGNA,COM,1450,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,TRICARE,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,UNITED HEALTHCARE,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,UNITED HEALTHCARE,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,VA,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,VA TRICARE,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,WELLMED,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,HUMANA,MGD,1440,,,,,,,per diem,880,21992.325,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,C0702,HIPPS,,,,,,,,Inpatient,,,21992.325,21992.325,HUMANA CHOICE PLUS,MGD,21992.325,,,,,,,case rate,880,21992.325,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,AETNA,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,COM,880,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,COM,880,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,COM,1100,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,COM,880,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,BCBS,COM,935,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,CIGNA,COM,1450,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,TRICARE,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,UNITED HEALTHCARE,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,UNITED HEALTHCARE,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,VA,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,VA TRICARE,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,WELLMED,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,HUMANA,MGD,1440,,,,,,,per diem,880,20885.907,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=52.50 and M <61.50,D0702,HIPPS,,,,,,,,Inpatient,,,20885.907,20885.907,HUMANA CHOICE PLUS,MGD,20885.907,,,,,,,case rate,880,20885.907,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,AETNA,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,COM,880,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,COM,880,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,COM,1100,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,COM,880,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,BCBS,COM,935,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,CIGNA,COM,1450,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,TRICARE,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,UNITED HEALTHCARE,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,UNITED HEALTHCARE,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,VA,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,VA TRICARE,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,WELLMED,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,HUMANA,MGD,1440,,,,,,,per diem,880,23383.5096,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,A0703,HIPPS,,,,,,,,Inpatient,,,23383.5096,23383.5096,HUMANA CHOICE PLUS,MGD,23383.5096,,,,,,,case rate,880,23383.5096,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,AETNA,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,COM,880,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,COM,880,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,COM,1100,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,COM,880,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,BCBS,COM,935,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,CIGNA,COM,1450,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,TRICARE,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,UNITED HEALTHCARE,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,UNITED HEALTHCARE,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,VA,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,VA TRICARE,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,WELLMED,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,HUMANA,MGD,1440,,,,,,,per diem,880,33696.7764,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,B0703,HIPPS,,,,,,,,Inpatient,,,33696.7764,33696.7764,HUMANA CHOICE PLUS,MGD,33696.7764,,,,,,,case rate,880,33696.7764,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,AETNA,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,COM,880,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,COM,880,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,COM,1100,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,COM,880,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,BCBS,COM,935,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,CIGNA,COM,1450,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,TRICARE,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,UNITED HEALTHCARE,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,UNITED HEALTHCARE,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,VA,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,VA TRICARE,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,WELLMED,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,HUMANA,MGD,1440,,,,,,,per diem,880,26942.1852,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,C0703,HIPPS,,,,,,,,Inpatient,,,26942.1852,26942.1852,HUMANA CHOICE PLUS,MGD,26942.1852,,,,,,,case rate,880,26942.1852,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,AETNA,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,COM,880,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,COM,880,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,COM,1100,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,COM,880,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,BCBS,COM,935,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,CIGNA,COM,1450,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,TRICARE,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,UNITED HEALTHCARE,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,UNITED HEALTHCARE,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,VA,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,VA TRICARE,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,WELLMED,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,HUMANA,MGD,1440,,,,,,,per diem,880,25589.0904,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M >=41.50 and M <52.50,D0703,HIPPS,,,,,,,,Inpatient,,,25589.0904,25589.0904,HUMANA CHOICE PLUS,MGD,25589.0904,,,,,,,case rate,880,25589.0904,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,AETNA,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,COM,880,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,COM,880,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,COM,1100,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,COM,880,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,BCBS,COM,935,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,CIGNA,COM,1450,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,TRICARE,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,UNITED HEALTHCARE,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,UNITED HEALTHCARE,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,VA,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,VA TRICARE,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,WELLMED,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,HUMANA,MGD,1440,,,,,,,per diem,880,28872.0684,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,A0704,HIPPS,,,,,,,,Inpatient,,,28872.0684,28872.0684,HUMANA CHOICE PLUS,MGD,28872.0684,,,,,,,case rate,880,28872.0684,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,AETNA,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,COM,880,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,COM,880,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,COM,1100,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,COM,880,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,BCBS,COM,935,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,CIGNA,COM,1450,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,TRICARE,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,UNITED HEALTHCARE,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,UNITED HEALTHCARE,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,VA,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,VA TRICARE,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,WELLMED,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,HUMANA,MGD,1440,,,,,,,per diem,880,41608.572,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,B0704,HIPPS,,,,,,,,Inpatient,,,41608.572,41608.572,HUMANA CHOICE PLUS,MGD,41608.572,,,,,,,case rate,880,41608.572,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,AETNA,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,COM,880,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,COM,880,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,COM,1100,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,COM,880,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,BCBS,COM,935,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,CIGNA,COM,1450,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,TRICARE,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,UNITED HEALTHCARE,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,UNITED HEALTHCARE,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,VA,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,VA TRICARE,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,WELLMED,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,HUMANA,MGD,1440,,,,,,,per diem,880,33268.7196,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,C0704,HIPPS,,,,,,,,Inpatient,,,33268.7196,33268.7196,HUMANA CHOICE PLUS,MGD,33268.7196,,,,,,,case rate,880,33268.7196,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,AETNA,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,COM,880,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,COM,880,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,COM,1100,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,COM,880,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,BCBS,COM,935,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,CIGNA,COM,1450,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,TRICARE,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,UNITED HEALTHCARE,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,UNITED HEALTHCARE,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,VA,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,VA TRICARE,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,WELLMED,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,HUMANA,MGD,1440,,,,,,,per diem,880,31596.396,"Per diem rate, all codes are bundled into service package"
Fracture of lower extremity M <41.50,D0704,HIPPS,,,,,,,,Inpatient,,,31596.396,31596.396,HUMANA CHOICE PLUS,MGD,31596.396,,,,,,,case rate,880,31596.396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,AETNA,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,COM,880,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,COM,880,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,COM,1100,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,COM,880,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,BCBS,COM,935,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,CIGNA,COM,1450,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,TRICARE,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,UNITED HEALTHCARE,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,UNITED HEALTHCARE,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,VA,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,VA TRICARE,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,WELLMED,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,HUMANA,MGD,1440,,,,,,,per diem,880,15072.678,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,A0801,HIPPS,,,,,,,,Inpatient,,,15072.678,15072.678,HUMANA CHOICE PLUS,MGD,15072.678,,,,,,,case rate,880,15072.678,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,AETNA,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,COM,880,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,COM,880,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,COM,1100,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,COM,880,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,BCBS,COM,935,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,CIGNA,COM,1450,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,TRICARE,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,UNITED HEALTHCARE,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,UNITED HEALTHCARE,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,VA,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,VA TRICARE,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,WELLMED,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,HUMANA,MGD,1440,,,,,,,per diem,880,21368.3778,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,B0801,HIPPS,,,,,,,,Inpatient,,,21368.3778,21368.3778,HUMANA CHOICE PLUS,MGD,21368.3778,,,,,,,case rate,880,21368.3778,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,AETNA,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,COM,880,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,COM,880,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,COM,1100,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,COM,880,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,BCBS,COM,935,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,CIGNA,COM,1450,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,TRICARE,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,UNITED HEALTHCARE,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,UNITED HEALTHCARE,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,VA,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,VA TRICARE,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,WELLMED,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,HUMANA,MGD,1440,,,,,,,per diem,880,17996.5236,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,C0801,HIPPS,,,,,,,,Inpatient,,,17996.5236,17996.5236,HUMANA CHOICE PLUS,MGD,17996.5236,,,,,,,case rate,880,17996.5236,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,AETNA,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,COM,880,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,COM,880,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,COM,1100,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,COM,880,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,BCBS,COM,935,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,CIGNA,COM,1450,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,TRICARE,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,UNITED HEALTHCARE,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,UNITED HEALTHCARE,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,VA,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,VA TRICARE,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,WELLMED,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,HUMANA,MGD,1440,,,,,,,per diem,880,16086.5922,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=63.50,D0801,HIPPS,,,,,,,,Inpatient,,,16086.5922,16086.5922,HUMANA CHOICE PLUS,MGD,16086.5922,,,,,,,case rate,880,16086.5922,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,AETNA,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,COM,880,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,COM,880,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,COM,1100,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,COM,880,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,BCBS,COM,935,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,CIGNA,COM,1450,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,TRICARE,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,UNITED HEALTHCARE,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,UNITED HEALTHCARE,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,VA,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,VA TRICARE,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,WELLMED,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,HUMANA,MGD,1440,,,,,,,per diem,880,17180.3136,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,A0802,HIPPS,,,,,,,,Inpatient,,,17180.3136,17180.3136,HUMANA CHOICE PLUS,MGD,17180.3136,,,,,,,case rate,880,17180.3136,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,AETNA,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,COM,880,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,COM,880,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,COM,1100,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,COM,880,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,BCBS,COM,935,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,CIGNA,COM,1450,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,TRICARE,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,UNITED HEALTHCARE,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,UNITED HEALTHCARE,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,VA,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,VA TRICARE,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,WELLMED,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,HUMANA,MGD,1440,,,,,,,per diem,880,24355.7064,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,B0802,HIPPS,,,,,,,,Inpatient,,,24355.7064,24355.7064,HUMANA CHOICE PLUS,MGD,24355.7064,,,,,,,case rate,880,24355.7064,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,AETNA,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,COM,880,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,COM,880,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,COM,1100,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,COM,880,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,BCBS,COM,935,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,CIGNA,COM,1450,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,TRICARE,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,UNITED HEALTHCARE,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,UNITED HEALTHCARE,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,VA,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,VA TRICARE,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,WELLMED,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,HUMANA,MGD,1440,,,,,,,per diem,880,20514.078,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,C0802,HIPPS,,,,,,,,Inpatient,,,20514.078,20514.078,HUMANA CHOICE PLUS,MGD,20514.078,,,,,,,case rate,880,20514.078,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,AETNA,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,COM,880,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,COM,880,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,COM,1100,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,COM,880,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,BCBS,COM,935,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,CIGNA,COM,1450,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,TRICARE,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,UNITED HEALTHCARE,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,UNITED HEALTHCARE,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,VA,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,VA TRICARE,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,WELLMED,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,HUMANA,MGD,1440,,,,,,,per diem,880,18335.7042,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=57.50 and M <63.50,D0802,HIPPS,,,,,,,,Inpatient,,,18335.7042,18335.7042,HUMANA CHOICE PLUS,MGD,18335.7042,,,,,,,case rate,880,18335.7042,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,AETNA,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,COM,880,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,COM,880,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,COM,1100,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,COM,880,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,BCBS,COM,935,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,CIGNA,COM,1450,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,TRICARE,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,UNITED HEALTHCARE,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,UNITED HEALTHCARE,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,VA,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,VA TRICARE,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,WELLMED,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,HUMANA,MGD,1440,,,,,,,per diem,880,18907.0512,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,A0803,HIPPS,,,,,,,,Inpatient,,,18907.0512,18907.0512,HUMANA CHOICE PLUS,MGD,18907.0512,,,,,,,case rate,880,18907.0512,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,AETNA,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,COM,880,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,COM,880,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,COM,1100,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,COM,880,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,BCBS,COM,935,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,CIGNA,COM,1450,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,TRICARE,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,UNITED HEALTHCARE,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,UNITED HEALTHCARE,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,VA,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,VA TRICARE,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,WELLMED,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,HUMANA,MGD,1440,,,,,,,per diem,880,26804.3364,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,B0803,HIPPS,,,,,,,,Inpatient,,,26804.3364,26804.3364,HUMANA CHOICE PLUS,MGD,26804.3364,,,,,,,case rate,880,26804.3364,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,AETNA,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,COM,880,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,COM,880,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,COM,1100,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,COM,880,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,BCBS,COM,935,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,CIGNA,COM,1450,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,TRICARE,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,UNITED HEALTHCARE,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,UNITED HEALTHCARE,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,VA,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,VA TRICARE,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,WELLMED,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,HUMANA,MGD,1440,,,,,,,per diem,880,22576.3686,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,C0803,HIPPS,,,,,,,,Inpatient,,,22576.3686,22576.3686,HUMANA CHOICE PLUS,MGD,22576.3686,,,,,,,case rate,880,22576.3686,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,AETNA,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,COM,880,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,COM,880,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,COM,1100,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,COM,880,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,BCBS,COM,935,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,CIGNA,COM,1450,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,TRICARE,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,UNITED HEALTHCARE,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,UNITED HEALTHCARE,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,VA,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,VA TRICARE,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,WELLMED,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,HUMANA,MGD,1440,,,,,,,per diem,880,20180.3388,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=51.50 and M <57.50,D0803,HIPPS,,,,,,,,Inpatient,,,20180.3388,20180.3388,HUMANA CHOICE PLUS,MGD,20180.3388,,,,,,,case rate,880,20180.3388,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,AETNA,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,COM,880,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,COM,880,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,COM,1100,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,COM,880,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,BCBS,COM,935,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,CIGNA,COM,1450,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,TRICARE,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,UNITED HEALTHCARE,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,UNITED HEALTHCARE,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,VA,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,VA TRICARE,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,WELLMED,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,HUMANA,MGD,1440,,,,,,,per diem,880,21479.0196,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,A0804,HIPPS,,,,,,,,Inpatient,,,21479.0196,21479.0196,HUMANA CHOICE PLUS,MGD,21479.0196,,,,,,,case rate,880,21479.0196,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,AETNA,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,COM,880,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,COM,880,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,COM,1100,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,COM,880,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,BCBS,COM,935,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,CIGNA,COM,1450,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,TRICARE,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,UNITED HEALTHCARE,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,UNITED HEALTHCARE,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,VA,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,VA TRICARE,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,WELLMED,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,HUMANA,MGD,1440,,,,,,,per diem,880,30450.0744,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,B0804,HIPPS,,,,,,,,Inpatient,,,30450.0744,30450.0744,HUMANA CHOICE PLUS,MGD,30450.0744,,,,,,,case rate,880,30450.0744,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,AETNA,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,COM,880,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,COM,880,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,COM,1100,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,COM,880,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,BCBS,COM,935,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,CIGNA,COM,1450,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,TRICARE,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,UNITED HEALTHCARE,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,UNITED HEALTHCARE,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,VA,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,VA TRICARE,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,WELLMED,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,HUMANA,MGD,1440,,,,,,,per diem,880,25647.132,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,C0804,HIPPS,,,,,,,,Inpatient,,,25647.132,25647.132,HUMANA CHOICE PLUS,MGD,25647.132,,,,,,,case rate,880,25647.132,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,AETNA,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,COM,880,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,COM,880,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,COM,1100,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,COM,880,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,BCBS,COM,935,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,CIGNA,COM,1450,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,TRICARE,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,UNITED HEALTHCARE,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,UNITED HEALTHCARE,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,VA,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,VA TRICARE,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,WELLMED,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,HUMANA,MGD,1440,,,,,,,per diem,880,22924.6182,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M >=42.50 and M <51.50,D0804,HIPPS,,,,,,,,Inpatient,,,22924.6182,22924.6182,HUMANA CHOICE PLUS,MGD,22924.6182,,,,,,,case rate,880,22924.6182,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,AETNA,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,COM,880,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,COM,880,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,COM,1100,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,COM,880,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,BCBS,COM,935,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,CIGNA,COM,1450,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,TRICARE,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,UNITED HEALTHCARE,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,UNITED HEALTHCARE,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,VA,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,VA TRICARE,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,WELLMED,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,HUMANA,MGD,1440,,,,,,,per diem,880,26751.7362,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,A0805,HIPPS,,,,,,,,Inpatient,,,26751.7362,26751.7362,HUMANA CHOICE PLUS,MGD,26751.7362,,,,,,,case rate,880,26751.7362,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,AETNA,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,COM,880,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,COM,880,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,COM,1100,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,COM,880,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,BCBS,COM,935,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,CIGNA,COM,1450,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,TRICARE,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,UNITED HEALTHCARE,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,UNITED HEALTHCARE,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,VA,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,VA TRICARE,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,WELLMED,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,HUMANA,MGD,1440,,,,,,,per diem,880,37926.558,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,B0805,HIPPS,,,,,,,,Inpatient,,,37926.558,37926.558,HUMANA CHOICE PLUS,MGD,37926.558,,,,,,,case rate,880,37926.558,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,AETNA,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,COM,880,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,COM,880,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,COM,1100,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,COM,880,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,BCBS,COM,935,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,CIGNA,COM,1450,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,TRICARE,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,UNITED HEALTHCARE,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,UNITED HEALTHCARE,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,VA,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,VA TRICARE,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,WELLMED,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,HUMANA,MGD,1440,,,,,,,per diem,880,31942.8318,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,C0805,HIPPS,,,,,,,,Inpatient,,,31942.8318,31942.8318,HUMANA CHOICE PLUS,MGD,31942.8318,,,,,,,case rate,880,31942.8318,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,AETNA,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,COM,880,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,COM,880,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,COM,1100,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,COM,880,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,BCBS,COM,935,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,CIGNA,COM,1450,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,TRICARE,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,UNITED HEALTHCARE,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,UNITED HEALTHCARE,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,VA,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,VA TRICARE,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,WELLMED,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,HUMANA,MGD,1440,,,,,,,per diem,880,28552.8396,"Per diem rate, all codes are bundled into service package"
Replacement of lower-extremity joint M <42.50,D0805,HIPPS,,,,,,,,Inpatient,,,28552.8396,28552.8396,HUMANA CHOICE PLUS,MGD,28552.8396,,,,,,,case rate,880,28552.8396,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,AETNA,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,COM,880,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,COM,880,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,COM,1100,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,COM,880,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,BCBS,COM,935,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,CIGNA,COM,1450,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,TRICARE,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,UNITED HEALTHCARE,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,UNITED HEALTHCARE,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,VA,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,VA TRICARE,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,WELLMED,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,HUMANA,MGD,1440,,,,,,,per diem,880,14662.7592,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,A0901,HIPPS,,,,,,,,Inpatient,,,14662.7592,14662.7592,HUMANA CHOICE PLUS,MGD,14662.7592,,,,,,,case rate,880,14662.7592,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,AETNA,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,COM,880,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,COM,880,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,COM,1100,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,COM,880,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,BCBS,COM,935,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,CIGNA,COM,1450,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,TRICARE,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,UNITED HEALTHCARE,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,UNITED HEALTHCARE,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,VA,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,VA TRICARE,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,WELLMED,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,HUMANA,MGD,1440,,,,,,,per diem,880,22463.913,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,B0901,HIPPS,,,,,,,,Inpatient,,,22463.913,22463.913,HUMANA CHOICE PLUS,MGD,22463.913,,,,,,,case rate,880,22463.913,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,AETNA,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,COM,880,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,COM,880,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,COM,1100,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,COM,880,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,BCBS,COM,935,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,CIGNA,COM,1450,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,TRICARE,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,UNITED HEALTHCARE,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,UNITED HEALTHCARE,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,VA,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,VA TRICARE,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,WELLMED,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,HUMANA,MGD,1440,,,,,,,per diem,880,17015.2578,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,C0901,HIPPS,,,,,,,,Inpatient,,,17015.2578,17015.2578,HUMANA CHOICE PLUS,MGD,17015.2578,,,,,,,case rate,880,17015.2578,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,AETNA,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,COM,880,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,COM,880,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,COM,1100,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,COM,880,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,BCBS,COM,935,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,CIGNA,COM,1450,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,TRICARE,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,UNITED HEALTHCARE,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,UNITED HEALTHCARE,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,VA,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,VA TRICARE,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,WELLMED,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,HUMANA,MGD,1440,,,,,,,per diem,880,16073.8956,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=63.50,D0901,HIPPS,,,,,,,,Inpatient,,,16073.8956,16073.8956,HUMANA CHOICE PLUS,MGD,16073.8956,,,,,,,case rate,880,16073.8956,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,AETNA,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,COM,880,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,COM,880,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,COM,1100,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,COM,880,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,BCBS,COM,935,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,CIGNA,COM,1450,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,TRICARE,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,UNITED HEALTHCARE,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,UNITED HEALTHCARE,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,VA,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,VA TRICARE,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,WELLMED,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,HUMANA,MGD,1440,,,,,,,per diem,880,18627.726,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,A0902,HIPPS,,,,,,,,Inpatient,,,18627.726,18627.726,HUMANA CHOICE PLUS,MGD,18627.726,,,,,,,case rate,880,18627.726,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,AETNA,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,COM,880,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,COM,880,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,COM,1100,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,COM,880,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,BCBS,COM,935,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,CIGNA,COM,1450,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,TRICARE,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,UNITED HEALTHCARE,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,UNITED HEALTHCARE,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,VA,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,VA TRICARE,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,WELLMED,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,HUMANA,MGD,1440,,,,,,,per diem,880,28536.5154,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,B0902,HIPPS,,,,,,,,Inpatient,,,28536.5154,28536.5154,HUMANA CHOICE PLUS,MGD,28536.5154,,,,,,,case rate,880,28536.5154,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,AETNA,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,COM,880,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,COM,880,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,COM,1100,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,COM,880,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,BCBS,COM,935,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,CIGNA,COM,1450,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,TRICARE,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,UNITED HEALTHCARE,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,UNITED HEALTHCARE,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,VA,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,VA TRICARE,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,WELLMED,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,HUMANA,MGD,1440,,,,,,,per diem,880,21615.0546,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,C0902,HIPPS,,,,,,,,Inpatient,,,21615.0546,21615.0546,HUMANA CHOICE PLUS,MGD,21615.0546,,,,,,,case rate,880,21615.0546,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,AETNA,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,COM,880,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,COM,880,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,COM,1100,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,COM,880,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,BCBS,COM,935,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,CIGNA,COM,1450,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,TRICARE,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,UNITED HEALTHCARE,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,UNITED HEALTHCARE,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,VA,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,VA TRICARE,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,WELLMED,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,HUMANA,MGD,1440,,,,,,,per diem,880,20417.9466,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=51.50 and M <63.50,D0902,HIPPS,,,,,,,,Inpatient,,,20417.9466,20417.9466,HUMANA CHOICE PLUS,MGD,20417.9466,,,,,,,case rate,880,20417.9466,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,AETNA,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,COM,880,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,COM,880,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,COM,1100,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,COM,880,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,BCBS,COM,935,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,CIGNA,COM,1450,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,TRICARE,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,UNITED HEALTHCARE,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,UNITED HEALTHCARE,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,VA,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,VA TRICARE,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,WELLMED,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,HUMANA,MGD,1440,,,,,,,per diem,880,22104.7806,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,A0903,HIPPS,,,,,,,,Inpatient,,,22104.7806,22104.7806,HUMANA CHOICE PLUS,MGD,22104.7806,,,,,,,case rate,880,22104.7806,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,AETNA,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,COM,880,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,COM,880,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,COM,1100,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,COM,880,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,BCBS,COM,935,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,CIGNA,COM,1450,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,TRICARE,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,UNITED HEALTHCARE,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,UNITED HEALTHCARE,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,VA,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,VA TRICARE,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,WELLMED,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,HUMANA,MGD,1440,,,,,,,per diem,880,33863.646,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,B0903,HIPPS,,,,,,,,Inpatient,,,33863.646,33863.646,HUMANA CHOICE PLUS,MGD,33863.646,,,,,,,case rate,880,33863.646,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,AETNA,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,COM,880,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,COM,880,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,COM,1100,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,COM,880,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,BCBS,COM,935,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,CIGNA,COM,1450,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,TRICARE,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,UNITED HEALTHCARE,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,UNITED HEALTHCARE,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,VA,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,VA TRICARE,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,WELLMED,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,HUMANA,MGD,1440,,,,,,,per diem,880,25648.9458,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,C0903,HIPPS,,,,,,,,Inpatient,,,25648.9458,25648.9458,HUMANA CHOICE PLUS,MGD,25648.9458,,,,,,,case rate,880,25648.9458,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,AETNA,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,COM,880,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,COM,880,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,COM,1100,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,COM,880,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,BCBS,COM,935,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,CIGNA,COM,1450,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,TRICARE,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,UNITED HEALTHCARE,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,UNITED HEALTHCARE,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,VA,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,VA TRICARE,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,WELLMED,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,HUMANA,MGD,1440,,,,,,,per diem,880,24228.7404,"Per diem rate, all codes are bundled into service package"
Other orthopedic M >=44.50 and M <51.50,D0903,HIPPS,,,,,,,,Inpatient,,,24228.7404,24228.7404,HUMANA CHOICE PLUS,MGD,24228.7404,,,,,,,case rate,880,24228.7404,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,AETNA,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,COM,880,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,COM,880,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,COM,1100,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,COM,880,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,BCBS,COM,935,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,CIGNA,COM,1450,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,TRICARE,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,UNITED HEALTHCARE,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,UNITED HEALTHCARE,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,VA,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,VA TRICARE,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,WELLMED,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,HUMANA,MGD,1440,,,,,,,per diem,880,26617.515,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,A0904,HIPPS,,,,,,,,Inpatient,,,26617.515,26617.515,HUMANA CHOICE PLUS,MGD,26617.515,,,,,,,case rate,880,26617.515,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,AETNA,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,COM,880,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,COM,880,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,COM,1100,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,COM,880,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,BCBS,COM,935,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,CIGNA,COM,1450,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,TRICARE,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,UNITED HEALTHCARE,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,UNITED HEALTHCARE,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,VA,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,VA TRICARE,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,WELLMED,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,HUMANA,MGD,1440,,,,,,,per diem,880,40777.8516,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,B0904,HIPPS,,,,,,,,Inpatient,,,40777.8516,40777.8516,HUMANA CHOICE PLUS,MGD,40777.8516,,,,,,,case rate,880,40777.8516,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,AETNA,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,COM,880,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,COM,880,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,COM,1100,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,COM,880,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,BCBS,COM,935,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,CIGNA,COM,1450,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,TRICARE,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,UNITED HEALTHCARE,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,UNITED HEALTHCARE,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,VA,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,VA TRICARE,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,WELLMED,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,HUMANA,MGD,1440,,,,,,,per diem,880,30887.2002,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,C0904,HIPPS,,,,,,,,Inpatient,,,30887.2002,30887.2002,HUMANA CHOICE PLUS,MGD,30887.2002,,,,,,,case rate,880,30887.2002,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,AETNA,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,COM,880,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,COM,880,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,COM,1100,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,COM,880,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,BCBS,COM,935,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,CIGNA,COM,1450,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,TRICARE,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,UNITED HEALTHCARE,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,UNITED HEALTHCARE,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,VA,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,VA TRICARE,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,WELLMED,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,HUMANA,MGD,1440,,,,,,,per diem,880,29176.7868,"Per diem rate, all codes are bundled into service package"
Other orthopedic M <44.5,D0904,HIPPS,,,,,,,,Inpatient,,,29176.7868,29176.7868,HUMANA CHOICE PLUS,MGD,29176.7868,,,,,,,case rate,880,29176.7868,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,AETNA,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,COM,880,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,COM,880,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,COM,1100,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,COM,880,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,BCBS,COM,935,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,CIGNA,COM,1450,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,TRICARE,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,UNITED HEALTHCARE,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,UNITED HEALTHCARE,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,VA,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,VA TRICARE,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,WELLMED,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,HUMANA,MGD,1440,,,,,,,per diem,880,15607.749,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,A1001,HIPPS,,,,,,,,Inpatient,,,15607.749,15607.749,HUMANA CHOICE PLUS,MGD,15607.749,,,,,,,case rate,880,15607.749,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,AETNA,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,COM,880,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,COM,880,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,COM,1100,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,COM,880,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,BCBS,COM,935,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,CIGNA,COM,1450,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,TRICARE,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,UNITED HEALTHCARE,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,UNITED HEALTHCARE,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,VA,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,VA TRICARE,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,WELLMED,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,HUMANA,MGD,1440,,,,,,,per diem,880,22289.7882,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,B1001,HIPPS,,,,,,,,Inpatient,,,22289.7882,22289.7882,HUMANA CHOICE PLUS,MGD,22289.7882,,,,,,,case rate,880,22289.7882,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,AETNA,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,COM,880,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,COM,880,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,COM,1100,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,COM,880,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,BCBS,COM,935,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,CIGNA,COM,1450,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,TRICARE,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,UNITED HEALTHCARE,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,UNITED HEALTHCARE,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,VA,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,VA TRICARE,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,WELLMED,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,HUMANA,MGD,1440,,,,,,,per diem,880,18520.7118,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,C1001,HIPPS,,,,,,,,Inpatient,,,18520.7118,18520.7118,HUMANA CHOICE PLUS,MGD,18520.7118,,,,,,,case rate,880,18520.7118,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,AETNA,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,COM,880,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,COM,880,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,COM,1100,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,COM,880,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,BCBS,COM,935,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,CIGNA,COM,1450,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,TRICARE,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,UNITED HEALTHCARE,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,UNITED HEALTHCARE,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,VA,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,VA TRICARE,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,WELLMED,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,HUMANA,MGD,1440,,,,,,,per diem,880,16810.2984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=64.50,D1001,HIPPS,,,,,,,,Inpatient,,,16810.2984,16810.2984,HUMANA CHOICE PLUS,MGD,16810.2984,,,,,,,case rate,880,16810.2984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,AETNA,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,COM,880,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,COM,880,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,COM,1100,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,COM,880,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,BCBS,COM,935,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,CIGNA,COM,1450,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,TRICARE,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,UNITED HEALTHCARE,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,UNITED HEALTHCARE,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,VA,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,VA TRICARE,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,WELLMED,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,HUMANA,MGD,1440,,,,,,,per diem,880,18961.4652,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,A1002,HIPPS,,,,,,,,Inpatient,,,18961.4652,18961.4652,HUMANA CHOICE PLUS,MGD,18961.4652,,,,,,,case rate,880,18961.4652,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,AETNA,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,COM,880,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,COM,880,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,COM,1100,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,COM,880,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,BCBS,COM,935,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,CIGNA,COM,1450,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,TRICARE,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,UNITED HEALTHCARE,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,UNITED HEALTHCARE,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,VA,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,VA TRICARE,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,WELLMED,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,HUMANA,MGD,1440,,,,,,,per diem,880,27078.2202,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,B1002,HIPPS,,,,,,,,Inpatient,,,27078.2202,27078.2202,HUMANA CHOICE PLUS,MGD,27078.2202,,,,,,,case rate,880,27078.2202,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,AETNA,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,COM,880,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,COM,880,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,COM,1100,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,COM,880,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,BCBS,COM,935,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,CIGNA,COM,1450,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,TRICARE,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,UNITED HEALTHCARE,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,UNITED HEALTHCARE,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,VA,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,VA TRICARE,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,WELLMED,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,HUMANA,MGD,1440,,,,,,,per diem,880,22500.189,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,C1002,HIPPS,,,,,,,,Inpatient,,,22500.189,22500.189,HUMANA CHOICE PLUS,MGD,22500.189,,,,,,,case rate,880,22500.189,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,AETNA,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,COM,880,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,COM,880,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,COM,1100,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,COM,880,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,BCBS,COM,935,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,CIGNA,COM,1450,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,TRICARE,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,UNITED HEALTHCARE,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,UNITED HEALTHCARE,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,VA,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,VA TRICARE,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,WELLMED,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,HUMANA,MGD,1440,,,,,,,per diem,880,20421.5742,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=55.50 and M <64.50,D1002,HIPPS,,,,,,,,Inpatient,,,20421.5742,20421.5742,HUMANA CHOICE PLUS,MGD,20421.5742,,,,,,,case rate,880,20421.5742,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,AETNA,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,COM,880,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,COM,880,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,COM,1100,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,COM,880,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,BCBS,COM,935,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,CIGNA,COM,1450,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,TRICARE,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,UNITED HEALTHCARE,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,UNITED HEALTHCARE,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,VA,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,VA TRICARE,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,WELLMED,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,HUMANA,MGD,1440,,,,,,,per diem,880,22567.2996,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,A1003,HIPPS,,,,,,,,Inpatient,,,22567.2996,22567.2996,HUMANA CHOICE PLUS,MGD,22567.2996,,,,,,,case rate,880,22567.2996,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,AETNA,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,COM,880,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,COM,880,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,COM,1100,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,COM,880,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,BCBS,COM,935,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,CIGNA,COM,1450,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,TRICARE,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,UNITED HEALTHCARE,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,UNITED HEALTHCARE,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,VA,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,VA TRICARE,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,WELLMED,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,HUMANA,MGD,1440,,,,,,,per diem,880,32227.5984,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,B1003,HIPPS,,,,,,,,Inpatient,,,32227.5984,32227.5984,HUMANA CHOICE PLUS,MGD,32227.5984,,,,,,,case rate,880,32227.5984,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,AETNA,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,COM,880,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,COM,880,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,COM,1100,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,COM,880,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,BCBS,COM,935,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,CIGNA,COM,1450,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,TRICARE,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,UNITED HEALTHCARE,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,UNITED HEALTHCARE,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,VA,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,VA TRICARE,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,WELLMED,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,HUMANA,MGD,1440,,,,,,,per diem,880,26778.9432,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,C1003,HIPPS,,,,,,,,Inpatient,,,26778.9432,26778.9432,HUMANA CHOICE PLUS,MGD,26778.9432,,,,,,,case rate,880,26778.9432,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,AETNA,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,COM,880,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,COM,880,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,COM,1100,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,COM,880,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,BCBS,COM,935,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,CIGNA,COM,1450,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,TRICARE,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,UNITED HEALTHCARE,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,UNITED HEALTHCARE,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,VA,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,VA TRICARE,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,WELLMED,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,HUMANA,MGD,1440,,,,,,,per diem,880,24304.92,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M >=47.50 and M <55.50,D1003,HIPPS,,,,,,,,Inpatient,,,24304.92,24304.92,HUMANA CHOICE PLUS,MGD,24304.92,,,,,,,case rate,880,24304.92,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,AETNA,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,COM,880,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,COM,880,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,COM,1100,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,COM,880,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,BCBS,COM,935,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,CIGNA,COM,1450,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,TRICARE,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,UNITED HEALTHCARE,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,UNITED HEALTHCARE,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,VA,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,VA TRICARE,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,WELLMED,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,HUMANA,MGD,1440,,,,,,,per diem,880,30018.39,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,A1004,HIPPS,,,,,,,,Inpatient,,,30018.39,30018.39,HUMANA CHOICE PLUS,MGD,30018.39,,,,,,,case rate,880,30018.39,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,AETNA,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,COM,880,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,COM,880,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,COM,1100,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,COM,880,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,BCBS,COM,935,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,CIGNA,COM,1450,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,TRICARE,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,UNITED HEALTHCARE,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,UNITED HEALTHCARE,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,VA,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,VA TRICARE,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,WELLMED,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,HUMANA,MGD,1440,,,,,,,per diem,880,42867.3492,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,B1004,HIPPS,,,,,,,,Inpatient,,,42867.3492,42867.3492,HUMANA CHOICE PLUS,MGD,42867.3492,,,,,,,case rate,880,42867.3492,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,AETNA,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,COM,880,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,COM,880,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,COM,1100,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,COM,880,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,BCBS,COM,935,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,CIGNA,COM,1450,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,TRICARE,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,UNITED HEALTHCARE,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,UNITED HEALTHCARE,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,VA,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,VA TRICARE,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,WELLMED,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,HUMANA,MGD,1440,,,,,,,per diem,880,35619.4044,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,C1004,HIPPS,,,,,,,,Inpatient,,,35619.4044,35619.4044,HUMANA CHOICE PLUS,MGD,35619.4044,,,,,,,case rate,880,35619.4044,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,AETNA,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,COM,880,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,COM,880,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,COM,1100,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,COM,880,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,BCBS,COM,935,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,CIGNA,COM,1450,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,TRICARE,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,UNITED HEALTHCARE,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,UNITED HEALTHCARE,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,VA,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,VA TRICARE,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,WELLMED,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,HUMANA,MGD,1440,,,,,,,per diem,880,32329.1712,"Per diem rate, all codes are bundled into service package"
Amputation lower extremity M <47.50,D1004,HIPPS,,,,,,,,Inpatient,,,32329.1712,32329.1712,HUMANA CHOICE PLUS,MGD,32329.1712,,,,,,,case rate,880,32329.1712,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,AETNA,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,COM,880,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,COM,880,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,COM,1100,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,COM,880,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,BCBS,COM,935,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,CIGNA,COM,1450,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,TRICARE,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,UNITED HEALTHCARE,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,UNITED HEALTHCARE,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,VA,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,VA TRICARE,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,WELLMED,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,HUMANA,MGD,1440,,,,,,,per diem,880,17486.8458,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,A1101,HIPPS,,,,,,,,Inpatient,,,17486.8458,17486.8458,HUMANA CHOICE PLUS,MGD,17486.8458,,,,,,,case rate,880,17486.8458,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,AETNA,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,COM,880,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,COM,880,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,COM,1100,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,COM,880,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,BCBS,COM,935,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,CIGNA,COM,1450,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,TRICARE,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,UNITED HEALTHCARE,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,UNITED HEALTHCARE,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,VA,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,VA TRICARE,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,WELLMED,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,HUMANA,MGD,1440,,,,,,,per diem,880,24529.8312,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,B1101,HIPPS,,,,,,,,Inpatient,,,24529.8312,24529.8312,HUMANA CHOICE PLUS,MGD,24529.8312,,,,,,,case rate,880,24529.8312,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,AETNA,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,COM,880,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,COM,880,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,COM,1100,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,COM,880,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,BCBS,COM,935,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,CIGNA,COM,1450,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,TRICARE,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,UNITED HEALTHCARE,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,UNITED HEALTHCARE,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,VA,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,VA TRICARE,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,WELLMED,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,HUMANA,MGD,1440,,,,,,,per diem,880,23223.8952,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,C1101,HIPPS,,,,,,,,Inpatient,,,23223.8952,23223.8952,HUMANA CHOICE PLUS,MGD,23223.8952,,,,,,,case rate,880,23223.8952,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,AETNA,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,COM,880,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,COM,880,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,COM,1100,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,COM,880,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,BCBS,COM,935,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,CIGNA,COM,1450,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,TRICARE,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,UNITED HEALTHCARE,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,UNITED HEALTHCARE,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,VA,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,VA TRICARE,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,WELLMED,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,HUMANA,MGD,1440,,,,,,,per diem,880,19986.2622,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=58.50,D1101,HIPPS,,,,,,,,Inpatient,,,19986.2622,19986.2622,HUMANA CHOICE PLUS,MGD,19986.2622,,,,,,,case rate,880,19986.2622,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,AETNA,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,COM,880,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,COM,880,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,COM,1100,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,COM,880,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,BCBS,COM,935,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,CIGNA,COM,1450,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,TRICARE,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,UNITED HEALTHCARE,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,UNITED HEALTHCARE,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,VA,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,VA TRICARE,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,WELLMED,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,HUMANA,MGD,1440,,,,,,,per diem,880,19968.1242,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,A1102,HIPPS,,,,,,,,Inpatient,,,19968.1242,19968.1242,HUMANA CHOICE PLUS,MGD,19968.1242,,,,,,,case rate,880,19968.1242,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,AETNA,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,COM,880,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,COM,880,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,COM,1100,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,COM,880,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,BCBS,COM,935,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,CIGNA,COM,1450,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,TRICARE,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,UNITED HEALTHCARE,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,UNITED HEALTHCARE,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,VA,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,VA TRICARE,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,WELLMED,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,HUMANA,MGD,1440,,,,,,,per diem,880,28012.3272,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,B1102,HIPPS,,,,,,,,Inpatient,,,28012.3272,28012.3272,HUMANA CHOICE PLUS,MGD,28012.3272,,,,,,,case rate,880,28012.3272,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,AETNA,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,COM,880,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,COM,880,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,COM,1100,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,COM,880,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,BCBS,COM,935,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,CIGNA,COM,1450,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,TRICARE,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,UNITED HEALTHCARE,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,UNITED HEALTHCARE,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,VA,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,VA TRICARE,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,WELLMED,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,HUMANA,MGD,1440,,,,,,,per diem,880,26519.5698,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,C1102,HIPPS,,,,,,,,Inpatient,,,26519.5698,26519.5698,HUMANA CHOICE PLUS,MGD,26519.5698,,,,,,,case rate,880,26519.5698,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,AETNA,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,COM,880,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,COM,880,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,COM,1100,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,COM,880,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,BCBS,COM,935,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,CIGNA,COM,1450,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,TRICARE,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,UNITED HEALTHCARE,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,UNITED HEALTHCARE,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,VA,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,VA TRICARE,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,WELLMED,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,HUMANA,MGD,1440,,,,,,,per diem,880,22821.2316,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M >=52.50 and M <58.50,D1102,HIPPS,,,,,,,,Inpatient,,,22821.2316,22821.2316,HUMANA CHOICE PLUS,MGD,22821.2316,,,,,,,case rate,880,22821.2316,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,AETNA,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,COM,880,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,COM,880,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,COM,1100,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,COM,880,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,BCBS,COM,935,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,CIGNA,COM,1450,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,TRICARE,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,UNITED HEALTHCARE,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,UNITED HEALTHCARE,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,VA,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,VA TRICARE,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,WELLMED,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,HUMANA,MGD,1440,,,,,,,per diem,880,25010.4882,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,A1103,HIPPS,,,,,,,,Inpatient,,,25010.4882,25010.4882,HUMANA CHOICE PLUS,MGD,25010.4882,,,,,,,case rate,880,25010.4882,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,AETNA,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,COM,880,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,COM,880,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,COM,1100,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,COM,880,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,BCBS,COM,935,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,CIGNA,COM,1450,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,TRICARE,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,UNITED HEALTHCARE,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,UNITED HEALTHCARE,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,VA,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,VA TRICARE,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,WELLMED,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,HUMANA,MGD,1440,,,,,,,per diem,880,35086.1472,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,B1103,HIPPS,,,,,,,,Inpatient,,,35086.1472,35086.1472,HUMANA CHOICE PLUS,MGD,35086.1472,,,,,,,case rate,880,35086.1472,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,AETNA,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,COM,880,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,COM,880,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,COM,1100,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,COM,880,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,BCBS,COM,935,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,CIGNA,COM,1450,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,TRICARE,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,UNITED HEALTHCARE,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,UNITED HEALTHCARE,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,VA,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,VA TRICARE,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,WELLMED,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,HUMANA,MGD,1440,,,,,,,per diem,880,33216.1194,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,C1103,HIPPS,,,,,,,,Inpatient,,,33216.1194,33216.1194,HUMANA CHOICE PLUS,MGD,33216.1194,,,,,,,case rate,880,33216.1194,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,AETNA,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,1100,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,935,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,CIGNA,COM,1450,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,TRICARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,UNITED HEALTHCARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,UNITED HEALTHCARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,VA,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,VA TRICARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,WELLMED,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,HUMANA,MGD,1440,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Amputation non-lower extremity M <52.50,D1103,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,HUMANA CHOICE PLUS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,AETNA,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,COM,880,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,COM,880,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,COM,1100,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,COM,880,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,BCBS,COM,935,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,CIGNA,COM,1450,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,TRICARE,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,UNITED HEALTHCARE,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,UNITED HEALTHCARE,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,VA,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,VA TRICARE,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,WELLMED,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,HUMANA,MGD,1440,,,,,,,per diem,880,15783.6876,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,A1201,HIPPS,,,,,,,,Inpatient,,,15783.6876,15783.6876,HUMANA CHOICE PLUS,MGD,15783.6876,,,,,,,case rate,880,15783.6876,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,AETNA,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,COM,880,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,COM,880,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,COM,1100,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,COM,880,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,BCBS,COM,935,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,CIGNA,COM,1450,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,TRICARE,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,UNITED HEALTHCARE,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,UNITED HEALTHCARE,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,VA,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,VA TRICARE,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,WELLMED,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,HUMANA,MGD,1440,,,,,,,per diem,880,24027.4086,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,B1201,HIPPS,,,,,,,,Inpatient,,,24027.4086,24027.4086,HUMANA CHOICE PLUS,MGD,24027.4086,,,,,,,case rate,880,24027.4086,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,AETNA,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,COM,880,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,COM,880,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,COM,1100,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,COM,880,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,BCBS,COM,935,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,CIGNA,COM,1450,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,TRICARE,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,UNITED HEALTHCARE,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,UNITED HEALTHCARE,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,VA,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,VA TRICARE,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,WELLMED,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,HUMANA,MGD,1440,,,,,,,per diem,880,19070.2932,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,C1201,HIPPS,,,,,,,,Inpatient,,,19070.2932,19070.2932,HUMANA CHOICE PLUS,MGD,19070.2932,,,,,,,case rate,880,19070.2932,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,AETNA,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,COM,880,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,COM,880,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,COM,1100,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,COM,880,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,BCBS,COM,935,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,CIGNA,COM,1450,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,TRICARE,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,UNITED HEALTHCARE,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,UNITED HEALTHCARE,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,VA,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,VA TRICARE,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,WELLMED,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,HUMANA,MGD,1440,,,,,,,per diem,880,17042.4648,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=61.50,D1201,HIPPS,,,,,,,,Inpatient,,,17042.4648,17042.4648,HUMANA CHOICE PLUS,MGD,17042.4648,,,,,,,case rate,880,17042.4648,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,AETNA,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,COM,880,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,COM,880,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,COM,1100,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,COM,880,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,BCBS,COM,935,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,CIGNA,COM,1450,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,TRICARE,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,UNITED HEALTHCARE,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,UNITED HEALTHCARE,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,VA,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,VA TRICARE,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,WELLMED,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,HUMANA,MGD,1440,,,,,,,per diem,880,18556.9878,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,A1202,HIPPS,,,,,,,,Inpatient,,,18556.9878,18556.9878,HUMANA CHOICE PLUS,MGD,18556.9878,,,,,,,case rate,880,18556.9878,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,AETNA,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,COM,880,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,COM,880,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,COM,1100,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,COM,880,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,BCBS,COM,935,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,CIGNA,COM,1450,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,TRICARE,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,UNITED HEALTHCARE,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,UNITED HEALTHCARE,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,VA,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,VA TRICARE,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,WELLMED,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,HUMANA,MGD,1440,,,,,,,per diem,880,28251.7488,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,B1202,HIPPS,,,,,,,,Inpatient,,,28251.7488,28251.7488,HUMANA CHOICE PLUS,MGD,28251.7488,,,,,,,case rate,880,28251.7488,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,AETNA,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,COM,880,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,COM,880,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,COM,1100,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,COM,880,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,BCBS,COM,935,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,CIGNA,COM,1450,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,TRICARE,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,UNITED HEALTHCARE,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,UNITED HEALTHCARE,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,VA,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,VA TRICARE,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,WELLMED,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,HUMANA,MGD,1440,,,,,,,per diem,880,22422.1956,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,C1202,HIPPS,,,,,,,,Inpatient,,,22422.1956,22422.1956,HUMANA CHOICE PLUS,MGD,22422.1956,,,,,,,case rate,880,22422.1956,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,AETNA,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,COM,880,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,COM,880,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,COM,1100,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,COM,880,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,BCBS,COM,935,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,CIGNA,COM,1450,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,TRICARE,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,UNITED HEALTHCARE,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,UNITED HEALTHCARE,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,VA,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,VA TRICARE,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,WELLMED,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,HUMANA,MGD,1440,,,,,,,per diem,880,20037.0486,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M >=49.50 and M <61.50,D1202,HIPPS,,,,,,,,Inpatient,,,20037.0486,20037.0486,HUMANA CHOICE PLUS,MGD,20037.0486,,,,,,,case rate,880,20037.0486,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,AETNA,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,COM,880,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,COM,880,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,COM,1100,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,COM,880,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,BCBS,COM,935,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,CIGNA,COM,1450,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,TRICARE,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,UNITED HEALTHCARE,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,UNITED HEALTHCARE,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,VA,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,VA TRICARE,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,WELLMED,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,HUMANA,MGD,1440,,,,,,,per diem,880,24841.8048,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,A1203,HIPPS,,,,,,,,Inpatient,,,24841.8048,24841.8048,HUMANA CHOICE PLUS,MGD,24841.8048,,,,,,,case rate,880,24841.8048,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,AETNA,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,COM,880,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,COM,880,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,COM,1100,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,COM,880,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,BCBS,COM,935,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,CIGNA,COM,1450,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,TRICARE,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,UNITED HEALTHCARE,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,UNITED HEALTHCARE,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,VA,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,VA TRICARE,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,WELLMED,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,HUMANA,MGD,1440,,,,,,,per diem,880,37817.73,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,B1203,HIPPS,,,,,,,,Inpatient,,,37817.73,37817.73,HUMANA CHOICE PLUS,MGD,37817.73,,,,,,,case rate,880,37817.73,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,AETNA,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,COM,880,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,COM,880,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,COM,1100,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,COM,880,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,BCBS,COM,935,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,CIGNA,COM,1450,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,TRICARE,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,UNITED HEALTHCARE,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,UNITED HEALTHCARE,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,VA,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,VA TRICARE,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,WELLMED,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,HUMANA,MGD,1440,,,,,,,per diem,880,30014.7624,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,C1203,HIPPS,,,,,,,,Inpatient,,,30014.7624,30014.7624,HUMANA CHOICE PLUS,MGD,30014.7624,,,,,,,case rate,880,30014.7624,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,AETNA,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,COM,880,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,COM,880,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,COM,1100,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,COM,880,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,BCBS,COM,935,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,CIGNA,COM,1450,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,TRICARE,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,UNITED HEALTHCARE,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,UNITED HEALTHCARE,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,VA,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,VA TRICARE,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,WELLMED,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,HUMANA,MGD,1440,,,,,,,per diem,880,26822.4744,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A >=74.50,D1203,HIPPS,,,,,,,,Inpatient,,,26822.4744,26822.4744,HUMANA CHOICE PLUS,MGD,26822.4744,,,,,,,case rate,880,26822.4744,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,AETNA,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,COM,880,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,COM,880,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,COM,1100,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,COM,880,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,BCBS,COM,935,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,CIGNA,COM,1450,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,TRICARE,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,UNITED HEALTHCARE,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,UNITED HEALTHCARE,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,VA,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,VA TRICARE,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,WELLMED,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,HUMANA,MGD,1440,,,,,,,per diem,880,25574.58,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,A1204,HIPPS,,,,,,,,Inpatient,,,25574.58,25574.58,HUMANA CHOICE PLUS,MGD,25574.58,,,,,,,case rate,880,25574.58,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,AETNA,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,COM,880,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,COM,880,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,COM,1100,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,COM,880,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,BCBS,COM,935,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,CIGNA,COM,1450,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,TRICARE,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,UNITED HEALTHCARE,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,UNITED HEALTHCARE,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,VA,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,VA TRICARE,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,WELLMED,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,HUMANA,MGD,1440,,,,,,,per diem,880,38933.217,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,B1204,HIPPS,,,,,,,,Inpatient,,,38933.217,38933.217,HUMANA CHOICE PLUS,MGD,38933.217,,,,,,,case rate,880,38933.217,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,AETNA,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,COM,880,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,COM,880,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,COM,1100,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,COM,880,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,BCBS,COM,935,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,CIGNA,COM,1450,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,TRICARE,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,UNITED HEALTHCARE,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,UNITED HEALTHCARE,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,VA,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,VA TRICARE,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,WELLMED,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,HUMANA,MGD,1440,,,,,,,per diem,880,30901.7106,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,C1204,HIPPS,,,,,,,,Inpatient,,,30901.7106,30901.7106,HUMANA CHOICE PLUS,MGD,30901.7106,,,,,,,case rate,880,30901.7106,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,AETNA,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,COM,880,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,COM,880,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,COM,1100,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,COM,880,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,BCBS,COM,935,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,CIGNA,COM,1450,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,TRICARE,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,UNITED HEALTHCARE,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,UNITED HEALTHCARE,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,VA,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,VA TRICARE,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,WELLMED,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,HUMANA,MGD,1440,,,,,,,per diem,880,27615.105,"Per diem rate, all codes are bundled into service package"
Osteoarthritis M <49.50 and A <74.50,D1204,HIPPS,,,,,,,,Inpatient,,,27615.105,27615.105,HUMANA CHOICE PLUS,MGD,27615.105,,,,,,,case rate,880,27615.105,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,AETNA,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,COM,880,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,COM,880,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,COM,1100,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,COM,880,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,BCBS,COM,935,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,CIGNA,COM,1450,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,TRICARE,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,UNITED HEALTHCARE,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,UNITED HEALTHCARE,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,VA,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,VA TRICARE,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,WELLMED,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,HUMANA,MGD,1440,,,,,,,per diem,880,15119.8368,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,A1301,HIPPS,,,,,,,,Inpatient,,,15119.8368,15119.8368,HUMANA CHOICE PLUS,MGD,15119.8368,,,,,,,case rate,880,15119.8368,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,AETNA,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,COM,880,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,COM,880,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,COM,1100,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,COM,880,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,BCBS,COM,935,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,CIGNA,COM,1450,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,TRICARE,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,UNITED HEALTHCARE,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,UNITED HEALTHCARE,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,VA,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,VA TRICARE,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,WELLMED,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,HUMANA,MGD,1440,,,,,,,per diem,880,22721.4726,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,B1301,HIPPS,,,,,,,,Inpatient,,,22721.4726,22721.4726,HUMANA CHOICE PLUS,MGD,22721.4726,,,,,,,case rate,880,22721.4726,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,AETNA,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,COM,880,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,COM,880,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,COM,1100,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,COM,880,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,BCBS,COM,935,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,CIGNA,COM,1450,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,TRICARE,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,UNITED HEALTHCARE,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,UNITED HEALTHCARE,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,VA,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,VA TRICARE,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,WELLMED,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,HUMANA,MGD,1440,,,,,,,per diem,880,18165.207,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,C1301,HIPPS,,,,,,,,Inpatient,,,18165.207,18165.207,HUMANA CHOICE PLUS,MGD,18165.207,,,,,,,case rate,880,18165.207,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,AETNA,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,COM,880,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,COM,880,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,COM,1100,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,COM,880,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,BCBS,COM,935,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,CIGNA,COM,1450,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,TRICARE,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,UNITED HEALTHCARE,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,UNITED HEALTHCARE,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,VA,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,VA TRICARE,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,WELLMED,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,HUMANA,MGD,1440,,,,,,,per diem,880,16643.4288,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=62.50,D1301,HIPPS,,,,,,,,Inpatient,,,16643.4288,16643.4288,HUMANA CHOICE PLUS,MGD,16643.4288,,,,,,,case rate,880,16643.4288,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,AETNA,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,COM,880,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,COM,880,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,COM,1100,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,COM,880,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,BCBS,COM,935,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,CIGNA,COM,1450,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,TRICARE,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,UNITED HEALTHCARE,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,UNITED HEALTHCARE,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,VA,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,VA TRICARE,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,WELLMED,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,HUMANA,MGD,1440,,,,,,,per diem,880,18538.8498,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,A1302,HIPPS,,,,,,,,Inpatient,,,18538.8498,18538.8498,HUMANA CHOICE PLUS,MGD,18538.8498,,,,,,,case rate,880,18538.8498,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,AETNA,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,COM,880,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,COM,880,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,COM,1100,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,COM,880,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,BCBS,COM,935,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,CIGNA,COM,1450,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,TRICARE,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,UNITED HEALTHCARE,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,UNITED HEALTHCARE,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,VA,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,VA TRICARE,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,WELLMED,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,HUMANA,MGD,1440,,,,,,,per diem,880,27859.968,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,B1302,HIPPS,,,,,,,,Inpatient,,,27859.968,27859.968,HUMANA CHOICE PLUS,MGD,27859.968,,,,,,,case rate,880,27859.968,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,AETNA,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,COM,880,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,COM,880,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,COM,1100,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,COM,880,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,BCBS,COM,935,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,CIGNA,COM,1450,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,TRICARE,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,UNITED HEALTHCARE,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,UNITED HEALTHCARE,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,VA,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,VA TRICARE,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,WELLMED,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,HUMANA,MGD,1440,,,,,,,per diem,880,22273.464,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,C1302,HIPPS,,,,,,,,Inpatient,,,22273.464,22273.464,HUMANA CHOICE PLUS,MGD,22273.464,,,,,,,case rate,880,22273.464,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,AETNA,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,COM,880,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,COM,880,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,COM,1100,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,COM,880,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,BCBS,COM,935,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,CIGNA,COM,1450,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,TRICARE,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,UNITED HEALTHCARE,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,UNITED HEALTHCARE,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,VA,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,VA TRICARE,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,WELLMED,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,HUMANA,MGD,1440,,,,,,,per diem,880,20408.8776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=51.50 and M <62.50,D1302,HIPPS,,,,,,,,Inpatient,,,20408.8776,20408.8776,HUMANA CHOICE PLUS,MGD,20408.8776,,,,,,,case rate,880,20408.8776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,AETNA,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,COM,880,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,COM,880,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,COM,1100,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,COM,880,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,BCBS,COM,935,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,CIGNA,COM,1450,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,TRICARE,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,UNITED HEALTHCARE,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,UNITED HEALTHCARE,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,VA,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,VA TRICARE,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,WELLMED,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,HUMANA,MGD,1440,,,,,,,per diem,880,21424.6056,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,A1303,HIPPS,,,,,,,,Inpatient,,,21424.6056,21424.6056,HUMANA CHOICE PLUS,MGD,21424.6056,,,,,,,case rate,880,21424.6056,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,AETNA,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,COM,880,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,COM,880,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,COM,1100,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,COM,880,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,BCBS,COM,935,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,CIGNA,COM,1450,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,TRICARE,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,UNITED HEALTHCARE,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,UNITED HEALTHCARE,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,VA,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,VA TRICARE,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,WELLMED,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,HUMANA,MGD,1440,,,,,,,per diem,880,32198.5776,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,B1303,HIPPS,,,,,,,,Inpatient,,,32198.5776,32198.5776,HUMANA CHOICE PLUS,MGD,32198.5776,,,,,,,case rate,880,32198.5776,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,AETNA,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,COM,880,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,COM,880,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,COM,1100,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,COM,880,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,BCBS,COM,935,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,CIGNA,COM,1450,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,TRICARE,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,UNITED HEALTHCARE,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,UNITED HEALTHCARE,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,VA,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,VA TRICARE,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,WELLMED,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,HUMANA,MGD,1440,,,,,,,per diem,880,25741.4496,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,C1303,HIPPS,,,,,,,,Inpatient,,,25741.4496,25741.4496,HUMANA CHOICE PLUS,MGD,25741.4496,,,,,,,case rate,880,25741.4496,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,AETNA,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,COM,880,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,COM,880,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,COM,1100,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,COM,880,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,BCBS,COM,935,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,CIGNA,COM,1450,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,TRICARE,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,UNITED HEALTHCARE,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,UNITED HEALTHCARE,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,VA,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,VA TRICARE,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,WELLMED,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,HUMANA,MGD,1440,,,,,,,per diem,880,23586.6552,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M >=44.50 and M <51.50 and A >=64.50,D1303,HIPPS,,,,,,,,Inpatient,,,23586.6552,23586.6552,HUMANA CHOICE PLUS,MGD,23586.6552,,,,,,,case rate,880,23586.6552,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,AETNA,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,COM,880,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,COM,880,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,COM,1100,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,COM,880,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,BCBS,COM,935,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,CIGNA,COM,1450,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,TRICARE,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,UNITED HEALTHCARE,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,UNITED HEALTHCARE,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,VA,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,VA TRICARE,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,WELLMED,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,HUMANA,MGD,1440,,,,,,,per diem,880,27653.1948,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,A1304,HIPPS,,,,,,,,Inpatient,,,27653.1948,27653.1948,HUMANA CHOICE PLUS,MGD,27653.1948,,,,,,,case rate,880,27653.1948,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,AETNA,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,COM,880,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,COM,880,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,COM,1100,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,COM,880,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,BCBS,COM,935,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,CIGNA,COM,1450,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,TRICARE,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,UNITED HEALTHCARE,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,UNITED HEALTHCARE,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,VA,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,VA TRICARE,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,WELLMED,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,HUMANA,MGD,1440,,,,,,,per diem,880,41557.7856,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,B1304,HIPPS,,,,,,,,Inpatient,,,41557.7856,41557.7856,HUMANA CHOICE PLUS,MGD,41557.7856,,,,,,,case rate,880,41557.7856,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,AETNA,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,COM,880,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,COM,880,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,COM,1100,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,COM,880,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,BCBS,COM,935,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,CIGNA,COM,1450,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,TRICARE,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,UNITED HEALTHCARE,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,UNITED HEALTHCARE,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,VA,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,VA TRICARE,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,WELLMED,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,HUMANA,MGD,1440,,,,,,,per diem,880,33225.1884,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,C1304,HIPPS,,,,,,,,Inpatient,,,33225.1884,33225.1884,HUMANA CHOICE PLUS,MGD,33225.1884,,,,,,,case rate,880,33225.1884,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,AETNA,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,COM,880,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,COM,880,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,COM,1100,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,COM,880,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,BCBS,COM,935,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,CIGNA,COM,1450,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,TRICARE,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,UNITED HEALTHCARE,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,UNITED HEALTHCARE,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,VA,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,VA TRICARE,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,WELLMED,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,HUMANA,MGD,1440,,,,,,,per diem,880,30442.8192,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <44.50 and A >=64.50,D1304,HIPPS,,,,,,,,Inpatient,,,30442.8192,30442.8192,HUMANA CHOICE PLUS,MGD,30442.8192,,,,,,,case rate,880,30442.8192,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,AETNA,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,COM,880,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,COM,880,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,COM,1100,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,COM,880,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,BCBS,COM,935,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,CIGNA,COM,1450,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,TRICARE,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,UNITED HEALTHCARE,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,UNITED HEALTHCARE,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,VA,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,VA TRICARE,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,WELLMED,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,HUMANA,MGD,1440,,,,,,,per diem,880,27598.7808,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,A1305,HIPPS,,,,,,,,Inpatient,,,27598.7808,27598.7808,HUMANA CHOICE PLUS,MGD,27598.7808,,,,,,,case rate,880,27598.7808,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,AETNA,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,COM,880,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,COM,880,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,COM,1100,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,COM,880,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,BCBS,COM,935,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,CIGNA,COM,1450,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,TRICARE,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,UNITED HEALTHCARE,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,UNITED HEALTHCARE,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,VA,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,VA TRICARE,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,WELLMED,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,HUMANA,MGD,1440,,,,,,,per diem,880,41476.1646,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,B1305,HIPPS,,,,,,,,Inpatient,,,41476.1646,41476.1646,HUMANA CHOICE PLUS,MGD,41476.1646,,,,,,,case rate,880,41476.1646,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,AETNA,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,COM,880,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,COM,880,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,COM,1100,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,COM,880,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,BCBS,COM,935,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,CIGNA,COM,1450,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,TRICARE,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,UNITED HEALTHCARE,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,UNITED HEALTHCARE,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,VA,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,VA TRICARE,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,WELLMED,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,HUMANA,MGD,1440,,,,,,,per diem,880,33158.0778,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,C1305,HIPPS,,,,,,,,Inpatient,,,33158.0778,33158.0778,HUMANA CHOICE PLUS,MGD,33158.0778,,,,,,,case rate,880,33158.0778,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,AETNA,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,COM,880,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,COM,880,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,COM,1100,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,COM,880,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,BCBS,COM,935,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,CIGNA,COM,1450,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,TRICARE,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,UNITED HEALTHCARE,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,UNITED HEALTHCARE,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,VA,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,VA TRICARE,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,WELLMED,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,HUMANA,MGD,1440,,,,,,,per diem,880,30381.15,"Per diem rate, all codes are bundled into service package"
Rheumatoid other arthritis M <51.50 and A <64.50,D1305,HIPPS,,,,,,,,Inpatient,,,30381.15,30381.15,HUMANA CHOICE PLUS,MGD,30381.15,,,,,,,case rate,880,30381.15,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,AETNA,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,COM,880,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,COM,880,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,COM,1100,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,COM,880,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,BCBS,COM,935,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,CIGNA,COM,1450,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,TRICARE,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,UNITED HEALTHCARE,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,UNITED HEALTHCARE,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,VA,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,VA TRICARE,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,WELLMED,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,HUMANA,MGD,1440,,,,,,,per diem,880,13882.8252,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,A1401,HIPPS,,,,,,,,Inpatient,,,13882.8252,13882.8252,HUMANA CHOICE PLUS,MGD,13882.8252,,,,,,,case rate,880,13882.8252,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,AETNA,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,COM,880,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,COM,880,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,COM,1100,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,COM,880,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,BCBS,COM,935,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,CIGNA,COM,1450,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,TRICARE,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,UNITED HEALTHCARE,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,UNITED HEALTHCARE,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,VA,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,VA TRICARE,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,WELLMED,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,HUMANA,MGD,1440,,,,,,,per diem,880,20269.215,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,B1401,HIPPS,,,,,,,,Inpatient,,,20269.215,20269.215,HUMANA CHOICE PLUS,MGD,20269.215,,,,,,,case rate,880,20269.215,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,AETNA,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,COM,880,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,COM,880,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,COM,1100,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,COM,880,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,BCBS,COM,935,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,CIGNA,COM,1450,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,TRICARE,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,UNITED HEALTHCARE,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,UNITED HEALTHCARE,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,VA,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,VA TRICARE,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,WELLMED,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,HUMANA,MGD,1440,,,,,,,per diem,880,16327.8276,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,C1401,HIPPS,,,,,,,,Inpatient,,,16327.8276,16327.8276,HUMANA CHOICE PLUS,MGD,16327.8276,,,,,,,case rate,880,16327.8276,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,AETNA,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,COM,880,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,COM,880,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,COM,1100,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,COM,880,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,BCBS,COM,935,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,CIGNA,COM,1450,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,TRICARE,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,UNITED HEALTHCARE,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,UNITED HEALTHCARE,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,VA,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,VA TRICARE,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,WELLMED,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,HUMANA,MGD,1440,,,,,,,per diem,880,15096.2574,"Per diem rate, all codes are bundled into service package"
Cardiac M >=68.50,D1401,HIPPS,,,,,,,,Inpatient,,,15096.2574,15096.2574,HUMANA CHOICE PLUS,MGD,15096.2574,,,,,,,case rate,880,15096.2574,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,AETNA,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,COM,880,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,COM,880,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,COM,1100,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,COM,880,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,BCBS,COM,935,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,CIGNA,COM,1450,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,TRICARE,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,UNITED HEALTHCARE,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,UNITED HEALTHCARE,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,VA,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,VA TRICARE,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,WELLMED,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,HUMANA,MGD,1440,,,,,,,per diem,880,17686.3638,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,A1402,HIPPS,,,,,,,,Inpatient,,,17686.3638,17686.3638,HUMANA CHOICE PLUS,MGD,17686.3638,,,,,,,case rate,880,17686.3638,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,AETNA,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,COM,880,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,COM,880,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,COM,1100,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,COM,880,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,BCBS,COM,935,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,CIGNA,COM,1450,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,TRICARE,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,UNITED HEALTHCARE,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,UNITED HEALTHCARE,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,VA,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,VA TRICARE,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,WELLMED,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,HUMANA,MGD,1440,,,,,,,per diem,880,25821.2568,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,B1402,HIPPS,,,,,,,,Inpatient,,,25821.2568,25821.2568,HUMANA CHOICE PLUS,MGD,25821.2568,,,,,,,case rate,880,25821.2568,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,AETNA,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,COM,880,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,COM,880,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,COM,1100,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,COM,880,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,BCBS,COM,935,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,CIGNA,COM,1450,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,TRICARE,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,UNITED HEALTHCARE,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,UNITED HEALTHCARE,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,VA,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,VA TRICARE,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,WELLMED,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,HUMANA,MGD,1440,,,,,,,per diem,880,20800.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,C1402,HIPPS,,,,,,,,Inpatient,,,20800.6584,20800.6584,HUMANA CHOICE PLUS,MGD,20800.6584,,,,,,,case rate,880,20800.6584,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,AETNA,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,COM,880,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,COM,880,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,COM,1100,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,COM,880,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,BCBS,COM,935,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,CIGNA,COM,1450,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,TRICARE,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,UNITED HEALTHCARE,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,UNITED HEALTHCARE,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,VA,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,VA TRICARE,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,WELLMED,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,HUMANA,MGD,1440,,,,,,,per diem,880,19231.7214,"Per diem rate, all codes are bundled into service package"
Cardiac M >=55.50 and M <68.50,D1402,HIPPS,,,,,,,,Inpatient,,,19231.7214,19231.7214,HUMANA CHOICE PLUS,MGD,19231.7214,,,,,,,case rate,880,19231.7214,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,AETNA,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,COM,880,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,COM,880,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,COM,1100,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,COM,880,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,BCBS,COM,935,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,CIGNA,COM,1450,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,TRICARE,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,UNITED HEALTHCARE,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,UNITED HEALTHCARE,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,VA,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,VA TRICARE,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,WELLMED,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,HUMANA,MGD,1440,,,,,,,per diem,880,21377.4468,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,A1403,HIPPS,,,,,,,,Inpatient,,,21377.4468,21377.4468,HUMANA CHOICE PLUS,MGD,21377.4468,,,,,,,case rate,880,21377.4468,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,AETNA,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,COM,880,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,COM,880,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,COM,1100,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,COM,880,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,BCBS,COM,935,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,CIGNA,COM,1450,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,TRICARE,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,UNITED HEALTHCARE,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,UNITED HEALTHCARE,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,VA,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,VA TRICARE,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,WELLMED,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,HUMANA,MGD,1440,,,,,,,per diem,880,31210.0566,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,B1403,HIPPS,,,,,,,,Inpatient,,,31210.0566,31210.0566,HUMANA CHOICE PLUS,MGD,31210.0566,,,,,,,case rate,880,31210.0566,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,AETNA,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,1100,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,880,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,BCBS,COM,935,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,CIGNA,COM,1450,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,TRICARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,UNITED HEALTHCARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,UNITED HEALTHCARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,VA,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,VA TRICARE,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,WELLMED,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,HUMANA,MGD,1440,,,,,,,per diem,880,25141.0818,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,C1403,HIPPS,,,,,,,,Inpatient,,,25141.0818,25141.0818,HUMANA CHOICE PLUS,MGD,25141.0818,,,,,,,case rate,880,25141.0818,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,AETNA,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,COM,880,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,COM,880,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,COM,1100,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,COM,880,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,BCBS,COM,935,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,CIGNA,COM,1450,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,TRICARE,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,UNITED HEALTHCARE,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,UNITED HEALTHCARE,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,VA,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,VA TRICARE,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,WELLMED,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,HUMANA,MGD,1440,,,,,,,per diem,880,23245.6608,"Per diem rate, all codes are bundled into service package"
Cardiac M >=45.50 and M <55.50,D1403,HIPPS,,,,,,,,Inpatient,,,23245.6608,23245.6608,HUMANA CHOICE PLUS,MGD,23245.6608,,,,,,,case rate,880,23245.6608,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,AETNA,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,COM,880,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,COM,880,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,COM,1100,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,COM,880,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,BCBS,COM,935,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,CIGNA,COM,1450,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,TRICARE,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,UNITED HEALTHCARE,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,UNITED HEALTHCARE,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,VA,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,VA TRICARE,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,WELLMED,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,HUMANA,MGD,1440,,,,,,,per diem,880,26671.929,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,A1404,HIPPS,,,,,,,,Inpatient,,,26671.929,26671.929,HUMANA CHOICE PLUS,MGD,26671.929,,,,,,,case rate,880,26671.929,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,AETNA,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,COM,880,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,COM,880,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,COM,1100,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,COM,880,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,BCBS,COM,935,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,CIGNA,COM,1450,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,TRICARE,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,UNITED HEALTHCARE,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,UNITED HEALTHCARE,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,VA,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,VA TRICARE,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,WELLMED,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,HUMANA,MGD,1440,,,,,,,per diem,880,38938.6584,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,B1404,HIPPS,,,,,,,,Inpatient,,,38938.6584,38938.6584,HUMANA CHOICE PLUS,MGD,38938.6584,,,,,,,case rate,880,38938.6584,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,AETNA,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,COM,880,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,COM,880,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,COM,1100,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,COM,880,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,BCBS,COM,935,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,CIGNA,COM,1450,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,TRICARE,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,UNITED HEALTHCARE,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,UNITED HEALTHCARE,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,VA,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,VA TRICARE,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,WELLMED,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,HUMANA,MGD,1440,,,,,,,per diem,880,31367.8572,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,C1404,HIPPS,,,,,,,,Inpatient,,,31367.8572,31367.8572,HUMANA CHOICE PLUS,MGD,31367.8572,,,,,,,case rate,880,31367.8572,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,AETNA,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,COM,880,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,COM,880,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,COM,1100,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,COM,880,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,BCBS,COM,935,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,CIGNA,COM,1450,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,TRICARE,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,UNITED HEALTHCARE,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,UNITED HEALTHCARE,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,VA,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,VA TRICARE,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,WELLMED,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,HUMANA,MGD,1440,,,,,,,per diem,880,29004.4758,"Per diem rate, all codes are bundled into service package"
Cardiac M <45.50,D1404,HIPPS,,,,,,,,Inpatient,,,29004.4758,29004.4758,HUMANA CHOICE PLUS,MGD,29004.4758,,,,,,,case rate,880,29004.4758,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,AETNA,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,COM,880,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,COM,880,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,COM,1100,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,COM,880,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,BCBS,COM,935,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,CIGNA,COM,1450,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,TRICARE,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,UNITED HEALTHCARE,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,UNITED HEALTHCARE,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,VA,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,VA TRICARE,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,WELLMED,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,HUMANA,MGD,1440,,,,,,,per diem,880,17107.7616,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,A1501,HIPPS,,,,,,,,Inpatient,,,17107.7616,17107.7616,HUMANA CHOICE PLUS,MGD,17107.7616,,,,,,,case rate,880,17107.7616,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,AETNA,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,COM,880,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,COM,880,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,COM,1100,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,COM,880,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,BCBS,COM,935,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,CIGNA,COM,1450,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,TRICARE,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,UNITED HEALTHCARE,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,UNITED HEALTHCARE,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,VA,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,VA TRICARE,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,WELLMED,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,HUMANA,MGD,1440,,,,,,,per diem,880,23766.2214,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,B1501,HIPPS,,,,,,,,Inpatient,,,23766.2214,23766.2214,HUMANA CHOICE PLUS,MGD,23766.2214,,,,,,,case rate,880,23766.2214,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,AETNA,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,COM,880,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,COM,880,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,COM,1100,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,COM,880,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,BCBS,COM,935,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,CIGNA,COM,1450,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,TRICARE,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,UNITED HEALTHCARE,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,UNITED HEALTHCARE,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,VA,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,VA TRICARE,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,WELLMED,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,HUMANA,MGD,1440,,,,,,,per diem,880,19110.1968,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,C1501,HIPPS,,,,,,,,Inpatient,,,19110.1968,19110.1968,HUMANA CHOICE PLUS,MGD,19110.1968,,,,,,,case rate,880,19110.1968,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,AETNA,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,COM,880,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,COM,880,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,COM,1100,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,COM,880,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,BCBS,COM,935,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,CIGNA,COM,1450,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,TRICARE,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,UNITED HEALTHCARE,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,UNITED HEALTHCARE,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,VA,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,VA TRICARE,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,WELLMED,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,HUMANA,MGD,1440,,,,,,,per diem,880,17896.7646,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=68.50,D1501,HIPPS,,,,,,,,Inpatient,,,17896.7646,17896.7646,HUMANA CHOICE PLUS,MGD,17896.7646,,,,,,,case rate,880,17896.7646,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,AETNA,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,COM,880,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,COM,880,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,COM,1100,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,COM,880,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,BCBS,COM,935,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,CIGNA,COM,1450,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,TRICARE,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,UNITED HEALTHCARE,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,UNITED HEALTHCARE,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,VA,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,VA TRICARE,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,WELLMED,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,HUMANA,MGD,1440,,,,,,,per diem,880,20920.3692,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,A1502,HIPPS,,,,,,,,Inpatient,,,20920.3692,20920.3692,HUMANA CHOICE PLUS,MGD,20920.3692,,,,,,,case rate,880,20920.3692,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,AETNA,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,COM,880,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,COM,880,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,COM,1100,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,COM,880,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,BCBS,COM,935,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,CIGNA,COM,1450,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,TRICARE,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,UNITED HEALTHCARE,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,UNITED HEALTHCARE,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,VA,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,VA TRICARE,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,WELLMED,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,HUMANA,MGD,1440,,,,,,,per diem,880,29060.7036,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,B1502,HIPPS,,,,,,,,Inpatient,,,29060.7036,29060.7036,HUMANA CHOICE PLUS,MGD,29060.7036,,,,,,,case rate,880,29060.7036,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,AETNA,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,COM,880,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,COM,880,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,COM,1100,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,COM,880,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,BCBS,COM,935,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,CIGNA,COM,1450,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,TRICARE,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,UNITED HEALTHCARE,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,UNITED HEALTHCARE,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,VA,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,VA TRICARE,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,WELLMED,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,HUMANA,MGD,1440,,,,,,,per diem,880,23367.1854,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,C1502,HIPPS,,,,,,,,Inpatient,,,23367.1854,23367.1854,HUMANA CHOICE PLUS,MGD,23367.1854,,,,,,,case rate,880,23367.1854,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,AETNA,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,COM,880,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,COM,880,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,COM,1100,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,COM,880,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,BCBS,COM,935,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,CIGNA,COM,1450,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,TRICARE,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,UNITED HEALTHCARE,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,UNITED HEALTHCARE,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,VA,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,VA TRICARE,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,WELLMED,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,HUMANA,MGD,1440,,,,,,,per diem,880,21883.497,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=56.50 and M <68.50,D1502,HIPPS,,,,,,,,Inpatient,,,21883.497,21883.497,HUMANA CHOICE PLUS,MGD,21883.497,,,,,,,case rate,880,21883.497,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,AETNA,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,COM,880,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,COM,880,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,COM,1100,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,COM,880,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,BCBS,COM,935,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,CIGNA,COM,1450,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,TRICARE,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,UNITED HEALTHCARE,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,UNITED HEALTHCARE,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,VA,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,VA TRICARE,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,WELLMED,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,HUMANA,MGD,1440,,,,,,,per diem,880,24388.3548,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,A1503,HIPPS,,,,,,,,Inpatient,,,24388.3548,24388.3548,HUMANA CHOICE PLUS,MGD,24388.3548,,,,,,,case rate,880,24388.3548,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,AETNA,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,COM,880,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,COM,880,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,COM,1100,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,COM,880,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,BCBS,COM,935,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,CIGNA,COM,1450,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,TRICARE,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,UNITED HEALTHCARE,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,UNITED HEALTHCARE,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,VA,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,VA TRICARE,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,WELLMED,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,HUMANA,MGD,1440,,,,,,,per diem,880,33881.784,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,B1503,HIPPS,,,,,,,,Inpatient,,,33881.784,33881.784,HUMANA CHOICE PLUS,MGD,33881.784,,,,,,,case rate,880,33881.784,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,AETNA,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,COM,880,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,COM,880,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,COM,1100,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,COM,880,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,BCBS,COM,935,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,CIGNA,COM,1450,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,TRICARE,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,UNITED HEALTHCARE,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,UNITED HEALTHCARE,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,VA,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,VA TRICARE,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,WELLMED,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,HUMANA,MGD,1440,,,,,,,per diem,880,27243.276,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,C1503,HIPPS,,,,,,,,Inpatient,,,27243.276,27243.276,HUMANA CHOICE PLUS,MGD,27243.276,,,,,,,case rate,880,27243.276,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,AETNA,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,COM,880,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,COM,880,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,COM,1100,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,COM,880,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,BCBS,COM,935,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,CIGNA,COM,1450,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,TRICARE,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,UNITED HEALTHCARE,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,UNITED HEALTHCARE,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,VA,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,VA TRICARE,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,WELLMED,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,HUMANA,MGD,1440,,,,,,,per diem,880,25512.9108,"Per diem rate, all codes are bundled into service package"
Pulmonary M >=45.50 and M <56.50,D1503,HIPPS,,,,,,,,Inpatient,,,25512.9108,25512.9108,HUMANA CHOICE PLUS,MGD,25512.9108,,,,,,,case rate,880,25512.9108,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,AETNA,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,COM,880,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,COM,880,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,COM,1100,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,COM,880,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,BCBS,COM,935,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,CIGNA,COM,1450,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,TRICARE,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,UNITED HEALTHCARE,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,UNITED HEALTHCARE,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,VA,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,VA TRICARE,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,WELLMED,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,HUMANA,MGD,1440,,,,,,,per diem,880,30584.2956,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,A1504,HIPPS,,,,,,,,Inpatient,,,30584.2956,30584.2956,HUMANA CHOICE PLUS,MGD,30584.2956,,,,,,,case rate,880,30584.2956,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,AETNA,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,COM,880,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,COM,880,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,COM,1100,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,COM,880,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,BCBS,COM,935,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,CIGNA,COM,1450,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,TRICARE,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,UNITED HEALTHCARE,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,UNITED HEALTHCARE,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,VA,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,VA TRICARE,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,WELLMED,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,HUMANA,MGD,1440,,,,,,,per diem,880,42488.265,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,B1504,HIPPS,,,,,,,,Inpatient,,,42488.265,42488.265,HUMANA CHOICE PLUS,MGD,42488.265,,,,,,,case rate,880,42488.265,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,AETNA,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,COM,880,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,COM,880,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,COM,1100,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,COM,880,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,BCBS,COM,935,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,CIGNA,COM,1450,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,TRICARE,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,UNITED HEALTHCARE,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,UNITED HEALTHCARE,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,VA,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,VA TRICARE,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,WELLMED,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,HUMANA,MGD,1440,,,,,,,per diem,880,34162.923,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,C1504,HIPPS,,,,,,,,Inpatient,,,34162.923,34162.923,HUMANA CHOICE PLUS,MGD,34162.923,,,,,,,case rate,880,34162.923,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,AETNA,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,COM,880,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,COM,880,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,COM,1100,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,COM,880,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,BCBS,COM,935,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,CIGNA,COM,1450,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,TRICARE,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,UNITED HEALTHCARE,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,UNITED HEALTHCARE,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,VA,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,VA TRICARE,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,WELLMED,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,HUMANA,MGD,1440,,,,,,,per diem,880,31993.6182,"Per diem rate, all codes are bundled into service package"
Pulmonary M <45.50,D1504,HIPPS,,,,,,,,Inpatient,,,31993.6182,31993.6182,HUMANA CHOICE PLUS,MGD,31993.6182,,,,,,,case rate,880,31993.6182,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,AETNA,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,COM,880,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,COM,880,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,COM,1100,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,COM,880,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,BCBS,COM,935,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,CIGNA,COM,1450,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,TRICARE,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,UNITED HEALTHCARE,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,UNITED HEALTHCARE,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,VA,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,VA TRICARE,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,WELLMED,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,HUMANA,MGD,1440,,,,,,,per diem,880,14167.5918,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,A1601,HIPPS,,,,,,,,Inpatient,,,14167.5918,14167.5918,HUMANA CHOICE PLUS,MGD,14167.5918,,,,,,,case rate,880,14167.5918,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,AETNA,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,COM,880,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,COM,880,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,COM,1100,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,COM,880,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,BCBS,COM,935,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,CIGNA,COM,1450,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,TRICARE,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,UNITED HEALTHCARE,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,UNITED HEALTHCARE,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,VA,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,VA TRICARE,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,WELLMED,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,HUMANA,MGD,1440,,,,,,,per diem,880,19066.6656,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,B1601,HIPPS,,,,,,,,Inpatient,,,19066.6656,19066.6656,HUMANA CHOICE PLUS,MGD,19066.6656,,,,,,,case rate,880,19066.6656,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,AETNA,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,COM,880,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,COM,880,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,COM,1100,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,COM,880,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,BCBS,COM,935,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,CIGNA,COM,1450,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,TRICARE,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,UNITED HEALTHCARE,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,UNITED HEALTHCARE,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,VA,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,VA TRICARE,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,WELLMED,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,HUMANA,MGD,1440,,,,,,,per diem,880,17085.996,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,C1601,HIPPS,,,,,,,,Inpatient,,,17085.996,17085.996,HUMANA CHOICE PLUS,MGD,17085.996,,,,,,,case rate,880,17085.996,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,AETNA,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,COM,880,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,COM,880,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,COM,1100,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,COM,880,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,BCBS,COM,935,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,CIGNA,COM,1450,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,TRICARE,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,UNITED HEALTHCARE,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,UNITED HEALTHCARE,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,VA,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,VA TRICARE,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,WELLMED,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,HUMANA,MGD,1440,,,,,,,per diem,880,15629.5146,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=65.50,D1601,HIPPS,,,,,,,,Inpatient,,,15629.5146,15629.5146,HUMANA CHOICE PLUS,MGD,15629.5146,,,,,,,case rate,880,15629.5146,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,AETNA,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,COM,880,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,COM,880,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,COM,1100,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,COM,880,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,BCBS,COM,935,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,CIGNA,COM,1450,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,TRICARE,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,UNITED HEALTHCARE,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,UNITED HEALTHCARE,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,VA,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,VA TRICARE,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,WELLMED,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,HUMANA,MGD,1440,,,,,,,per diem,880,17047.9062,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,A1602,HIPPS,,,,,,,,Inpatient,,,17047.9062,17047.9062,HUMANA CHOICE PLUS,MGD,17047.9062,,,,,,,case rate,880,17047.9062,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,AETNA,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,COM,880,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,COM,880,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,COM,1100,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,COM,880,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,BCBS,COM,935,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,CIGNA,COM,1450,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,TRICARE,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,UNITED HEALTHCARE,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,UNITED HEALTHCARE,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,VA,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,VA TRICARE,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,WELLMED,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,HUMANA,MGD,1440,,,,,,,per diem,880,22940.9424,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,B1602,HIPPS,,,,,,,,Inpatient,,,22940.9424,22940.9424,HUMANA CHOICE PLUS,MGD,22940.9424,,,,,,,case rate,880,22940.9424,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,AETNA,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,COM,880,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,COM,880,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,COM,1100,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,COM,880,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,BCBS,COM,935,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,CIGNA,COM,1450,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,TRICARE,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,UNITED HEALTHCARE,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,UNITED HEALTHCARE,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,VA,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,VA TRICARE,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,WELLMED,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,HUMANA,MGD,1440,,,,,,,per diem,880,20559.423,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,C1602,HIPPS,,,,,,,,Inpatient,,,20559.423,20559.423,HUMANA CHOICE PLUS,MGD,20559.423,,,,,,,case rate,880,20559.423,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,AETNA,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,COM,880,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,COM,880,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,COM,1100,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,COM,880,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,BCBS,COM,935,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,CIGNA,COM,1450,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,TRICARE,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,UNITED HEALTHCARE,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,UNITED HEALTHCARE,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,VA,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,VA TRICARE,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,WELLMED,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,HUMANA,MGD,1440,,,,,,,per diem,880,18805.4784,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=58.50 and M <65.50,D1602,HIPPS,,,,,,,,Inpatient,,,18805.4784,18805.4784,HUMANA CHOICE PLUS,MGD,18805.4784,,,,,,,case rate,880,18805.4784,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,AETNA,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,COM,880,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,COM,880,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,COM,1100,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,COM,880,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,BCBS,COM,935,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,CIGNA,COM,1450,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,TRICARE,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,UNITED HEALTHCARE,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,UNITED HEALTHCARE,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,VA,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,VA TRICARE,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,WELLMED,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,HUMANA,MGD,1440,,,,,,,per diem,880,20644.6716,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,A1603,HIPPS,,,,,,,,Inpatient,,,20644.6716,20644.6716,HUMANA CHOICE PLUS,MGD,20644.6716,,,,,,,case rate,880,20644.6716,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,AETNA,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,COM,880,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,COM,880,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,COM,1100,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,COM,880,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,BCBS,COM,935,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,CIGNA,COM,1450,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,TRICARE,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,UNITED HEALTHCARE,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,UNITED HEALTHCARE,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,VA,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,VA TRICARE,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,WELLMED,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,HUMANA,MGD,1440,,,,,,,per diem,880,27781.9746,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,B1603,HIPPS,,,,,,,,Inpatient,,,27781.9746,27781.9746,HUMANA CHOICE PLUS,MGD,27781.9746,,,,,,,case rate,880,27781.9746,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,AETNA,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,COM,880,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,COM,880,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,COM,1100,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,COM,880,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,BCBS,COM,935,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,CIGNA,COM,1450,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,TRICARE,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,UNITED HEALTHCARE,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,UNITED HEALTHCARE,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,VA,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,VA TRICARE,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,WELLMED,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,HUMANA,MGD,1440,,,,,,,per diem,880,24898.0326,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,C1603,HIPPS,,,,,,,,Inpatient,,,24898.0326,24898.0326,HUMANA CHOICE PLUS,MGD,24898.0326,,,,,,,case rate,880,24898.0326,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,AETNA,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,COM,880,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,COM,880,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,COM,1100,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,COM,880,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,BCBS,COM,935,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,CIGNA,COM,1450,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,TRICARE,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,UNITED HEALTHCARE,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,UNITED HEALTHCARE,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,VA,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,VA TRICARE,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,WELLMED,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,HUMANA,MGD,1440,,,,,,,per diem,880,22775.8866,"Per diem rate, all codes are bundled into service package"
Pain syndrome M >=43.50 and M <58.50,D1603,HIPPS,,,,,,,,Inpatient,,,22775.8866,22775.8866,HUMANA CHOICE PLUS,MGD,22775.8866,,,,,,,case rate,880,22775.8866,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,AETNA,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,COM,880,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,COM,880,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,COM,1100,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,COM,880,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,BCBS,COM,935,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,CIGNA,COM,1450,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,TRICARE,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,UNITED HEALTHCARE,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,UNITED HEALTHCARE,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,VA,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,VA TRICARE,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,WELLMED,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,HUMANA,MGD,1440,,,,,,,per diem,880,27021.9924,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,A1604,HIPPS,,,,,,,,Inpatient,,,27021.9924,27021.9924,HUMANA CHOICE PLUS,MGD,27021.9924,,,,,,,case rate,880,27021.9924,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,AETNA,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,COM,880,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,COM,880,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,COM,1100,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,COM,880,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,BCBS,COM,935,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,CIGNA,COM,1450,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,TRICARE,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,UNITED HEALTHCARE,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,UNITED HEALTHCARE,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,VA,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,VA TRICARE,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,WELLMED,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,HUMANA,MGD,1440,,,,,,,per diem,880,36364.8762,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,B1604,HIPPS,,,,,,,,Inpatient,,,36364.8762,36364.8762,HUMANA CHOICE PLUS,MGD,36364.8762,,,,,,,case rate,880,36364.8762,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,AETNA,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,COM,880,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,COM,880,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,COM,1100,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,COM,880,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,BCBS,COM,935,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,CIGNA,COM,1450,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,TRICARE,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,UNITED HEALTHCARE,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,UNITED HEALTHCARE,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,VA,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,VA TRICARE,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,WELLMED,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,HUMANA,MGD,1440,,,,,,,per diem,880,32590.3584,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,C1604,HIPPS,,,,,,,,Inpatient,,,32590.3584,32590.3584,HUMANA CHOICE PLUS,MGD,32590.3584,,,,,,,case rate,880,32590.3584,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,AETNA,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,COM,880,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,COM,880,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,COM,1100,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,COM,880,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,BCBS,COM,935,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,CIGNA,COM,1450,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,TRICARE,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,UNITED HEALTHCARE,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,UNITED HEALTHCARE,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,VA,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,VA TRICARE,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,WELLMED,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,HUMANA,MGD,1440,,,,,,,per diem,880,29811.6168,"Per diem rate, all codes are bundled into service package"
Pain syndrome M <43.50,D1604,HIPPS,,,,,,,,Inpatient,,,29811.6168,29811.6168,HUMANA CHOICE PLUS,MGD,29811.6168,,,,,,,case rate,880,29811.6168,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,AETNA,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,COM,880,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,COM,880,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,COM,1100,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,COM,880,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,BCBS,COM,935,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,CIGNA,COM,1450,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,TRICARE,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,UNITED HEALTHCARE,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,UNITED HEALTHCARE,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,VA,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,VA TRICARE,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,WELLMED,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,HUMANA,MGD,1440,,,,,,,per diem,880,16200.8616,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,A1701,HIPPS,,,,,,,,Inpatient,,,16200.8616,16200.8616,HUMANA CHOICE PLUS,MGD,16200.8616,,,,,,,case rate,880,16200.8616,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,AETNA,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,COM,880,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,COM,880,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,COM,1100,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,COM,880,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,BCBS,COM,935,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,CIGNA,COM,1450,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,TRICARE,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,UNITED HEALTHCARE,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,UNITED HEALTHCARE,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,VA,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,VA TRICARE,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,WELLMED,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,HUMANA,MGD,1440,,,,,,,per diem,880,23925.8358,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,B1701,HIPPS,,,,,,,,Inpatient,,,23925.8358,23925.8358,HUMANA CHOICE PLUS,MGD,23925.8358,,,,,,,case rate,880,23925.8358,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,AETNA,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,COM,880,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,COM,880,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,COM,1100,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,COM,880,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,BCBS,COM,935,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,CIGNA,COM,1450,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,TRICARE,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,UNITED HEALTHCARE,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,UNITED HEALTHCARE,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,VA,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,VA TRICARE,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,WELLMED,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,HUMANA,MGD,1440,,,,,,,per diem,880,18954.21,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,C1701,HIPPS,,,,,,,,Inpatient,,,18954.21,18954.21,HUMANA CHOICE PLUS,MGD,18954.21,,,,,,,case rate,880,18954.21,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,AETNA,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,COM,880,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,COM,880,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,COM,1100,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,COM,880,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,BCBS,COM,935,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,CIGNA,COM,1450,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,TRICARE,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,UNITED HEALTHCARE,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,UNITED HEALTHCARE,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,VA,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,VA TRICARE,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,WELLMED,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,HUMANA,MGD,1440,,,,,,,per diem,880,17597.4876,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=57.50,D1701,HIPPS,,,,,,,,Inpatient,,,17597.4876,17597.4876,HUMANA CHOICE PLUS,MGD,17597.4876,,,,,,,case rate,880,17597.4876,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,AETNA,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,COM,880,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,COM,880,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,COM,1100,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,COM,880,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,BCBS,COM,935,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,CIGNA,COM,1450,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,TRICARE,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,UNITED HEALTHCARE,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,UNITED HEALTHCARE,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,VA,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,VA TRICARE,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,WELLMED,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,HUMANA,MGD,1440,,,,,,,per diem,880,19969.938,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,A1702,HIPPS,,,,,,,,Inpatient,,,19969.938,19969.938,HUMANA CHOICE PLUS,MGD,19969.938,,,,,,,case rate,880,19969.938,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,AETNA,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,COM,880,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,COM,880,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,COM,1100,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,COM,880,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,BCBS,COM,935,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,CIGNA,COM,1450,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,TRICARE,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,UNITED HEALTHCARE,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,UNITED HEALTHCARE,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,VA,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,VA TRICARE,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,WELLMED,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,HUMANA,MGD,1440,,,,,,,per diem,880,29492.388,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,B1702,HIPPS,,,,,,,,Inpatient,,,29492.388,29492.388,HUMANA CHOICE PLUS,MGD,29492.388,,,,,,,case rate,880,29492.388,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,AETNA,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,COM,880,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,COM,880,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,COM,1100,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,COM,880,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,BCBS,COM,935,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,CIGNA,COM,1450,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,TRICARE,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,UNITED HEALTHCARE,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,UNITED HEALTHCARE,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,VA,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,VA TRICARE,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,WELLMED,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,HUMANA,MGD,1440,,,,,,,per diem,880,23363.5578,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,C1702,HIPPS,,,,,,,,Inpatient,,,23363.5578,23363.5578,HUMANA CHOICE PLUS,MGD,23363.5578,,,,,,,case rate,880,23363.5578,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,AETNA,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,COM,880,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,COM,880,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,COM,1100,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,COM,880,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,BCBS,COM,935,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,CIGNA,COM,1450,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,TRICARE,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,UNITED HEALTHCARE,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,UNITED HEALTHCARE,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,VA,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,VA TRICARE,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,WELLMED,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,HUMANA,MGD,1440,,,,,,,per diem,880,21693.048,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=50.50 and M <57.50,D1702,HIPPS,,,,,,,,Inpatient,,,21693.048,21693.048,HUMANA CHOICE PLUS,MGD,21693.048,,,,,,,case rate,880,21693.048,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,AETNA,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,COM,880,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,COM,880,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,COM,1100,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,COM,880,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,BCBS,COM,935,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,CIGNA,COM,1450,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,TRICARE,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,UNITED HEALTHCARE,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,UNITED HEALTHCARE,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,VA,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,VA TRICARE,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,WELLMED,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,HUMANA,MGD,1440,,,,,,,per diem,880,23432.4822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,A1703,HIPPS,,,,,,,,Inpatient,,,23432.4822,23432.4822,HUMANA CHOICE PLUS,MGD,23432.4822,,,,,,,case rate,880,23432.4822,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,AETNA,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,COM,880,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,COM,880,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,COM,1100,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,COM,880,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,BCBS,COM,935,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,CIGNA,COM,1450,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,TRICARE,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,UNITED HEALTHCARE,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,UNITED HEALTHCARE,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,VA,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,VA TRICARE,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,WELLMED,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,HUMANA,MGD,1440,,,,,,,per diem,880,34603.6764,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,B1703,HIPPS,,,,,,,,Inpatient,,,34603.6764,34603.6764,HUMANA CHOICE PLUS,MGD,34603.6764,,,,,,,case rate,880,34603.6764,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,AETNA,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,COM,880,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,COM,880,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,COM,1100,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,COM,880,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,BCBS,COM,935,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,CIGNA,COM,1450,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,TRICARE,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,UNITED HEALTHCARE,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,UNITED HEALTHCARE,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,VA,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,VA TRICARE,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,WELLMED,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,HUMANA,MGD,1440,,,,,,,per diem,880,27413.7732,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,C1703,HIPPS,,,,,,,,Inpatient,,,27413.7732,27413.7732,HUMANA CHOICE PLUS,MGD,27413.7732,,,,,,,case rate,880,27413.7732,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,AETNA,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,COM,880,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,COM,880,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,COM,1100,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,COM,880,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,BCBS,COM,935,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,CIGNA,COM,1450,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,TRICARE,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,UNITED HEALTHCARE,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,UNITED HEALTHCARE,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,VA,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,VA TRICARE,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,WELLMED,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,HUMANA,MGD,1440,,,,,,,per diem,880,25453.0554,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=41.50 and M <50.50,D1703,HIPPS,,,,,,,,Inpatient,,,25453.0554,25453.0554,HUMANA CHOICE PLUS,MGD,25453.0554,,,,,,,case rate,880,25453.0554,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,AETNA,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,COM,880,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,COM,880,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,COM,1100,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,COM,880,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,BCBS,COM,935,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,CIGNA,COM,1450,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,TRICARE,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,UNITED HEALTHCARE,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,UNITED HEALTHCARE,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,VA,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,VA TRICARE,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,WELLMED,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,HUMANA,MGD,1440,,,,,,,per diem,880,26963.9508,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,A1704,HIPPS,,,,,,,,Inpatient,,,26963.9508,26963.9508,HUMANA CHOICE PLUS,MGD,26963.9508,,,,,,,case rate,880,26963.9508,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,AETNA,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,COM,880,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,COM,880,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,COM,1100,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,COM,880,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,BCBS,COM,935,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,CIGNA,COM,1450,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,TRICARE,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,UNITED HEALTHCARE,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,UNITED HEALTHCARE,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,VA,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,VA TRICARE,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,WELLMED,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,HUMANA,MGD,1440,,,,,,,per diem,880,39818.3514,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,B1704,HIPPS,,,,,,,,Inpatient,,,39818.3514,39818.3514,HUMANA CHOICE PLUS,MGD,39818.3514,,,,,,,case rate,880,39818.3514,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,AETNA,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,COM,880,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,COM,880,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,COM,1100,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,COM,880,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,BCBS,COM,935,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,CIGNA,COM,1450,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,TRICARE,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,UNITED HEALTHCARE,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,UNITED HEALTHCARE,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,VA,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,VA TRICARE,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,WELLMED,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,HUMANA,MGD,1440,,,,,,,per diem,880,31545.6096,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,C1704,HIPPS,,,,,,,,Inpatient,,,31545.6096,31545.6096,HUMANA CHOICE PLUS,MGD,31545.6096,,,,,,,case rate,880,31545.6096,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,AETNA,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,COM,880,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,COM,880,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,COM,1100,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,COM,880,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,BCBS,COM,935,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,CIGNA,COM,1450,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,TRICARE,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,UNITED HEALTHCARE,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,UNITED HEALTHCARE,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,VA,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,VA TRICARE,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,WELLMED,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,HUMANA,MGD,1440,,,,,,,per diem,880,29289.2424,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M >=36.50 and M <41.50,D1704,HIPPS,,,,,,,,Inpatient,,,29289.2424,29289.2424,HUMANA CHOICE PLUS,MGD,29289.2424,,,,,,,case rate,880,29289.2424,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,AETNA,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,COM,880,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,COM,880,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,COM,1100,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,COM,880,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,BCBS,COM,935,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,CIGNA,COM,1450,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,TRICARE,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,UNITED HEALTHCARE,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,UNITED HEALTHCARE,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,VA,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,VA TRICARE,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,WELLMED,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,HUMANA,MGD,1440,,,,,,,per diem,880,31389.6228,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,A1705,HIPPS,,,,,,,,Inpatient,,,31389.6228,31389.6228,HUMANA CHOICE PLUS,MGD,31389.6228,,,,,,,case rate,880,31389.6228,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,AETNA,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,COM,880,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,COM,880,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,COM,1100,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,COM,880,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,BCBS,COM,935,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,CIGNA,COM,1450,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,TRICARE,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,UNITED HEALTHCARE,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,UNITED HEALTHCARE,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,VA,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,VA TRICARE,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,WELLMED,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,HUMANA,MGD,1440,,,,,,,per diem,880,46355.2866,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,B1705,HIPPS,,,,,,,,Inpatient,,,46355.2866,46355.2866,HUMANA CHOICE PLUS,MGD,46355.2866,,,,,,,case rate,880,46355.2866,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,AETNA,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,COM,880,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,COM,880,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,COM,1100,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,COM,880,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,BCBS,COM,935,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,CIGNA,COM,1450,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,TRICARE,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,UNITED HEALTHCARE,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,UNITED HEALTHCARE,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,VA,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,VA TRICARE,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,WELLMED,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,HUMANA,MGD,1440,,,,,,,per diem,880,36724.0086,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,C1705,HIPPS,,,,,,,,Inpatient,,,36724.0086,36724.0086,HUMANA CHOICE PLUS,MGD,36724.0086,,,,,,,case rate,880,36724.0086,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,AETNA,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,COM,880,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,COM,880,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,COM,1100,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,COM,880,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,BCBS,COM,935,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,CIGNA,COM,1450,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,TRICARE,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,UNITED HEALTHCARE,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,UNITED HEALTHCARE,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,VA,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,VA TRICARE,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,WELLMED,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,HUMANA,MGD,1440,,,,,,,per diem,880,34097.6262,"Per diem rate, all codes are bundled into service package"
Major multiple trauma without brain or spinal cord injury M <36.50,D1705,HIPPS,,,,,,,,Inpatient,,,34097.6262,34097.6262,HUMANA CHOICE PLUS,MGD,34097.6262,,,,,,,case rate,880,34097.6262,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,AETNA,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,COM,880,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,COM,880,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,COM,1100,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,COM,880,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,BCBS,COM,935,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,CIGNA,COM,1450,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,TRICARE,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,UNITED HEALTHCARE,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,UNITED HEALTHCARE,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,VA,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,VA TRICARE,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,WELLMED,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,HUMANA,MGD,1440,,,,,,,per diem,880,14336.2752,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,A1801,HIPPS,,,,,,,,Inpatient,,,14336.2752,14336.2752,HUMANA CHOICE PLUS,MGD,14336.2752,,,,,,,case rate,880,14336.2752,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,AETNA,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,COM,880,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,COM,880,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,COM,1100,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,COM,880,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,BCBS,COM,935,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,CIGNA,COM,1450,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,TRICARE,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,UNITED HEALTHCARE,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,UNITED HEALTHCARE,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,VA,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,VA TRICARE,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,WELLMED,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,HUMANA,MGD,1440,,,,,,,per diem,880,20294.6082,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,B1801,HIPPS,,,,,,,,Inpatient,,,20294.6082,20294.6082,HUMANA CHOICE PLUS,MGD,20294.6082,,,,,,,case rate,880,20294.6082,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,AETNA,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,COM,880,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,COM,880,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,COM,1100,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,COM,880,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,BCBS,COM,935,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,CIGNA,COM,1450,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,TRICARE,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,UNITED HEALTHCARE,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,UNITED HEALTHCARE,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,VA,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,VA TRICARE,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,WELLMED,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,HUMANA,MGD,1440,,,,,,,per diem,880,16603.5252,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,C1801,HIPPS,,,,,,,,Inpatient,,,16603.5252,16603.5252,HUMANA CHOICE PLUS,MGD,16603.5252,,,,,,,case rate,880,16603.5252,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,AETNA,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,COM,880,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,COM,880,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,COM,1100,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,COM,880,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,BCBS,COM,935,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,CIGNA,COM,1450,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,TRICARE,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,UNITED HEALTHCARE,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,UNITED HEALTHCARE,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,VA,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,VA TRICARE,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,WELLMED,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,HUMANA,MGD,1440,,,,,,,per diem,880,15274.0098,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=67.50,D1801,HIPPS,,,,,,,,Inpatient,,,15274.0098,15274.0098,HUMANA CHOICE PLUS,MGD,15274.0098,,,,,,,case rate,880,15274.0098,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,AETNA,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,COM,880,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,COM,880,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,COM,1100,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,COM,880,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,BCBS,COM,935,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,CIGNA,COM,1450,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,TRICARE,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,UNITED HEALTHCARE,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,UNITED HEALTHCARE,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,VA,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,VA TRICARE,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,WELLMED,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,HUMANA,MGD,1440,,,,,,,per diem,880,18223.2486,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,A1802,HIPPS,,,,,,,,Inpatient,,,18223.2486,18223.2486,HUMANA CHOICE PLUS,MGD,18223.2486,,,,,,,case rate,880,18223.2486,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,AETNA,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,COM,880,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,COM,880,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,COM,1100,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,COM,880,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,BCBS,COM,935,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,CIGNA,COM,1450,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,TRICARE,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,UNITED HEALTHCARE,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,UNITED HEALTHCARE,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,VA,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,VA TRICARE,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,WELLMED,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,HUMANA,MGD,1440,,,,,,,per diem,880,25797.6774,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,B1802,HIPPS,,,,,,,,Inpatient,,,25797.6774,25797.6774,HUMANA CHOICE PLUS,MGD,25797.6774,,,,,,,case rate,880,25797.6774,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,AETNA,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,COM,880,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,COM,880,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,COM,1100,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,COM,880,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,BCBS,COM,935,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,CIGNA,COM,1450,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,TRICARE,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,UNITED HEALTHCARE,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,UNITED HEALTHCARE,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,VA,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,VA TRICARE,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,WELLMED,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,HUMANA,MGD,1440,,,,,,,per diem,880,21105.3768,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,C1802,HIPPS,,,,,,,,Inpatient,,,21105.3768,21105.3768,HUMANA CHOICE PLUS,MGD,21105.3768,,,,,,,case rate,880,21105.3768,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,AETNA,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,COM,880,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,COM,880,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,COM,1100,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,COM,880,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,BCBS,COM,935,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,CIGNA,COM,1450,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,TRICARE,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,UNITED HEALTHCARE,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,UNITED HEALTHCARE,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,VA,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,VA TRICARE,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,WELLMED,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,HUMANA,MGD,1440,,,,,,,per diem,880,19414.9152,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=55.50 and M <67.50,D1802,HIPPS,,,,,,,,Inpatient,,,19414.9152,19414.9152,HUMANA CHOICE PLUS,MGD,19414.9152,,,,,,,case rate,880,19414.9152,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,AETNA,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,COM,880,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,COM,880,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,COM,1100,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,COM,880,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,BCBS,COM,935,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,CIGNA,COM,1450,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,TRICARE,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,UNITED HEALTHCARE,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,UNITED HEALTHCARE,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,VA,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,VA TRICARE,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,WELLMED,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,HUMANA,MGD,1440,,,,,,,per diem,880,22668.8724,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,A1803,HIPPS,,,,,,,,Inpatient,,,22668.8724,22668.8724,HUMANA CHOICE PLUS,MGD,22668.8724,,,,,,,case rate,880,22668.8724,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,AETNA,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,COM,880,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,COM,880,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,COM,1100,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,COM,880,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,BCBS,COM,935,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,CIGNA,COM,1450,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,TRICARE,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,UNITED HEALTHCARE,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,UNITED HEALTHCARE,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,VA,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,VA TRICARE,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,WELLMED,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,HUMANA,MGD,1440,,,,,,,per diem,880,32093.3772,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,B1803,HIPPS,,,,,,,,Inpatient,,,32093.3772,32093.3772,HUMANA CHOICE PLUS,MGD,32093.3772,,,,,,,case rate,880,32093.3772,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,AETNA,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,COM,880,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,COM,880,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,COM,1100,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,COM,880,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,BCBS,COM,935,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,CIGNA,COM,1450,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,TRICARE,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,UNITED HEALTHCARE,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,UNITED HEALTHCARE,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,VA,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,VA TRICARE,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,WELLMED,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,HUMANA,MGD,1440,,,,,,,per diem,880,26254.755,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,C1803,HIPPS,,,,,,,,Inpatient,,,26254.755,26254.755,HUMANA CHOICE PLUS,MGD,26254.755,,,,,,,case rate,880,26254.755,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,AETNA,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,COM,880,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,COM,880,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,COM,1100,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,COM,880,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,BCBS,COM,935,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,CIGNA,COM,1450,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,TRICARE,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,UNITED HEALTHCARE,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,UNITED HEALTHCARE,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,VA,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,VA TRICARE,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,WELLMED,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,HUMANA,MGD,1440,,,,,,,per diem,880,24152.5608,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=45.50 and M <55.50,D1803,HIPPS,,,,,,,,Inpatient,,,24152.5608,24152.5608,HUMANA CHOICE PLUS,MGD,24152.5608,,,,,,,case rate,880,24152.5608,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,AETNA,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,COM,880,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,COM,880,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,COM,1100,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,COM,880,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,BCBS,COM,935,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,CIGNA,COM,1450,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,TRICARE,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,UNITED HEALTHCARE,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,UNITED HEALTHCARE,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,VA,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,VA TRICARE,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,WELLMED,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,HUMANA,MGD,1440,,,,,,,per diem,880,26476.0386,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,A1804,HIPPS,,,,,,,,Inpatient,,,26476.0386,26476.0386,HUMANA CHOICE PLUS,MGD,26476.0386,,,,,,,case rate,880,26476.0386,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,AETNA,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,COM,880,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,COM,880,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,COM,1100,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,COM,880,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,BCBS,COM,935,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,CIGNA,COM,1450,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,TRICARE,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,UNITED HEALTHCARE,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,UNITED HEALTHCARE,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,VA,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,VA TRICARE,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,WELLMED,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,HUMANA,MGD,1440,,,,,,,per diem,880,37482.177,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,B1804,HIPPS,,,,,,,,Inpatient,,,37482.177,37482.177,HUMANA CHOICE PLUS,MGD,37482.177,,,,,,,case rate,880,37482.177,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,AETNA,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,COM,880,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,COM,880,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,COM,1100,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,COM,880,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,BCBS,COM,935,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,CIGNA,COM,1450,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,TRICARE,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,UNITED HEALTHCARE,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,UNITED HEALTHCARE,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,VA,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,VA TRICARE,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,WELLMED,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,HUMANA,MGD,1440,,,,,,,per diem,880,30664.1028,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,C1804,HIPPS,,,,,,,,Inpatient,,,30664.1028,30664.1028,HUMANA CHOICE PLUS,MGD,30664.1028,,,,,,,case rate,880,30664.1028,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,AETNA,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,COM,880,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,COM,880,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,COM,1100,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,COM,880,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,BCBS,COM,935,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,CIGNA,COM,1450,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,TRICARE,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,UNITED HEALTHCARE,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,UNITED HEALTHCARE,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,VA,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,VA TRICARE,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,WELLMED,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,HUMANA,MGD,1440,,,,,,,per diem,880,28208.2176,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=40.50 and M <45.50,D1804,HIPPS,,,,,,,,Inpatient,,,28208.2176,28208.2176,HUMANA CHOICE PLUS,MGD,28208.2176,,,,,,,case rate,880,28208.2176,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,AETNA,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,COM,880,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,COM,880,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,COM,1100,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,COM,880,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,BCBS,COM,935,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,CIGNA,COM,1450,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,TRICARE,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,UNITED HEALTHCARE,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,UNITED HEALTHCARE,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,VA,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,VA TRICARE,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,WELLMED,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,HUMANA,MGD,1440,,,,,,,per diem,880,31763.2656,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,A1805,HIPPS,,,,,,,,Inpatient,,,31763.2656,31763.2656,HUMANA CHOICE PLUS,MGD,31763.2656,,,,,,,case rate,880,31763.2656,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,AETNA,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,COM,880,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,COM,880,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,COM,1100,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,COM,880,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,BCBS,COM,935,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,CIGNA,COM,1450,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,TRICARE,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,UNITED HEALTHCARE,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,UNITED HEALTHCARE,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,VA,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,VA TRICARE,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,WELLMED,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,HUMANA,MGD,1440,,,,,,,per diem,880,44967.7296,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,B1805,HIPPS,,,,,,,,Inpatient,,,44967.7296,44967.7296,HUMANA CHOICE PLUS,MGD,44967.7296,,,,,,,case rate,880,44967.7296,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,AETNA,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,COM,880,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,COM,880,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,COM,1100,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,COM,880,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,BCBS,COM,935,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,CIGNA,COM,1450,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,TRICARE,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,UNITED HEALTHCARE,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,UNITED HEALTHCARE,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,VA,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,VA TRICARE,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,WELLMED,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,HUMANA,MGD,1440,,,,,,,per diem,880,36787.4916,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,C1805,HIPPS,,,,,,,,Inpatient,,,36787.4916,36787.4916,HUMANA CHOICE PLUS,MGD,36787.4916,,,,,,,case rate,880,36787.4916,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,AETNA,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,COM,880,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,COM,880,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,COM,1100,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,COM,880,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,BCBS,COM,935,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,CIGNA,COM,1450,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,TRICARE,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,UNITED HEALTHCARE,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,UNITED HEALTHCARE,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,VA,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,VA TRICARE,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,WELLMED,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,HUMANA,MGD,1440,,,,,,,per diem,880,33841.8804,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M >=30.50 and M <40.50,D1805,HIPPS,,,,,,,,Inpatient,,,33841.8804,33841.8804,HUMANA CHOICE PLUS,MGD,33841.8804,,,,,,,case rate,880,33841.8804,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,AETNA,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,COM,880,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,COM,880,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,COM,1100,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,COM,880,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,BCBS,COM,935,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,CIGNA,COM,1450,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,TRICARE,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,UNITED HEALTHCARE,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,UNITED HEALTHCARE,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,VA,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,VA TRICARE,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,WELLMED,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,HUMANA,MGD,1440,,,,,,,per diem,880,46019.7336,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,A1806,HIPPS,,,,,,,,Inpatient,,,46019.7336,46019.7336,HUMANA CHOICE PLUS,MGD,46019.7336,,,,,,,case rate,880,46019.7336,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,AETNA,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,COM,880,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,COM,880,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,COM,1100,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,COM,880,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,BCBS,COM,935,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,CIGNA,COM,1450,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,TRICARE,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,UNITED HEALTHCARE,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,UNITED HEALTHCARE,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,VA,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,VA TRICARE,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,WELLMED,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,HUMANA,MGD,1440,,,,,,,per diem,880,65149.8822,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,B1806,HIPPS,,,,,,,,Inpatient,,,65149.8822,65149.8822,HUMANA CHOICE PLUS,MGD,65149.8822,,,,,,,case rate,880,65149.8822,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,AETNA,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,COM,880,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,COM,880,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,COM,1100,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,COM,880,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,BCBS,COM,935,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,CIGNA,COM,1450,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,TRICARE,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,UNITED HEALTHCARE,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,UNITED HEALTHCARE,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,VA,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,VA TRICARE,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,WELLMED,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,HUMANA,MGD,1440,,,,,,,per diem,880,53298.513,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,C1806,HIPPS,,,,,,,,Inpatient,,,53298.513,53298.513,HUMANA CHOICE PLUS,MGD,53298.513,,,,,,,case rate,880,53298.513,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,AETNA,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,COM,880,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,COM,880,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,COM,1100,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,COM,880,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,BCBS,COM,935,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,CIGNA,COM,1450,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,TRICARE,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,UNITED HEALTHCARE,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,UNITED HEALTHCARE,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,VA,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,VA TRICARE,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,WELLMED,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,HUMANA,MGD,1440,,,,,,,per diem,880,49030.6416,"Per diem rate, all codes are bundled into service package"
Major multiple trauma with brain or spinal cord injury M <30.50,D1806,HIPPS,,,,,,,,Inpatient,,,49030.6416,49030.6416,HUMANA CHOICE PLUS,MGD,49030.6416,,,,,,,case rate,880,49030.6416,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,AETNA,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,COM,880,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,COM,880,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,COM,1100,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,COM,880,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,BCBS,COM,935,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,CIGNA,COM,1450,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,TRICARE,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,UNITED HEALTHCARE,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,UNITED HEALTHCARE,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,VA,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,VA TRICARE,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,WELLMED,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,HUMANA,MGD,1440,,,,,,,per diem,880,14945.712,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,A1901,HIPPS,,,,,,,,Inpatient,,,14945.712,14945.712,HUMANA CHOICE PLUS,MGD,14945.712,,,,,,,case rate,880,14945.712,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,AETNA,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,COM,880,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,COM,880,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,COM,1100,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,COM,880,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,BCBS,COM,935,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,CIGNA,COM,1450,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,TRICARE,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,UNITED HEALTHCARE,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,UNITED HEALTHCARE,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,VA,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,VA TRICARE,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,WELLMED,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,HUMANA,MGD,1440,,,,,,,per diem,880,24317.6166,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,B1901,HIPPS,,,,,,,,Inpatient,,,24317.6166,24317.6166,HUMANA CHOICE PLUS,MGD,24317.6166,,,,,,,case rate,880,24317.6166,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,AETNA,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,COM,880,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,COM,880,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,COM,1100,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,COM,880,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,BCBS,COM,935,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,CIGNA,COM,1450,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,TRICARE,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,UNITED HEALTHCARE,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,UNITED HEALTHCARE,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,VA,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,VA TRICARE,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,WELLMED,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,HUMANA,MGD,1440,,,,,,,per diem,880,17185.755,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,C1901,HIPPS,,,,,,,,Inpatient,,,17185.755,17185.755,HUMANA CHOICE PLUS,MGD,17185.755,,,,,,,case rate,880,17185.755,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,AETNA,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,COM,880,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,COM,880,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,COM,1100,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,COM,880,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,BCBS,COM,935,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,CIGNA,COM,1450,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,TRICARE,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,UNITED HEALTHCARE,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,UNITED HEALTHCARE,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,VA,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,VA TRICARE,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,WELLMED,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,HUMANA,MGD,1440,,,,,,,per diem,880,14940.2706,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=66.50,D1901,HIPPS,,,,,,,,Inpatient,,,14940.2706,14940.2706,HUMANA CHOICE PLUS,MGD,14940.2706,,,,,,,case rate,880,14940.2706,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,AETNA,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,COM,880,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,COM,880,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,COM,1100,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,COM,880,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,BCBS,COM,935,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,CIGNA,COM,1450,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,TRICARE,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,UNITED HEALTHCARE,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,UNITED HEALTHCARE,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,VA,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,VA TRICARE,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,WELLMED,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,HUMANA,MGD,1440,,,,,,,per diem,880,21742.0206,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,A1902,HIPPS,,,,,,,,Inpatient,,,21742.0206,21742.0206,HUMANA CHOICE PLUS,MGD,21742.0206,,,,,,,case rate,880,21742.0206,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,AETNA,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,COM,880,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,COM,880,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,COM,1100,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,COM,880,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,BCBS,COM,935,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,CIGNA,COM,1450,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,TRICARE,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,UNITED HEALTHCARE,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,UNITED HEALTHCARE,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,VA,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,VA TRICARE,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,WELLMED,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,HUMANA,MGD,1440,,,,,,,per diem,880,35378.169,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,B1902,HIPPS,,,,,,,,Inpatient,,,35378.169,35378.169,HUMANA CHOICE PLUS,MGD,35378.169,,,,,,,case rate,880,35378.169,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,AETNA,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,COM,880,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,COM,880,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,COM,1100,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,COM,880,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,BCBS,COM,935,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,CIGNA,COM,1450,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,TRICARE,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,UNITED HEALTHCARE,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,UNITED HEALTHCARE,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,VA,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,VA TRICARE,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,WELLMED,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,HUMANA,MGD,1440,,,,,,,per diem,880,25003.233,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,C1902,HIPPS,,,,,,,,Inpatient,,,25003.233,25003.233,HUMANA CHOICE PLUS,MGD,25003.233,,,,,,,case rate,880,25003.233,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,AETNA,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,COM,880,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,COM,880,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,COM,1100,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,COM,880,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,BCBS,COM,935,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,CIGNA,COM,1450,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,TRICARE,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,UNITED HEALTHCARE,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,UNITED HEALTHCARE,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,VA,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,VA TRICARE,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,WELLMED,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,HUMANA,MGD,1440,,,,,,,per diem,880,21736.5792,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=51.50 and M <66.50,D1902,HIPPS,,,,,,,,Inpatient,,,21736.5792,21736.5792,HUMANA CHOICE PLUS,MGD,21736.5792,,,,,,,case rate,880,21736.5792,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,AETNA,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,COM,880,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,COM,880,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,COM,1100,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,COM,880,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,BCBS,COM,935,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,CIGNA,COM,1450,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,TRICARE,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,UNITED HEALTHCARE,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,UNITED HEALTHCARE,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,VA,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,VA TRICARE,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,WELLMED,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,HUMANA,MGD,1440,,,,,,,per diem,880,30762.048,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,A1903,HIPPS,,,,,,,,Inpatient,,,30762.048,30762.048,HUMANA CHOICE PLUS,MGD,30762.048,,,,,,,case rate,880,30762.048,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,AETNA,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,COM,880,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,COM,880,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,COM,1100,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,COM,880,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,BCBS,COM,935,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,CIGNA,COM,1450,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,TRICARE,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,UNITED HEALTHCARE,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,UNITED HEALTHCARE,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,VA,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,VA TRICARE,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,WELLMED,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,HUMANA,MGD,1440,,,,,,,per diem,880,50055.4386,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,B1903,HIPPS,,,,,,,,Inpatient,,,50055.4386,50055.4386,HUMANA CHOICE PLUS,MGD,50055.4386,,,,,,,case rate,880,50055.4386,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,AETNA,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,COM,880,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,COM,880,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,COM,1100,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,COM,880,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,BCBS,COM,935,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,CIGNA,COM,1450,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,TRICARE,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,UNITED HEALTHCARE,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,UNITED HEALTHCARE,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,VA,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,VA TRICARE,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,WELLMED,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,HUMANA,MGD,1440,,,,,,,per diem,880,35376.3552,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,C1903,HIPPS,,,,,,,,Inpatient,,,35376.3552,35376.3552,HUMANA CHOICE PLUS,MGD,35376.3552,,,,,,,case rate,880,35376.3552,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,AETNA,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,COM,880,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,COM,880,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,COM,1100,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,COM,880,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,BCBS,COM,935,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,CIGNA,COM,1450,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,TRICARE,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,UNITED HEALTHCARE,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,UNITED HEALTHCARE,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,VA,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,VA TRICARE,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,WELLMED,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,HUMANA,MGD,1440,,,,,,,per diem,880,30754.7928,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M >=38.50 and M <51.50,D1903,HIPPS,,,,,,,,Inpatient,,,30754.7928,30754.7928,HUMANA CHOICE PLUS,MGD,30754.7928,,,,,,,case rate,880,30754.7928,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,AETNA,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,COM,880,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,COM,880,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,COM,1100,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,COM,880,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,BCBS,COM,935,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,CIGNA,COM,1450,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,TRICARE,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,UNITED HEALTHCARE,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,UNITED HEALTHCARE,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,VA,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,VA TRICARE,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,WELLMED,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,HUMANA,MGD,1440,,,,,,,per diem,880,47303.904,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,A1904,HIPPS,,,,,,,,Inpatient,,,47303.904,47303.904,HUMANA CHOICE PLUS,MGD,47303.904,,,,,,,case rate,880,47303.904,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,AETNA,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,COM,880,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,COM,880,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,COM,1100,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,COM,880,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,BCBS,COM,935,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,CIGNA,COM,1450,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,TRICARE,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,UNITED HEALTHCARE,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,UNITED HEALTHCARE,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,VA,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,VA TRICARE,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,WELLMED,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,HUMANA,MGD,1440,,,,,,,per diem,880,76970.4168,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,B1904,HIPPS,,,,,,,,Inpatient,,,76970.4168,76970.4168,HUMANA CHOICE PLUS,MGD,76970.4168,,,,,,,case rate,880,76970.4168,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,AETNA,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,COM,880,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,COM,880,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,COM,1100,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,COM,880,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,BCBS,COM,935,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,CIGNA,COM,1450,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,TRICARE,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,UNITED HEALTHCARE,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,UNITED HEALTHCARE,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,VA,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,VA TRICARE,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,WELLMED,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,HUMANA,MGD,1440,,,,,,,per diem,880,54397.6758,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,C1904,HIPPS,,,,,,,,Inpatient,,,54397.6758,54397.6758,HUMANA CHOICE PLUS,MGD,54397.6758,,,,,,,case rate,880,54397.6758,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,AETNA,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,COM,880,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,COM,880,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,COM,1100,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,COM,880,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,BCBS,COM,935,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,CIGNA,COM,1450,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,TRICARE,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,UNITED HEALTHCARE,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,UNITED HEALTHCARE,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,VA,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,VA TRICARE,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,WELLMED,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,HUMANA,MGD,1440,,,,,,,per diem,880,47289.3936,"Per diem rate, all codes are bundled into service package"
Guillain-Barré M <38.50,D1904,HIPPS,,,,,,,,Inpatient,,,47289.3936,47289.3936,HUMANA CHOICE PLUS,MGD,47289.3936,,,,,,,case rate,880,47289.3936,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,AETNA,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,COM,880,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,COM,880,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,COM,1100,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,COM,880,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,BCBS,COM,935,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,CIGNA,COM,1450,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,TRICARE,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,UNITED HEALTHCARE,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,UNITED HEALTHCARE,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,VA,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,VA TRICARE,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,WELLMED,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,HUMANA,MGD,1440,,,,,,,per diem,880,14717.1732,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,A2001,HIPPS,,,,,,,,Inpatient,,,14717.1732,14717.1732,HUMANA CHOICE PLUS,MGD,14717.1732,,,,,,,case rate,880,14717.1732,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,AETNA,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,COM,880,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,COM,880,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,COM,1100,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,COM,880,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,BCBS,COM,935,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,CIGNA,COM,1450,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,TRICARE,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,UNITED HEALTHCARE,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,UNITED HEALTHCARE,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,VA,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,VA TRICARE,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,WELLMED,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,HUMANA,MGD,1440,,,,,,,per diem,880,21555.1992,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,B2001,HIPPS,,,,,,,,Inpatient,,,21555.1992,21555.1992,HUMANA CHOICE PLUS,MGD,21555.1992,,,,,,,case rate,880,21555.1992,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,AETNA,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,COM,880,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,COM,880,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,COM,1100,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,COM,880,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,BCBS,COM,935,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,CIGNA,COM,1450,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,TRICARE,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,UNITED HEALTHCARE,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,UNITED HEALTHCARE,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,VA,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,VA TRICARE,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,WELLMED,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,HUMANA,MGD,1440,,,,,,,per diem,880,17287.3278,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,C2001,HIPPS,,,,,,,,Inpatient,,,17287.3278,17287.3278,HUMANA CHOICE PLUS,MGD,17287.3278,,,,,,,case rate,880,17287.3278,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,AETNA,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,COM,880,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,COM,880,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,COM,1100,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,COM,880,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,BCBS,COM,935,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,CIGNA,COM,1450,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,TRICARE,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,UNITED HEALTHCARE,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,UNITED HEALTHCARE,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,VA,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,VA TRICARE,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,WELLMED,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,HUMANA,MGD,1440,,,,,,,per diem,880,16077.5232,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=66.50,D2001,HIPPS,,,,,,,,Inpatient,,,16077.5232,16077.5232,HUMANA CHOICE PLUS,MGD,16077.5232,,,,,,,case rate,880,16077.5232,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,AETNA,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,COM,880,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,COM,880,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,COM,1100,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,COM,880,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,BCBS,COM,935,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,CIGNA,COM,1450,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,TRICARE,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,UNITED HEALTHCARE,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,UNITED HEALTHCARE,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,VA,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,VA TRICARE,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,WELLMED,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,HUMANA,MGD,1440,,,,,,,per diem,880,18272.2212,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,A2002,HIPPS,,,,,,,,Inpatient,,,18272.2212,18272.2212,HUMANA CHOICE PLUS,MGD,18272.2212,,,,,,,case rate,880,18272.2212,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,AETNA,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,COM,880,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,COM,880,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,COM,1100,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,COM,880,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,BCBS,COM,935,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,CIGNA,COM,1450,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,TRICARE,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,UNITED HEALTHCARE,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,UNITED HEALTHCARE,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,VA,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,VA TRICARE,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,WELLMED,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,HUMANA,MGD,1440,,,,,,,per diem,880,26762.619,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,B2002,HIPPS,,,,,,,,Inpatient,,,26762.619,26762.619,HUMANA CHOICE PLUS,MGD,26762.619,,,,,,,case rate,880,26762.619,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,AETNA,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,COM,880,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,COM,880,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,COM,1100,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,COM,880,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,BCBS,COM,935,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,CIGNA,COM,1450,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,TRICARE,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,UNITED HEALTHCARE,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,UNITED HEALTHCARE,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,VA,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,VA TRICARE,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,WELLMED,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,HUMANA,MGD,1440,,,,,,,per diem,880,21462.6954,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,C2002,HIPPS,,,,,,,,Inpatient,,,21462.6954,21462.6954,HUMANA CHOICE PLUS,MGD,21462.6954,,,,,,,case rate,880,21462.6954,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,AETNA,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,COM,880,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,COM,880,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,COM,1100,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,COM,880,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,BCBS,COM,935,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,CIGNA,COM,1450,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,TRICARE,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,UNITED HEALTHCARE,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,UNITED HEALTHCARE,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,VA,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,VA TRICARE,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,WELLMED,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,HUMANA,MGD,1440,,,,,,,per diem,880,19959.0552,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=55.50 and M <66.50,D2002,HIPPS,,,,,,,,Inpatient,,,19959.0552,19959.0552,HUMANA CHOICE PLUS,MGD,19959.0552,,,,,,,case rate,880,19959.0552,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,AETNA,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,COM,880,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,COM,880,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,COM,1100,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,COM,880,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,BCBS,COM,935,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,CIGNA,COM,1450,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,TRICARE,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,UNITED HEALTHCARE,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,UNITED HEALTHCARE,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,VA,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,VA TRICARE,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,WELLMED,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,HUMANA,MGD,1440,,,,,,,per diem,880,21457.254,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,A2003,HIPPS,,,,,,,,Inpatient,,,21457.254,21457.254,HUMANA CHOICE PLUS,MGD,21457.254,,,,,,,case rate,880,21457.254,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,AETNA,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,COM,880,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,COM,880,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,COM,1100,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,COM,880,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,BCBS,COM,935,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,CIGNA,COM,1450,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,TRICARE,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,UNITED HEALTHCARE,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,UNITED HEALTHCARE,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,VA,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,VA TRICARE,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,WELLMED,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,HUMANA,MGD,1440,,,,,,,per diem,880,31425.8988,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,B2003,HIPPS,,,,,,,,Inpatient,,,31425.8988,31425.8988,HUMANA CHOICE PLUS,MGD,31425.8988,,,,,,,case rate,880,31425.8988,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,AETNA,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,COM,880,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,COM,880,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,COM,1100,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,COM,880,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,BCBS,COM,935,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,CIGNA,COM,1450,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,TRICARE,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,UNITED HEALTHCARE,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,UNITED HEALTHCARE,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,VA,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,VA TRICARE,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,WELLMED,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,HUMANA,MGD,1440,,,,,,,per diem,880,25202.751,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,C2003,HIPPS,,,,,,,,Inpatient,,,25202.751,25202.751,HUMANA CHOICE PLUS,MGD,25202.751,,,,,,,case rate,880,25202.751,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,AETNA,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,COM,880,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,COM,880,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,COM,1100,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,COM,880,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,BCBS,COM,935,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,CIGNA,COM,1450,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,TRICARE,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,UNITED HEALTHCARE,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,UNITED HEALTHCARE,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,VA,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,VA TRICARE,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,WELLMED,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,HUMANA,MGD,1440,,,,,,,per diem,880,23437.9236,"Per diem rate, all codes are bundled into service package"
Miscellaneous M >=46.50 and M <55.50,D2003,HIPPS,,,,,,,,Inpatient,,,23437.9236,23437.9236,HUMANA CHOICE PLUS,MGD,23437.9236,,,,,,,case rate,880,23437.9236,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,AETNA,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,COM,880,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,COM,880,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,COM,1100,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,COM,880,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,BCBS,COM,935,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,CIGNA,COM,1450,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,TRICARE,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,UNITED HEALTHCARE,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,UNITED HEALTHCARE,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,VA,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,VA TRICARE,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,WELLMED,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,HUMANA,MGD,1440,,,,,,,per diem,880,26167.6926,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,A2004,HIPPS,,,,,,,,Inpatient,,,26167.6926,26167.6926,HUMANA CHOICE PLUS,MGD,26167.6926,,,,,,,case rate,880,26167.6926,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,AETNA,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,COM,880,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,COM,880,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,COM,1100,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,COM,880,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,BCBS,COM,935,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,CIGNA,COM,1450,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,TRICARE,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,UNITED HEALTHCARE,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,UNITED HEALTHCARE,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,VA,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,VA TRICARE,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,WELLMED,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,HUMANA,MGD,1440,,,,,,,per diem,880,38327.4078,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,B2004,HIPPS,,,,,,,,Inpatient,,,38327.4078,38327.4078,HUMANA CHOICE PLUS,MGD,38327.4078,,,,,,,case rate,880,38327.4078,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,AETNA,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,COM,880,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,COM,880,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,COM,1100,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,COM,880,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,BCBS,COM,935,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,CIGNA,COM,1450,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,TRICARE,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,UNITED HEALTHCARE,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,UNITED HEALTHCARE,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,VA,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,VA TRICARE,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,WELLMED,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,HUMANA,MGD,1440,,,,,,,per diem,880,30736.6548,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,C2004,HIPPS,,,,,,,,Inpatient,,,30736.6548,30736.6548,HUMANA CHOICE PLUS,MGD,30736.6548,,,,,,,case rate,880,30736.6548,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,AETNA,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,1100,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,880,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,BCBS,COM,935,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,CIGNA,COM,1450,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,TRICARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,UNITED HEALTHCARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,UNITED HEALTHCARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,VA,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,VA TRICARE,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,WELLMED,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,HUMANA,MGD,1440,,,,,,,per diem,880,28585.488,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A >=77.50,D2004,HIPPS,,,,,,,,Inpatient,,,28585.488,28585.488,HUMANA CHOICE PLUS,MGD,28585.488,,,,,,,case rate,880,28585.488,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,AETNA,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,COM,880,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,COM,880,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,COM,1100,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,COM,880,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,BCBS,COM,935,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,CIGNA,COM,1450,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,TRICARE,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,UNITED HEALTHCARE,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,UNITED HEALTHCARE,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,VA,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,VA TRICARE,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,WELLMED,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,HUMANA,MGD,1440,,,,,,,per diem,880,27390.1938,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,A2005,HIPPS,,,,,,,,Inpatient,,,27390.1938,27390.1938,HUMANA CHOICE PLUS,MGD,27390.1938,,,,,,,case rate,880,27390.1938,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,AETNA,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,COM,880,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,COM,880,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,COM,1100,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,COM,880,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,BCBS,COM,935,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,CIGNA,COM,1450,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,TRICARE,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,UNITED HEALTHCARE,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,UNITED HEALTHCARE,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,VA,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,VA TRICARE,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,WELLMED,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,HUMANA,MGD,1440,,,,,,,per diem,880,40117.6284,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,B2005,HIPPS,,,,,,,,Inpatient,,,40117.6284,40117.6284,HUMANA CHOICE PLUS,MGD,40117.6284,,,,,,,case rate,880,40117.6284,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,AETNA,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,COM,880,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,COM,880,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,COM,1100,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,COM,880,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,BCBS,COM,935,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,CIGNA,COM,1450,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,TRICARE,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,UNITED HEALTHCARE,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,UNITED HEALTHCARE,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,VA,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,VA TRICARE,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,WELLMED,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,HUMANA,MGD,1440,,,,,,,per diem,880,32173.1844,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,C2005,HIPPS,,,,,,,,Inpatient,,,32173.1844,32173.1844,HUMANA CHOICE PLUS,MGD,32173.1844,,,,,,,case rate,880,32173.1844,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,AETNA,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,COM,880,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,COM,880,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,COM,1100,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,COM,880,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,BCBS,COM,935,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,CIGNA,COM,1450,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,TRICARE,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,UNITED HEALTHCARE,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,UNITED HEALTHCARE,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,VA,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,VA TRICARE,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,WELLMED,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,HUMANA,MGD,1440,,,,,,,per diem,880,29920.4448,"Per diem rate, all codes are bundled into service package"
Miscellaneous M <46.50 and A <77.50,D2005,HIPPS,,,,,,,,Inpatient,,,29920.4448,29920.4448,HUMANA CHOICE PLUS,MGD,29920.4448,,,,,,,case rate,880,29920.4448,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,AETNA,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,COM,880,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,COM,880,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,COM,1100,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,COM,880,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,BCBS,COM,935,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,CIGNA,COM,1450,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,TRICARE,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,UNITED HEALTHCARE,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,UNITED HEALTHCARE,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,VA,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,VA TRICARE,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,WELLMED,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,HUMANA,MGD,1440,,,,,,,per diem,880,17711.757,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,A2101,HIPPS,,,,,,,,Inpatient,,,17711.757,17711.757,HUMANA CHOICE PLUS,MGD,17711.757,,,,,,,case rate,880,17711.757,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,AETNA,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,COM,880,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,COM,880,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,COM,1100,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,COM,880,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,BCBS,COM,935,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,CIGNA,COM,1450,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,TRICARE,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,UNITED HEALTHCARE,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,UNITED HEALTHCARE,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,VA,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,VA TRICARE,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,WELLMED,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,HUMANA,MGD,1440,,,,,,,per diem,880,29131.4418,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,B2101,HIPPS,,,,,,,,Inpatient,,,29131.4418,29131.4418,HUMANA CHOICE PLUS,MGD,29131.4418,,,,,,,case rate,880,29131.4418,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,AETNA,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,COM,880,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,COM,880,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,COM,1100,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,COM,880,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,BCBS,COM,935,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,CIGNA,COM,1450,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,TRICARE,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,UNITED HEALTHCARE,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,UNITED HEALTHCARE,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,VA,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,VA TRICARE,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,WELLMED,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,HUMANA,MGD,1440,,,,,,,per diem,880,24491.7414,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,C2101,HIPPS,,,,,,,,Inpatient,,,24491.7414,24491.7414,HUMANA CHOICE PLUS,MGD,24491.7414,,,,,,,case rate,880,24491.7414,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,AETNA,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,COM,880,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,COM,880,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,COM,1100,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,COM,880,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,BCBS,COM,935,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,CIGNA,COM,1450,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,TRICARE,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,UNITED HEALTHCARE,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,UNITED HEALTHCARE,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,VA,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,VA TRICARE,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,WELLMED,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,HUMANA,MGD,1440,,,,,,,per diem,880,18469.9254,"Per diem rate, all codes are bundled into service package"
Burns M >=52.50,D2101,HIPPS,,,,,,,,Inpatient,,,18469.9254,18469.9254,HUMANA CHOICE PLUS,MGD,18469.9254,,,,,,,case rate,880,18469.9254,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,AETNA,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,COM,880,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,COM,880,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,COM,1100,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,COM,880,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,BCBS,COM,935,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,CIGNA,COM,1450,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,TRICARE,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,UNITED HEALTHCARE,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,UNITED HEALTHCARE,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,VA,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,VA TRICARE,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,WELLMED,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,HUMANA,MGD,1440,,,,,,,per diem,880,28066.7412,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,A2102,HIPPS,,,,,,,,Inpatient,,,28066.7412,28066.7412,HUMANA CHOICE PLUS,MGD,28066.7412,,,,,,,case rate,880,28066.7412,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,AETNA,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,COM,880,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,COM,880,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,COM,1100,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,COM,880,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,BCBS,COM,935,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,CIGNA,COM,1450,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,TRICARE,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,UNITED HEALTHCARE,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,UNITED HEALTHCARE,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,VA,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,VA TRICARE,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,WELLMED,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,HUMANA,MGD,1440,,,,,,,per diem,880,46163.0238,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,B2102,HIPPS,,,,,,,,Inpatient,,,46163.0238,46163.0238,HUMANA CHOICE PLUS,MGD,46163.0238,,,,,,,case rate,880,46163.0238,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,AETNA,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,COM,880,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,COM,880,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,COM,1100,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,COM,880,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,BCBS,COM,935,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,CIGNA,COM,1450,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,TRICARE,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,UNITED HEALTHCARE,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,UNITED HEALTHCARE,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,VA,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,VA TRICARE,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,WELLMED,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,HUMANA,MGD,1440,,,,,,,per diem,880,38809.8786,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,C2102,HIPPS,,,,,,,,Inpatient,,,38809.8786,38809.8786,HUMANA CHOICE PLUS,MGD,38809.8786,,,,,,,case rate,880,38809.8786,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,AETNA,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,COM,880,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,COM,880,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,COM,1100,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,COM,880,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,BCBS,COM,935,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,CIGNA,COM,1450,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,TRICARE,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,UNITED HEALTHCARE,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,UNITED HEALTHCARE,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,VA,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,VA TRICARE,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,WELLMED,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,HUMANA,MGD,1440,,,,,,,per diem,880,29267.4768,"Per diem rate, all codes are bundled into service package"
Burns M <52.50,D2102,HIPPS,,,,,,,,Inpatient,,,29267.4768,29267.4768,HUMANA CHOICE PLUS,MGD,29267.4768,,,,,,,case rate,880,29267.4768,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,AETNA,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,COM,880,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,COM,880,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,COM,1100,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,COM,880,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,BCBS,COM,935,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,CIGNA,COM,1450,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,TRICARE,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,UNITED HEALTHCARE,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,UNITED HEALTHCARE,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,VA,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,VA TRICARE,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,WELLMED,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,HUMANA,MGD,1440,,,,,,,per diem,880,3183.219,"Per diem rate, all codes are bundled into service package"
"Short-stay cases, length of stay is 3 days or fewer",A5001,HIPPS,,,,,,,,Inpatient,,,3183.219,3183.219,HUMANA CHOICE PLUS,MGD,3183.219,,,,,,,case rate,880,3183.219,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,AETNA,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,COM,880,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,COM,880,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,COM,1100,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,COM,880,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,BCBS,COM,935,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,CIGNA,COM,1450,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,TRICARE,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,UNITED HEALTHCARE,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,UNITED HEALTHCARE,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,VA,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,VA TRICARE,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,WELLMED,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,HUMANA,MGD,1440,,,,,,,per diem,880,15488.0382,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 13 days or fewer",A5101,HIPPS,,,,,,,,Inpatient,,,15488.0382,15488.0382,HUMANA CHOICE PLUS,MGD,15488.0382,,,,,,,case rate,880,15488.0382,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,AETNA,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,COM,880,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,COM,880,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,COM,1100,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,COM,880,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,BCBS,COM,935,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,CIGNA,COM,1450,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,TRICARE,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,UNITED HEALTHCARE,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,UNITED HEALTHCARE,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,VA,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,VA TRICARE,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,WELLMED,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,HUMANA,MGD,1440,,,,,,,per diem,880,37155.693,"Per diem rate, all codes are bundled into service package"
"Expired, orthopedic, length of stay is 14 days or more",A5102,HIPPS,,,,,,,,Inpatient,,,37155.693,37155.693,HUMANA CHOICE PLUS,MGD,37155.693,,,,,,,case rate,880,37155.693,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,AETNA,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,COM,880,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,COM,880,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,COM,1100,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,COM,880,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,BCBS,COM,935,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,CIGNA,COM,1450,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,TRICARE,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,UNITED HEALTHCARE,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,UNITED HEALTHCARE,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,VA,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,VA TRICARE,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,WELLMED,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,HUMANA,MGD,1440,,,,,,,per diem,880,16538.2284,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 15 days or fewer",A5103,HIPPS,,,,,,,,Inpatient,,,16538.2284,16538.2284,HUMANA CHOICE PLUS,MGD,16538.2284,,,,,,,case rate,880,16538.2284,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,AETNA,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,COM,880,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,COM,880,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,COM,1100,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,COM,880,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,BCBS,COM,935,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,CIGNA,COM,1450,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,TRICARE,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,UNITED HEALTHCARE,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,UNITED HEALTHCARE,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,VA,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,VA TRICARE,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,WELLMED,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,HUMANA,MGD,1440,,,,,,,per diem,880,39687.7578,"Per diem rate, all codes are bundled into service package"
"Expired, not orthopedic, length of stay is 16 days or more",A5104,HIPPS,,,,,,,,Inpatient,,,39687.7578,39687.7578,HUMANA CHOICE PLUS,MGD,39687.7578,,,,,,,case rate,880,39687.7578,Base Rate * Tier * Negotiated Percent
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,AETNA,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,BCBS,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,CIGNA,COM,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,TRICARE,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,UNITED HEALTHCARE,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,UNITED HEALTHCARE,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,VA,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,VA TRICARE,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,WELLMED,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,HUMANA,MGD,2225.24,,,,,,,per diem,2225.24,2225.24,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10600400,CDM,118,RC,,,,,,Inpatient,,,2225.24,2225.24,HUMANA CHOICE PLUS,MGD,2225.24,,,,,,,case rate,2225.24,2225.24,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,AETNA,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,BCBS,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,CIGNA,COM,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,TRICARE,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,UNITED HEALTHCARE,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,UNITED HEALTHCARE,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,VA,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,VA TRICARE,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,WELLMED,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,HUMANA,MGD,1012.1,,,,,,,per diem,1012.1,1012.1,"Per diem rate, code is bundled with other services"
WARD REHAB SEMI-PRIVATE       ,10600480,CDM,158,RC,,,,,,Inpatient,,,1012.1,1012.1,HUMANA CHOICE PLUS,MGD,1012.1,,,,,,,case rate,1012.1,1012.1,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,AETNA,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,BCBS,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,CIGNA,COM,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,TRICARE,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,UNITED HEALTHCARE,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,UNITED HEALTHCARE,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,VA,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,VA TRICARE,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,WELLMED,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,HUMANA,MGD,1006.58,,,,,,,per diem,1006.58,1006.58,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB PRIVATE    ,10700400,CDM,118,RC,,,,,,Inpatient,,,1006.58,1006.58,HUMANA CHOICE PLUS,MGD,1006.58,,,,,,,case rate,1006.58,1006.58,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,AETNA,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,BCBS,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,CIGNA,COM,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,TRICARE,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,UNITED HEALTHCARE,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,UNITED HEALTHCARE,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,VA,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,VA TRICARE,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,WELLMED,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,HUMANA,MGD,999.97,,,,,,,per diem,999.97,999.97,"Per diem rate, code is bundled with other services"
INTERMEDIATE REHAB SEMI-PRIV  ,10700450,CDM,128,RC,,,,,,Inpatient,,,999.97,999.97,HUMANA CHOICE PLUS,MGD,999.97,,,,,,,case rate,999.97,999.97,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,AETNA,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,BCBS,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,CIGNA,COM,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,TRICARE,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,UNITED HEALTHCARE,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,UNITED HEALTHCARE,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,VA,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,VA TRICARE,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,WELLMED,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,HUMANA,MGD,2283.32,,,,,,,per diem,2283.32,2283.32,"Per diem rate, code is bundled with other services"
HOSPITAL HOLD                 ,11000050,CDM,185,RC,,,,,,Inpatient,,,2283.32,2283.32,HUMANA CHOICE PLUS,MGD,2283.32,,,,,,,case rate,2283.32,2283.32,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,AETNA,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,BCBS,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,CIGNA,COM,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,TRICARE,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,UNITED HEALTHCARE,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,UNITED HEALTHCARE,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,VA,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,VA TRICARE,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,WELLMED,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,HUMANA,MGD,328.37,,,,,,,per diem,328.37,328.37,"Per diem rate, code is bundled with other services"
RECOVERY ROOM                 ,11400010,CDM,710,RC,,,,,,Inpatient,,,328.37,328.37,HUMANA CHOICE PLUS,MGD,328.37,,,,,,,case rate,328.37,328.37,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,AETNA,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,BCBS,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,CIGNA,COM,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,TRICARE,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,UNITED HEALTHCARE,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,UNITED HEALTHCARE,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,VA,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,VA TRICARE,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,WELLMED,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,HUMANA,MGD,124.95,,,,,,,per diem,124.95,124.95,"Per diem rate, code is bundled with other services"
HCHG EXTENDED RECOVERY PE     ,11400020,CDM,710,RC,,,,,,Inpatient,,,124.95,124.95,HUMANA CHOICE PLUS,MGD,124.95,,,,,,,case rate,124.95,124.95,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,AETNA,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,BCBS,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,CIGNA,COM,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,TRICARE,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,UNITED HEALTHCARE,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,UNITED HEALTHCARE,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,VA,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,VA TRICARE,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,WELLMED,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,HUMANA,MGD,253.05,,,,,,,per diem,253.05,253.05,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,11600050,CDM,360,RC,,,,,,Inpatient,,,253.05,253.05,HUMANA CHOICE PLUS,MGD,253.05,,,,,,,case rate,253.05,253.05,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,AETNA,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,BCBS,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,CIGNA,COM,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,TRICARE,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,UNITED HEALTHCARE,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,UNITED HEALTHCARE,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,VA,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,VA TRICARE,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,WELLMED,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,HUMANA,MGD,2688.38,,,,,,,per diem,2688.38,2688.38,"Per diem rate, code is bundled with other services"
CENTRAL LINE INSERTION        ,11600110,CDM,360,RC,36569,CPT,,,,Inpatient,,,2688.38,2688.38,HUMANA CHOICE PLUS,MGD,2688.38,,,,,,,case rate,2688.38,2688.38,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,AETNA,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,BCBS,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,CIGNA,COM,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,TRICARE,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,UNITED HEALTHCARE,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,UNITED HEALTHCARE,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,VA,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,VA TRICARE,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,WELLMED,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,HUMANA,MGD,1032.15,,,,,,,per diem,1032.15,1032.15,"Per diem rate, code is bundled with other services"
REMOVAL CENTRAL LINE          ,11600111,CDM,360,RC,,,,,,Inpatient,,,1032.15,1032.15,HUMANA CHOICE PLUS,MGD,1032.15,,,,,,,case rate,1032.15,1032.15,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,AETNA,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,BCBS,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,CIGNA,COM,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,TRICARE,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,UNITED HEALTHCARE,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,UNITED HEALTHCARE,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,VA,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,VA TRICARE,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,WELLMED,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,HUMANA,MGD,1456.88,,,,,,,per diem,1456.88,1456.88,"Per diem rate, code is bundled with other services"
PIC LINE INSERTION            ,11600510,CDM,761,RC,,,,,,Inpatient,,,1456.88,1456.88,HUMANA CHOICE PLUS,MGD,1456.88,,,,,,,case rate,1456.88,1456.88,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,AETNA,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,BCBS,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,CIGNA,COM,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,TRICARE,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,UNITED HEALTHCARE,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,UNITED HEALTHCARE,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,VA,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,VA TRICARE,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,WELLMED,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,HUMANA,MGD,800.1,,,,,,,per diem,800.1,800.1,"Per diem rate, code is bundled with other services"
PICC INSERTION >5 YR OLD PT   ,11600517,CDM,761,RC,36569,CPT,,,,Inpatient,,,800.1,800.1,HUMANA CHOICE PLUS,MGD,800.1,,,,,,,case rate,800.1,800.1,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,AETNA,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,BCBS,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,CIGNA,COM,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,TRICARE,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,UNITED HEALTHCARE,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,UNITED HEALTHCARE,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,VA,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,VA TRICARE,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,WELLMED,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,HUMANA,MGD,230.85,,,,,,,per diem,230.85,230.85,"Per diem rate, code is bundled with other services"
APPLY MULTI-LAYER VENOUS WND  ,11600806,CDM,361,RC,29581,CPT,,,,Inpatient,,,230.85,230.85,HUMANA CHOICE PLUS,MGD,230.85,,,,,,,case rate,230.85,230.85,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,AETNA,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,BCBS,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,CIGNA,COM,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,TRICARE,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,UNITED HEALTHCARE,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,UNITED HEALTHCARE,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,VA,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,VA TRICARE,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,WELLMED,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,HUMANA,MGD,987.22,,,,,,,per diem,987.22,987.22,"Per diem rate, code is bundled with other services"
CYSTO W/REMOVE FB/CALCUL STENT,11600807,CDM,361,RC,52310,CPT,,,,Inpatient,,,987.22,987.22,HUMANA CHOICE PLUS,MGD,987.22,,,,,,,case rate,987.22,987.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,AETNA,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,BCBS,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,CIGNA,COM,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,TRICARE,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,UNITED HEALTHCARE,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,UNITED HEALTHCARE,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,VA,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,VA TRICARE,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,WELLMED,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,HUMANA,MGD,1499.22,,,,,,,per diem,1499.22,1499.22,"Per diem rate, code is bundled with other services"
REMOVE TUNNELED CEN VEN CATH  ,11600808,CDM,261,RC,36589,CPT,,,,Inpatient,,,1499.22,1499.22,HUMANA CHOICE PLUS,MGD,1499.22,,,,,,,case rate,1499.22,1499.22,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,AETNA,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,BCBS,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,CIGNA,COM,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,TRICARE,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,UNITED HEALTHCARE,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,UNITED HEALTHCARE,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,VA,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,VA TRICARE,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,WELLMED,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,HUMANA,MGD,1217.51,,,,,,,per diem,1217.51,1217.51,"Per diem rate, code is bundled with other services"
RENAL BIOPSY PERC             ,11600809,CDM,360,RC,50200,CPT,,,,Inpatient,,,1217.51,1217.51,HUMANA CHOICE PLUS,MGD,1217.51,,,,,,,case rate,1217.51,1217.51,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,AETNA,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,BCBS,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,CIGNA,COM,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,TRICARE,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,UNITED HEALTHCARE,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,UNITED HEALTHCARE,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,VA,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,VA TRICARE,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,WELLMED,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,HUMANA,MGD,1095.07,,,,,,,per diem,1095.07,1095.07,"Per diem rate, code is bundled with other services"
OPERATING ROOM SERVICE        ,11601001,CDM,260,RC,10021,CPT,,,,Inpatient,,,1095.07,1095.07,HUMANA CHOICE PLUS,MGD,1095.07,,,,,,,case rate,1095.07,1095.07,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,AETNA,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,BCBS,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,CIGNA,COM,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,TRICARE,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,UNITED HEALTHCARE,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,UNITED HEALTHCARE,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,VA,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,VA TRICARE,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,WELLMED,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,HUMANA,MGD,88.85,,,,,,,per diem,88.85,88.85,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR                ,33100297,CDM,270,RC,,,,,,Inpatient,,,88.85,88.85,HUMANA CHOICE PLUS,MGD,88.85,,,,,,,case rate,88.85,88.85,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,AETNA,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,BCBS,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,CIGNA,COM,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,TRICARE,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,UNITED HEALTHCARE,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,UNITED HEALTHCARE,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,VA,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,VA TRICARE,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,WELLMED,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,HUMANA,MGD,74.84,,,,,,,per diem,74.84,74.84,"Per diem rate, code is bundled with other services"
BOOT CASTING XL               ,33105807,CDM,270,RC,,,,,,Inpatient,,,74.84,74.84,HUMANA CHOICE PLUS,MGD,74.84,,,,,,,case rate,74.84,74.84,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,AETNA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,CIGNA,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,VA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,VA TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,WELLMED,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,HUMANA,MGD,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
SUPPORT HAND WRIST CARROT     ,33105844,CDM,270,RC,,,,,,Inpatient,,,66.15,66.15,HUMANA CHOICE PLUS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,AETNA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,CIGNA,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,WELLMED,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA,MGD,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZAA2.25""",33105845,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA CHOICE PLUS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,AETNA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,CIGNA,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,WELLMED,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA,MGD,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZA2.625""",33105846,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA CHOICE PLUS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,AETNA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,CIGNA,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,WELLMED,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA,MGD,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
"SPLINT FNGR EXT ASST SZC3.125""",33105847,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA CHOICE PLUS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-SMALL  ,33105848,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE SMALL    ,33105849,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MEDIUM   ,33105850,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE MED/LG   ,33105851,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE LARGE    ,33105852,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
SHOE CAST CLOSED TOE X-LARGE  ,33105853,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,AETNA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,CIGNA,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,VA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,VA TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,WELLMED,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,HUMANA,MGD,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
SHOE CAST OPEN TOE MED/LG     ,33105854,CDM,270,RC,,,,,,Inpatient,,,43.05,43.05,HUMANA CHOICE PLUS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,AETNA,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,BCBS,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,CIGNA,COM,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,TRICARE,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,UNITED HEALTHCARE,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,UNITED HEALTHCARE,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,VA,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,VA TRICARE,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,WELLMED,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,HUMANA,MGD,96.6,,,,,,,per diem,96.6,96.6,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL OPPO PREM LG  ,33105855,CDM,270,RC,,,,,,Inpatient,,,96.6,96.6,HUMANA CHOICE PLUS,MGD,96.6,,,,,,,case rate,96.6,96.6,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,AETNA,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,BCBS,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,CIGNA,COM,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,TRICARE,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,UNITED HEALTHCARE,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,UNITED HEALTHCARE,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,VA,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,VA TRICARE,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,WELLMED,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,HUMANA,MGD,565.95,,,,,,,per diem,565.95,565.95,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS ADULT   ,33106404,CDM,270,RC,,,,,,Inpatient,,,565.95,565.95,HUMANA CHOICE PLUS,MGD,565.95,,,,,,,case rate,565.95,565.95,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,AETNA,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,BCBS,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,CIGNA,COM,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,TRICARE,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,UNITED HEALTHCARE,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,UNITED HEALTHCARE,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,VA,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,VA TRICARE,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,WELLMED,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,HUMANA,MGD,806.4,,,,,,,per diem,806.4,806.4,"Per diem rate, code is bundled with other services"
POSITIONER PATNT TRTS BARIATRC,33106405,CDM,270,RC,,,,,,Inpatient,,,806.4,806.4,HUMANA CHOICE PLUS,MGD,806.4,,,,,,,case rate,806.4,806.4,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,AETNA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,CIGNA,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,VA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,VA TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,WELLMED,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,HUMANA,MGD,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
PROTECTOR FOOT                ,33107058,CDM,270,RC,,,,,,Inpatient,,,10.5,10.5,HUMANA CHOICE PLUS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,AETNA,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,BCBS,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,CIGNA,COM,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,TRICARE,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,UNITED HEALTHCARE,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,UNITED HEALTHCARE,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,VA,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,VA TRICARE,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,WELLMED,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,HUMANA,MGD,180.6,,,,,,,per diem,180.6,180.6,"Per diem rate, code is bundled with other services"
BOOT ANK CONTRCT VELCROFOAM LG,33107236,CDM,270,RC,,,,,,Inpatient,,,180.6,180.6,HUMANA CHOICE PLUS,MGD,180.6,,,,,,,case rate,180.6,180.6,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW DISP     ,33107263,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,AETNA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,CIGNA,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,VA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,VA TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,WELLMED,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA,MGD,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT SHEEEPSKIN               ,33107282,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA CHOICE PLUS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP MALE LARGE       ,33108434,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELB SOCK W/KODE,33108878,CDM,270,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE UNIV 16IN    ,33109008,CDM,270,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,AETNA,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,BCBS,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,CIGNA,COM,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,TRICARE,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,UNITED HEALTHCARE,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,UNITED HEALTHCARE,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,VA,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,VA TRICARE,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,WELLMED,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,HUMANA,MGD,19.34,,,,,,,per diem,19.34,19.34,"Per diem rate, code is bundled with other services"
DRESSING HYDROFERA BLUEFOAM4X5,33109273,CDM,270,RC,,,,,,Inpatient,,,19.34,19.34,HUMANA CHOICE PLUS,MGD,19.34,,,,,,,case rate,19.34,19.34,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,AETNA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,CIGNA,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,VA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,VA TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,WELLMED,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,HUMANA,MGD,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE TRIPANEL 22IN,33109843,CDM,270,RC,,,,,,Inpatient,,,117.6,117.6,HUMANA CHOICE PLUS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SHOE POST OP WOMEN MED        ,33109876,CDM,270,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,AETNA,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,BCBS,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,CIGNA,COM,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,TRICARE,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,UNITED HEALTHCARE,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,UNITED HEALTHCARE,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,VA,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,VA TRICARE,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,WELLMED,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,HUMANA,MGD,78.55,,,,,,,per diem,78.55,78.55,"Per diem rate, code is bundled with other services"
BOOT SMOOTH HEEL LIFT         ,33109899,CDM,270,RC,,,,,,Inpatient,,,78.55,78.55,HUMANA CHOICE PLUS,MGD,78.55,,,,,,,case rate,78.55,78.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,AETNA,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,CIGNA,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,TRICARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,UNITED HEALTHCARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,UNITED HEALTHCARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,VA,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,VA TRICARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,WELLMED,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,HUMANA,MGD,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 24IN         ,33109976,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,HUMANA CHOICE PLUS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SPIROMETER VOL INCENT 2500ML  ,33110165,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,AETNA,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,BCBS,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,CIGNA,COM,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,TRICARE,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,UNITED HEALTHCARE,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,UNITED HEALTHCARE,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,VA,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,VA TRICARE,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,WELLMED,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,HUMANA,MGD,96.08,,,,,,,per diem,96.08,96.08,"Per diem rate, code is bundled with other services"
SPLINT POST LEAF MEN RT 9-11  ,33110999,CDM,270,RC,,,,,,Inpatient,,,96.08,96.08,HUMANA CHOICE PLUS,MGD,96.08,,,,,,,case rate,96.08,96.08,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,AETNA,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,BCBS,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,CIGNA,COM,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,TRICARE,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,UNITED HEALTHCARE,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,UNITED HEALTHCARE,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,VA,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,VA TRICARE,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,WELLMED,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,HUMANA,MGD,29.55,,,,,,,per diem,29.55,29.55,"Per diem rate, code is bundled with other services"
BANDAGE COMP 4LAYER FOURFLEX  ,33111446,CDM,270,RC,,,,,,Inpatient,,,29.55,29.55,HUMANA CHOICE PLUS,MGD,29.55,,,,,,,case rate,29.55,29.55,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
IMMOBILIZER SHOULDER MED      ,33111804,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN LG 8.5-10    ,33112169,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN LARGE          ,33112375,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO MEN MEDIUM         ,33112376,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SHOE DARCO WOMEN MED          ,33112377,CDM,270,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,AETNA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,CIGNA,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,WELLMED,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA,MGD,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
SUPPORT WRIST RIGHT SMALL     ,33112478,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA CHOICE PLUS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,AETNA,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,CIGNA,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,TRICARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,UNITED HEALTHCARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,UNITED HEALTHCARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,VA,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,VA TRICARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,WELLMED,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,HUMANA,MGD,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
DRSG BIATAIN SOFT HOLD 4X4    ,33118600,CDM,270,RC,,,,,,Inpatient,,,7.15,7.15,HUMANA CHOICE PLUS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,AETNA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,CIGNA,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,VA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,VA TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,WELLMED,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA,MGD,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE SM,33120101,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA CHOICE PLUS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,AETNA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,CIGNA,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,VA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,VA TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,WELLMED,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA,MGD,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE LG,33120102,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA CHOICE PLUS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,AETNA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,BCBS,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,CIGNA,COM,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,UNITED HEALTHCARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,VA,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,VA TRICARE,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,WELLMED,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA,MGD,567,,,,,,,per diem,567,567,"Per diem rate, code is bundled with other services"
ORTH KNEE SOFT ROM COMPLETE XL,33120103,CDM,270,RC,,,,,,Inpatient,,,567,567,HUMANA CHOICE PLUS,MGD,567,,,,,,,case rate,567,567,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
SPLINT KYDEX SML RT           ,33122454,CDM,270,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,AETNA,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,CIGNA,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,TRICARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,UNITED HEALTHCARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,UNITED HEALTHCARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,VA,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,VA TRICARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,WELLMED,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,HUMANA,MGD,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC MED   ,33122468,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,HUMANA CHOICE PLUS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,AETNA,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,BCBS,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,CIGNA,COM,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,TRICARE,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,UNITED HEALTHCARE,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,UNITED HEALTHCARE,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,VA,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,VA TRICARE,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,WELLMED,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,HUMANA,MGD,37.42,,,,,,,per diem,37.42,37.42,"Per diem rate, code is bundled with other services"
DRESSING BARR SIL ACT 4X8     ,33123879,CDM,270,RC,,,,,,Inpatient,,,37.42,37.42,HUMANA CHOICE PLUS,MGD,37.42,,,,,,,case rate,37.42,37.42,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,AETNA,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,BCBS,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,CIGNA,COM,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,TRICARE,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,UNITED HEALTHCARE,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,UNITED HEALTHCARE,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,VA,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,VA TRICARE,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,WELLMED,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,HUMANA,MGD,52.06,,,,,,,per diem,52.06,52.06,"Per diem rate, code is bundled with other services"
"DRESSING, BIOPATCH, 1 DISK, CH",33124393,CDM,270,RC,,,,,,Inpatient,,,52.06,52.06,HUMANA CHOICE PLUS,MGD,52.06,,,,,,,case rate,52.06,52.06,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SPIROMETER, VOL INCENT, 4000ML",33124396,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,AETNA,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,BCBS,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,CIGNA,COM,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,TRICARE,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,UNITED HEALTHCARE,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,UNITED HEALTHCARE,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,VA,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,VA TRICARE,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,WELLMED,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,HUMANA,MGD,5.74,,,,,,,per diem,5.74,5.74,"Per diem rate, code is bundled with other services"
"MASK, OXYGEN, NON-REBREATHER  ",33124398,CDM,270,RC,,,,,,Inpatient,,,5.74,5.74,HUMANA CHOICE PLUS,MGD,5.74,,,,,,,case rate,5.74,5.74,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,AETNA,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,CIGNA,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,TRICARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,UNITED HEALTHCARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,UNITED HEALTHCARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,VA,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,VA TRICARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,WELLMED,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,HUMANA,MGD,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
"CONTROL, ACCU-CHEK, INFORM II ",33124457,CDM,270,RC,,,,,,Inpatient,,,5.69,5.69,HUMANA CHOICE PLUS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,AETNA,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,BCBS,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,CIGNA,COM,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,TRICARE,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,UNITED HEALTHCARE,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,UNITED HEALTHCARE,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,VA,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,VA TRICARE,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,WELLMED,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,HUMANA,MGD,51,,,,,,,per diem,51,51,"Per diem rate, code is bundled with other services"
ARMBOARD A LINE               ,33124590,CDM,270,RC,,,,,,Inpatient,,,51,51,HUMANA CHOICE PLUS,MGD,51,,,,,,,case rate,51,51,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,AETNA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,CIGNA,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,VA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,VA TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,WELLMED,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,HUMANA,MGD,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PILLOW MEDSOFT 18X24 WHT 20EA/,33124623,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,HUMANA CHOICE PLUS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM LG/XL,33124686,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ABDOMINAL 9TRI-PANL PREM SM/MD,33124687,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,AETNA,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,BCBS,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,CIGNA,COM,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,TRICARE,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,UNITED HEALTHCARE,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,UNITED HEALTHCARE,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,VA,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,VA TRICARE,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,WELLMED,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,HUMANA,MGD,13.19,,,,,,,per diem,13.19,13.19,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL / ELBOW, KNIT ",33124721,CDM,270,RC,,,,,,Inpatient,,,13.19,13.19,HUMANA CHOICE PLUS,MGD,13.19,,,,,,,case rate,13.19,13.19,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,AETNA,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,BCBS,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,CIGNA,COM,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,TRICARE,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,UNITED HEALTHCARE,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,UNITED HEALTHCARE,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,VA,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,VA TRICARE,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,WELLMED,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,HUMANA,MGD,56.48,,,,,,,per diem,56.48,56.48,"Per diem rate, code is bundled with other services"
"CHAIR, SHOWER, W/BACK         ",33124728,CDM,279,RC,,,,,,Inpatient,,,56.48,56.48,HUMANA CHOICE PLUS,MGD,56.48,,,,,,,case rate,56.48,56.48,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,AETNA,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,BCBS,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,CIGNA,COM,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,TRICARE,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,UNITED HEALTHCARE,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,UNITED HEALTHCARE,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,VA,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,VA TRICARE,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,WELLMED,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,HUMANA,MGD,24.96,,,,,,,per diem,24.96,24.96,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, MEDIUM",33124738,CDM,270,RC,,,,,,Inpatient,,,24.96,24.96,HUMANA CHOICE PLUS,MGD,24.96,,,,,,,case rate,24.96,24.96,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NAVY    ",33124741,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,AETNA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,CIGNA,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,WELLMED,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA,MGD,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"HOE, POST-OP, RIGID, NVY      ",33124742,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA CHOICE PLUS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,AETNA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,CIGNA,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,WELLMED,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA,MGD,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGID, NVY     ",33124743,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA CHOICE PLUS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,AETNA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,CIGNA,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,VA TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,WELLMED,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA,MGD,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
"SHOE, POST OP, RIGD, NVY      ",33124744,CDM,270,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA CHOICE PLUS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,AETNA,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,CIGNA,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,TRICARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,UNITED HEALTHCARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,UNITED HEALTHCARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,VA,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,VA TRICARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,WELLMED,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,HUMANA,MGD,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR                    ,33124759,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,HUMANA CHOICE PLUS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,AETNA,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,BCBS,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,CIGNA,COM,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,TRICARE,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,UNITED HEALTHCARE,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,UNITED HEALTHCARE,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,VA,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,VA TRICARE,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,WELLMED,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,HUMANA,MGD,29.95,,,,,,,per diem,29.95,29.95,"Per diem rate, code is bundled with other services"
"PROTECTOR, HEEL, ELBOW, WHT   ",33124776,CDM,270,RC,,,,,,Inpatient,,,29.95,29.95,HUMANA CHOICE PLUS,MGD,29.95,,,,,,,case rate,29.95,29.95,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT LG    ,33124827,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT MED   ,33124828,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,AETNA,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,CIGNA,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,TRICARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,UNITED HEALTHCARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,UNITED HEALTHCARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,VA,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,VA TRICARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,WELLMED,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,HUMANA,MGD,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPRO IN-BED AFO BOOT XL    ,33124829,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,HUMANA CHOICE PLUS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,AETNA,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,BCBS,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,CIGNA,COM,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,TRICARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,UNITED HEALTHCARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,UNITED HEALTHCARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,VA,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,VA TRICARE,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,WELLMED,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,HUMANA,MGD,108.64,,,,,,,per diem,108.64,108.64,"Per diem rate, code is bundled with other services"
SOFTPROF IN-BED AFO BOOT SM   ,33124854,CDM,270,RC,,,,,,Inpatient,,,108.64,108.64,HUMANA CHOICE PLUS,MGD,108.64,,,,,,,case rate,108.64,108.64,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO, LARGE, L    ",33124859,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM,L     ",33124860,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LEEDER REST WHFO,MEDIUM, R    ",33124861,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,AETNA,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,CIGNA,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,TRICARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,UNITED HEALTHCARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,UNITED HEALTHCARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,VA,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,VA TRICARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,WELLMED,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,HUMANA,MGD,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
CPM - CHATANUGA REMOTE PENDANT,33124863,CDM,279,RC,,,,,,Inpatient,,,10.8,10.8,HUMANA CHOICE PLUS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,AETNA,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,BCBS,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,CIGNA,COM,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,TRICARE,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,UNITED HEALTHCARE,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,UNITED HEALTHCARE,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,VA,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,VA TRICARE,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,WELLMED,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,HUMANA,MGD,146.85,,,,,,,per diem,146.85,146.85,"Per diem rate, code is bundled with other services"
GIVMOHR SLING LARGE           ,33124871,CDM,270,RC,,,,,,Inpatient,,,146.85,146.85,HUMANA CHOICE PLUS,MGD,146.85,,,,,,,case rate,146.85,146.85,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,AETNA,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,BCBS,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,CIGNA,COM,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,TRICARE,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,UNITED HEALTHCARE,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,UNITED HEALTHCARE,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,VA,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,VA TRICARE,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,WELLMED,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,HUMANA,MGD,68.91,,,,,,,per diem,68.91,68.91,"Per diem rate, code is bundled with other services"
BOOT HEEL PROT HEELMEXIX BASIC,33124894,CDM,270,RC,,,,,,Inpatient,,,68.91,68.91,HUMANA CHOICE PLUS,MGD,68.91,,,,,,,case rate,68.91,68.91,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,AETNA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,CIGNA,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,WELLMED,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA,MGD,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL L      ,33124901,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA CHOICE PLUS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,AETNA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,CIGNA,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,WELLMED,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA,MGD,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO SMALL R      ,33124902,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA CHOICE PLUS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,AETNA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,BCBS,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,CIGNA,COM,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,UNITED HEALTHCARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,VA TRICARE,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,WELLMED,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA,MGD,128.3,,,,,,,per diem,128.3,128.3,"Per diem rate, code is bundled with other services"
LEEDER REST WHFO LARGE R      ,33124903,CDM,270,RC,,,,,,Inpatient,,,128.3,128.3,HUMANA CHOICE PLUS,MGD,128.3,,,,,,,case rate,128.3,128.3,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN LEFT LR,33124909,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
SPLINT THUMB SPICA 6IN RT LG  ,33124910,CDM,270,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,AETNA,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,BCBS,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,CIGNA,COM,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,TRICARE,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,UNITED HEALTHCARE,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,UNITED HEALTHCARE,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,VA,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,VA TRICARE,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,WELLMED,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,HUMANA,MGD,157.41,,,,,,,per diem,157.41,157.41,"Per diem rate, code is bundled with other services"
OVERLAY WAFFLE EC PLS 76X34X3 ,33124913,CDM,279,RC,,,,,,Inpatient,,,157.41,157.41,HUMANA CHOICE PLUS,MGD,157.41,,,,,,,case rate,157.41,157.41,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,AETNA,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,BCBS,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,CIGNA,COM,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,TRICARE,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,UNITED HEALTHCARE,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,UNITED HEALTHCARE,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,VA,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,VA TRICARE,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,WELLMED,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,HUMANA,MGD,409.48,,,,,,,per diem,409.48,409.48,"Per diem rate, code is bundled with other services"
VISION BIPAP MACHINE DAILY REN,33125233,CDM,279,RC,,,,,,Inpatient,,,409.48,409.48,HUMANA CHOICE PLUS,MGD,409.48,,,,,,,case rate,409.48,409.48,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,AETNA,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,BCBS,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,CIGNA,COM,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,TRICARE,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,UNITED HEALTHCARE,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,UNITED HEALTHCARE,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,VA,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,VA TRICARE,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,WELLMED,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,HUMANA,MGD,990.66,,,,,,,per diem,990.66,990.66,"Per diem rate, code is bundled with other services"
RENASYS WOUND VAC GO PUMP DAIL,33125236,CDM,279,RC,,,,,,Inpatient,,,990.66,990.66,HUMANA CHOICE PLUS,MGD,990.66,,,,,,,case rate,990.66,990.66,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,AETNA,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,BCBS,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,CIGNA,COM,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,TRICARE,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,UNITED HEALTHCARE,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,UNITED HEALTHCARE,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,VA,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,VA TRICARE,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,WELLMED,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,HUMANA,MGD,6.78,,,,,,,per diem,6.78,6.78,"Per diem rate, code is bundled with other services"
KANGAROO EXTERNAL FEEDING PUMP,33125237,CDM,279,RC,,,,,,Inpatient,,,6.78,6.78,HUMANA CHOICE PLUS,MGD,6.78,,,,,,,case rate,6.78,6.78,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,AETNA,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,BCBS,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,CIGNA,COM,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,TRICARE,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,UNITED HEALTHCARE,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,UNITED HEALTHCARE,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,VA,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,VA TRICARE,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,WELLMED,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,HUMANA,MGD,1754.66,,,,,,,per diem,1754.66,1754.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED (1000LBS) DAILY ,33125238,CDM,279,RC,,,,,,Inpatient,,,1754.66,1754.66,HUMANA CHOICE PLUS,MGD,1754.66,,,,,,,case rate,1754.66,1754.66,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,AETNA,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,BCBS,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,CIGNA,COM,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,TRICARE,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,UNITED HEALTHCARE,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,UNITED HEALTHCARE,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,VA,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,VA TRICARE,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,WELLMED,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,HUMANA,MGD,2063.88,,,,,,,per diem,2063.88,2063.88,"Per diem rate, code is bundled with other services"
STAGE IV 3000 LAL MATTRESS    ,33125239,CDM,279,RC,,,,,,Inpatient,,,2063.88,2063.88,HUMANA CHOICE PLUS,MGD,2063.88,,,,,,,case rate,2063.88,2063.88,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,AETNA,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,BCBS,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,CIGNA,COM,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,TRICARE,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,UNITED HEALTHCARE,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,UNITED HEALTHCARE,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,VA,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,VA TRICARE,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,WELLMED,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,HUMANA,MGD,991.64,,,,,,,per diem,991.64,991.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS FOAM (500LB L,33125241,CDM,279,RC,,,,,,Inpatient,,,991.64,991.64,HUMANA CHOICE PLUS,MGD,991.64,,,,,,,case rate,991.64,991.64,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,AETNA,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,BCBS,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,CIGNA,COM,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,TRICARE,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,UNITED HEALTHCARE,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,UNITED HEALTHCARE,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,VA,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,VA TRICARE,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,WELLMED,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,HUMANA,MGD,396.27,,,,,,,per diem,396.27,396.27,"Per diem rate, code is bundled with other services"
AIR 2 LAL PULSATE MATTRESS    ,33125242,CDM,279,RC,,,,,,Inpatient,,,396.27,396.27,HUMANA CHOICE PLUS,MGD,396.27,,,,,,,case rate,396.27,396.27,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CHAIR SENSOR PAD              ,33125253,CDM,270,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,AETNA,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,BCBS,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,CIGNA,COM,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,TRICARE,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,UNITED HEALTHCARE,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,UNITED HEALTHCARE,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,VA,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,VA TRICARE,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,WELLMED,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,HUMANA,MGD,12.23,,,,,,,per diem,12.23,12.23,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33125296,CDM,270,RC,,,,,,Inpatient,,,12.23,12.23,HUMANA CHOICE PLUS,MGD,12.23,,,,,,,case rate,12.23,12.23,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,AETNA,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,BCBS,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,CIGNA,COM,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,TRICARE,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,UNITED HEALTHCARE,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,UNITED HEALTHCARE,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,VA,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,VA TRICARE,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,WELLMED,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,HUMANA,MGD,191.05,,,,,,,per diem,191.05,191.05,"Per diem rate, code is bundled with other services"
HEEL PRESSURE RELIEVING BOOT  ,33125298,CDM,270,RC,,,,,,Inpatient,,,191.05,191.05,HUMANA CHOICE PLUS,MGD,191.05,,,,,,,case rate,191.05,191.05,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,AETNA,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,BCBS,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,CIGNA,COM,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,TRICARE,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,UNITED HEALTHCARE,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,UNITED HEALTHCARE,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,VA,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,VA TRICARE,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,WELLMED,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,HUMANA,MGD,52.31,,,,,,,per diem,52.31,52.31,"Per diem rate, code is bundled with other services"
PILLOW ABDUCT DSPB SM 6X12X18 ,33125320,CDM,270,RC,,,,,,Inpatient,,,52.31,52.31,HUMANA CHOICE PLUS,MGD,52.31,,,,,,,case rate,52.31,52.31,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,AETNA,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,CIGNA,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,TRICARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,UNITED HEALTHCARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,UNITED HEALTHCARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,VA,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,VA TRICARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,WELLMED,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,HUMANA,MGD,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATTRESS         ,33125330,CDM,279,RC,,,,,,Inpatient,,,102.21,102.21,HUMANA CHOICE PLUS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,AETNA,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,BCBS,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,CIGNA,COM,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,TRICARE,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,UNITED HEALTHCARE,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,UNITED HEALTHCARE,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,VA,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,VA TRICARE,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,WELLMED,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,HUMANA,MGD,78.62,,,,,,,per diem,78.62,78.62,"Per diem rate, code is bundled with other services"
VISION BIPAP/CPAP             ,33125356,CDM,279,RC,,,,,,Inpatient,,,78.62,78.62,HUMANA CHOICE PLUS,MGD,78.62,,,,,,,case rate,78.62,78.62,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,AETNA,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,CIGNA,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,TRICARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,UNITED HEALTHCARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,UNITED HEALTHCARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,VA,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,VA TRICARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,WELLMED,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,HUMANA,MGD,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
BARI BED                      ,33125357,CDM,279,RC,,,,,,Inpatient,,,97.71,97.71,HUMANA CHOICE PLUS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,AETNA,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,BCBS,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,CIGNA,COM,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,TRICARE,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,UNITED HEALTHCARE,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,UNITED HEALTHCARE,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,VA,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,VA TRICARE,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,WELLMED,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,HUMANA,MGD,39.31,,,,,,,per diem,39.31,39.31,"Per diem rate, code is bundled with other services"
CONTINUOUS POX - UHS          ,33125358,CDM,279,RC,,,,,,Inpatient,,,39.31,39.31,HUMANA CHOICE PLUS,MGD,39.31,,,,,,,case rate,39.31,39.31,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33125360,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,AETNA,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,BCBS,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,CIGNA,COM,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,TRICARE,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,UNITED HEALTHCARE,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,UNITED HEALTHCARE,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,VA,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,VA TRICARE,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,WELLMED,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,HUMANA,MGD,29.07,,,,,,,per diem,29.07,29.07,"Per diem rate, code is bundled with other services"
SCD PUMP                      ,33125361,CDM,279,RC,,,,,,Inpatient,,,29.07,29.07,HUMANA CHOICE PLUS,MGD,29.07,,,,,,,case rate,29.07,29.07,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,AETNA,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,BCBS,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,CIGNA,COM,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,TRICARE,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,UNITED HEALTHCARE,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,UNITED HEALTHCARE,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,VA,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,VA TRICARE,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,WELLMED,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,HUMANA,MGD,133.17,,,,,,,per diem,133.17,133.17,"Per diem rate, code is bundled with other services"
WOUND VAC VCOK11537           ,33125362,CDM,279,RC,,,,,,Inpatient,,,133.17,133.17,HUMANA CHOICE PLUS,MGD,133.17,,,,,,,case rate,133.17,133.17,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,AETNA,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,CIGNA,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,TRICARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,UNITED HEALTHCARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,UNITED HEALTHCARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,VA,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,VA TRICARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,WELLMED,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,HUMANA,MGD,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
BARI MATTRESS                 ,33125363,CDM,279,RC,,,,,,Inpatient,,,36.75,36.75,HUMANA CHOICE PLUS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,AETNA,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,CIGNA,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,TRICARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,UNITED HEALTHCARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,UNITED HEALTHCARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,VA,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,VA TRICARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,WELLMED,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,HUMANA,MGD,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
BARIMATT 1000 PLUS MATTRESS   ,33125364,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,HUMANA CHOICE PLUS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,AETNA,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,BCBS,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,CIGNA,COM,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,TRICARE,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,UNITED HEALTHCARE,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,UNITED HEALTHCARE,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,VA,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,VA TRICARE,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,WELLMED,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,HUMANA,MGD,227.04,,,,,,,per diem,227.04,227.04,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33125365,CDM,270,RC,,,,,,Inpatient,,,227.04,227.04,HUMANA CHOICE PLUS,MGD,227.04,,,,,,,case rate,227.04,227.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,AETNA,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,BCBS,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,CIGNA,COM,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,TRICARE,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,UNITED HEALTHCARE,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,UNITED HEALTHCARE,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,VA,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,VA TRICARE,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,WELLMED,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,HUMANA,MGD,173.24,,,,,,,per diem,173.24,173.24,"Per diem rate, code is bundled with other services"
FREEDOM VAC                   ,33125366,CDM,279,RC,,,,,,Inpatient,,,173.24,173.24,HUMANA CHOICE PLUS,MGD,173.24,,,,,,,case rate,173.24,173.24,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,AETNA,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,BCBS,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,CIGNA,COM,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,TRICARE,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,UNITED HEALTHCARE,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,UNITED HEALTHCARE,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,VA,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,VA TRICARE,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,WELLMED,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,HUMANA,MGD,250.58,,,,,,,per diem,250.58,250.58,"Per diem rate, code is bundled with other services"
LIFEVEST WEARABLE DEFIB       ,33125369,CDM,279,RC,,,,,,Inpatient,,,250.58,250.58,HUMANA CHOICE PLUS,MGD,250.58,,,,,,,case rate,250.58,250.58,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,AETNA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,CIGNA,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,VA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,VA TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,WELLMED,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA,MGD,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
CATHETER FOLEY 5CC 16FR ALL   ,33125449,CDM,270,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA CHOICE PLUS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,AETNA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,CIGNA,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,VA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,VA TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,WELLMED,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA,MGD,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
BARI SHUTTLE CHAIR            ,33125776,CDM,279,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA CHOICE PLUS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,AETNA,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,BCBS,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,CIGNA,COM,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,TRICARE,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,UNITED HEALTHCARE,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,UNITED HEALTHCARE,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,VA,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,VA TRICARE,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,WELLMED,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,HUMANA,MGD,95.76,,,,,,,per diem,95.76,95.76,"Per diem rate, code is bundled with other services"
BARI HOYER LIFT WITH SCALE    ,33125777,CDM,279,RC,,,,,,Inpatient,,,95.76,95.76,HUMANA CHOICE PLUS,MGD,95.76,,,,,,,case rate,95.76,95.76,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,AETNA,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,BCBS,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,CIGNA,COM,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,TRICARE,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,UNITED HEALTHCARE,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,UNITED HEALTHCARE,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,VA,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,VA TRICARE,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,WELLMED,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,HUMANA,MGD,22.34,,,,,,,per diem,22.34,22.34,"Per diem rate, code is bundled with other services"
BARI BEDSIDE COMMODE          ,33125778,CDM,279,RC,,,,,,Inpatient,,,22.34,22.34,HUMANA CHOICE PLUS,MGD,22.34,,,,,,,case rate,22.34,22.34,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,AETNA,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,CIGNA,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,TRICARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,UNITED HEALTHCARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,UNITED HEALTHCARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,VA,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,VA TRICARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,WELLMED,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,HUMANA,MGD,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
BARIATRIC STAND-ALONE TRAPEZE ,33125864,CDM,279,RC,,,,,,Inpatient,,,24.07,24.07,HUMANA CHOICE PLUS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,AETNA,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,BCBS,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,CIGNA,COM,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,TRICARE,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,UNITED HEALTHCARE,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,UNITED HEALTHCARE,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,VA,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,VA TRICARE,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,WELLMED,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,HUMANA,MGD,0.37,,,,,,,per diem,0.37,0.37,"Per diem rate, code is bundled with other services"
ABDOMINAL PAD 5X9             ,33126010,CDM,270,RC,,,,,,Inpatient,,,0.37,0.37,HUMANA CHOICE PLUS,MGD,0.37,,,,,,,case rate,0.37,0.37,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,AETNA,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,BCBS,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,CIGNA,COM,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,TRICARE,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,UNITED HEALTHCARE,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,UNITED HEALTHCARE,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,VA,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,VA TRICARE,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,WELLMED,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,HUMANA,MGD,18.51,,,,,,,per diem,18.51,18.51,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33127208,CDM,270,RC,,,,,,Inpatient,,,18.51,18.51,HUMANA CHOICE PLUS,MGD,18.51,,,,,,,case rate,18.51,18.51,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,AETNA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,CIGNA,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,VA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,VA TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,WELLMED,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,HUMANA,MGD,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33127342,CDM,270,RC,,,,,,Inpatient,,,43,43,HUMANA CHOICE PLUS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,AETNA,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,BCBS,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,CIGNA,COM,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,TRICARE,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,UNITED HEALTHCARE,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,UNITED HEALTHCARE,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,VA,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,VA TRICARE,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,WELLMED,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,HUMANA,MGD,107.89,,,,,,,per diem,107.89,107.89,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33127451,CDM,279,RC,,,,,,Inpatient,,,107.89,107.89,HUMANA CHOICE PLUS,MGD,107.89,,,,,,,case rate,107.89,107.89,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,AETNA,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,BCBS,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,CIGNA,COM,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,TRICARE,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,UNITED HEALTHCARE,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,UNITED HEALTHCARE,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,VA,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,VA TRICARE,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,WELLMED,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,HUMANA,MGD,195.04,,,,,,,per diem,195.04,195.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33127456,CDM,279,RC,,,,,,Inpatient,,,195.04,195.04,HUMANA CHOICE PLUS,MGD,195.04,,,,,,,case rate,195.04,195.04,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,AETNA,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,BCBS,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,CIGNA,COM,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,TRICARE,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,UNITED HEALTHCARE,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,UNITED HEALTHCARE,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,VA,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,VA TRICARE,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,WELLMED,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,HUMANA,MGD,94.76,,,,,,,per diem,94.76,94.76,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33127462,CDM,279,RC,,,,,,Inpatient,,,94.76,94.76,HUMANA CHOICE PLUS,MGD,94.76,,,,,,,case rate,94.76,94.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,AETNA,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,BCBS,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,CIGNA,COM,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,TRICARE,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,UNITED HEALTHCARE,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,UNITED HEALTHCARE,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,VA,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,VA TRICARE,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,WELLMED,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,HUMANA,MGD,283.76,,,,,,,per diem,283.76,283.76,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33127464,CDM,279,RC,,,,,,Inpatient,,,283.76,283.76,HUMANA CHOICE PLUS,MGD,283.76,,,,,,,case rate,283.76,283.76,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,AETNA,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,BCBS,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,CIGNA,COM,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,TRICARE,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,UNITED HEALTHCARE,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,UNITED HEALTHCARE,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,VA,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,VA TRICARE,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,WELLMED,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,HUMANA,MGD,35.57,,,,,,,per diem,35.57,35.57,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33127465,CDM,279,RC,,,,,,Inpatient,,,35.57,35.57,HUMANA CHOICE PLUS,MGD,35.57,,,,,,,case rate,35.57,35.57,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,AETNA,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,BCBS,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,CIGNA,COM,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,TRICARE,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,UNITED HEALTHCARE,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,UNITED HEALTHCARE,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,VA,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,VA TRICARE,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,WELLMED,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,HUMANA,MGD,57.75,,,,,,,per diem,57.75,57.75,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33127466,CDM,279,RC,,,,,,Inpatient,,,57.75,57.75,HUMANA CHOICE PLUS,MGD,57.75,,,,,,,case rate,57.75,57.75,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33127467,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33127482,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,AETNA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,CIGNA,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,VA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,VA TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,WELLMED,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA,MGD,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33127489,CDM,279,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA CHOICE PLUS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,AETNA,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,BCBS,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,CIGNA,COM,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,TRICARE,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,UNITED HEALTHCARE,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,UNITED HEALTHCARE,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,VA,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,VA TRICARE,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,WELLMED,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,HUMANA,MGD,82.95,,,,,,,per diem,82.95,82.95,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33127490,CDM,279,RC,,,,,,Inpatient,,,82.95,82.95,HUMANA CHOICE PLUS,MGD,82.95,,,,,,,case rate,82.95,82.95,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
PAD SENSOR-CHAIR              ,33127508,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33127518,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,AETNA,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,BCBS,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,CIGNA,COM,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,TRICARE,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,UNITED HEALTHCARE,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,UNITED HEALTHCARE,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,VA,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,VA TRICARE,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,WELLMED,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,HUMANA,MGD,76.91,,,,,,,per diem,76.91,76.91,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE) DA,33127520,CDM,279,RC,,,,,,Inpatient,,,76.91,76.91,HUMANA CHOICE PLUS,MGD,76.91,,,,,,,case rate,76.91,76.91,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,AETNA,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,CIGNA,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,TRICARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,UNITED HEALTHCARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,UNITED HEALTHCARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,VA,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,VA TRICARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,WELLMED,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,HUMANA,MGD,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33127521,CDM,279,RC,,,,,,Inpatient,,,10.43,10.43,HUMANA CHOICE PLUS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,AETNA,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,BCBS,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,CIGNA,COM,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,TRICARE,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,UNITED HEALTHCARE,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,UNITED HEALTHCARE,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,VA,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,VA TRICARE,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,WELLMED,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,HUMANA,MGD,12.34,,,,,,,per diem,12.34,12.34,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33127523,CDM,279,RC,,,,,,Inpatient,,,12.34,12.34,HUMANA CHOICE PLUS,MGD,12.34,,,,,,,case rate,12.34,12.34,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,AETNA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,CIGNA,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,VA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,VA TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,WELLMED,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,HUMANA,MGD,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33127527,CDM,279,RC,,,,,,Inpatient,,,6.56,6.56,HUMANA CHOICE PLUS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,AETNA,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,BCBS,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,CIGNA,COM,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,TRICARE,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,UNITED HEALTHCARE,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,UNITED HEALTHCARE,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,VA,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,VA TRICARE,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,WELLMED,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,HUMANA,MGD,66.68,,,,,,,per diem,66.68,66.68,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33127533,CDM,279,RC,,,,,,Inpatient,,,66.68,66.68,HUMANA CHOICE PLUS,MGD,66.68,,,,,,,case rate,66.68,66.68,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33127534,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,AETNA,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,BCBS,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,CIGNA,COM,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,TRICARE,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,UNITED HEALTHCARE,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,UNITED HEALTHCARE,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,VA,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,VA TRICARE,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,WELLMED,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,HUMANA,MGD,138.98,,,,,,,per diem,138.98,138.98,"Per diem rate, code is bundled with other services"
COLLAR UNIVERSAL ASPEN # 5255-,33129235,CDM,270,RC,,,,,,Inpatient,,,138.98,138.98,HUMANA CHOICE PLUS,MGD,138.98,,,,,,,case rate,138.98,138.98,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,AETNA,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,CIGNA,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,TRICARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,UNITED HEALTHCARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,UNITED HEALTHCARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,VA,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,VA TRICARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,WELLMED,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,HUMANA,MGD,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN TO 45I,33129236,CDM,270,RC,,,,,,Inpatient,,,17.8,17.8,HUMANA CHOICE PLUS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,AETNA,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,BCBS,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,CIGNA,COM,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,TRICARE,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,UNITED HEALTHCARE,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,UNITED HEALTHCARE,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,VA,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,VA TRICARE,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,WELLMED,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,HUMANA,MGD,15.05,,,,,,,per diem,15.05,15.05,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33129237,CDM,270,RC,,,,,,Inpatient,,,15.05,15.05,HUMANA CHOICE PLUS,MGD,15.05,,,,,,,case rate,15.05,15.05,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,AETNA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,CIGNA,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,VA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,VA TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,WELLMED,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,HUMANA,MGD,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33129250,CDM,270,RC,,,,,,Inpatient,,,8.51,8.51,HUMANA CHOICE PLUS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,AETNA,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,BCBS,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,CIGNA,COM,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,TRICARE,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,UNITED HEALTHCARE,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,UNITED HEALTHCARE,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,VA,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,VA TRICARE,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,WELLMED,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,HUMANA,MGD,41.36,,,,,,,per diem,41.36,41.36,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR LG 3 1/4 # 79-,33129258,CDM,270,RC,,,,,,Inpatient,,,41.36,41.36,HUMANA CHOICE PLUS,MGD,41.36,,,,,,,case rate,41.36,41.36,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,AETNA,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,BCBS,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,CIGNA,COM,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,TRICARE,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,UNITED HEALTHCARE,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,UNITED HEALTHCARE,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,VA,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,VA TRICARE,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,WELLMED,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,HUMANA,MGD,41.52,,,,,,,per diem,41.52,41.52,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR SMALL 4 1/4 # ,33129259,CDM,270,RC,,,,,,Inpatient,,,41.52,41.52,HUMANA CHOICE PLUS,MGD,41.52,,,,,,,case rate,41.52,41.52,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,AETNA,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,CIGNA,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,TRICARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,UNITED HEALTHCARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,UNITED HEALTHCARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,VA,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,VA TRICARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,WELLMED,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,HUMANA,MGD,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
KNEE SEPARATOR W/ POLYESTER CO,33129261,CDM,270,RC,,,,,,Inpatient,,,72.01,72.01,HUMANA CHOICE PLUS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,AETNA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,CIGNA,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,VA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,VA TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,WELLMED,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,HUMANA,MGD,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER MED # A545,33129263,CDM,270,RC,,,,,,Inpatient,,,19.69,19.69,HUMANA CHOICE PLUS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,AETNA,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,BCBS,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,CIGNA,COM,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,TRICARE,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,UNITED HEALTHCARE,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,UNITED HEALTHCARE,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,VA,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,VA TRICARE,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,WELLMED,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,HUMANA,MGD,54.51,,,,,,,per diem,54.51,54.51,"Per diem rate, code is bundled with other services"
SHOULDER IMMOBILZER LARGE # A5,33129264,CDM,270,RC,,,,,,Inpatient,,,54.51,54.51,HUMANA CHOICE PLUS,MGD,54.51,,,,,,,case rate,54.51,54.51,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,AETNA,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,CIGNA,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,TRICARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,UNITED HEALTHCARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,UNITED HEALTHCARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,VA,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,VA TRICARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,WELLMED,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,HUMANA,MGD,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33129303,CDM,279,RC,,,,,,Inpatient,,,5.72,5.72,HUMANA CHOICE PLUS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,AETNA,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,BCBS,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,CIGNA,COM,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,TRICARE,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,UNITED HEALTHCARE,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,UNITED HEALTHCARE,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,VA,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,VA TRICARE,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,WELLMED,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,HUMANA,MGD,121.17,,,,,,,per diem,121.17,121.17,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33129317,CDM,279,RC,,,,,,Inpatient,,,121.17,121.17,HUMANA CHOICE PLUS,MGD,121.17,,,,,,,case rate,121.17,121.17,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,AETNA,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,BCBS,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,CIGNA,COM,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,TRICARE,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,UNITED HEALTHCARE,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,UNITED HEALTHCARE,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,VA,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,VA TRICARE,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,WELLMED,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,HUMANA,MGD,158.55,,,,,,,per diem,158.55,158.55,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33129320,CDM,270,RC,,,,,,Inpatient,,,158.55,158.55,HUMANA CHOICE PLUS,MGD,158.55,,,,,,,case rate,158.55,158.55,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,AETNA,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,BCBS,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,CIGNA,COM,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,TRICARE,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,UNITED HEALTHCARE,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,UNITED HEALTHCARE,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,VA,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,VA TRICARE,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,WELLMED,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,HUMANA,MGD,103.74,,,,,,,per diem,103.74,103.74,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33129383,CDM,270,RC,,,,,,Inpatient,,,103.74,103.74,HUMANA CHOICE PLUS,MGD,103.74,,,,,,,case rate,103.74,103.74,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,AETNA,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,BCBS,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,CIGNA,COM,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,TRICARE,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,UNITED HEALTHCARE,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,UNITED HEALTHCARE,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,VA,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,VA TRICARE,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,WELLMED,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,HUMANA,MGD,78.02,,,,,,,per diem,78.02,78.02,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33129385,CDM,270,RC,,,,,,Inpatient,,,78.02,78.02,HUMANA CHOICE PLUS,MGD,78.02,,,,,,,case rate,78.02,78.02,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,AETNA,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,BCBS,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,CIGNA,COM,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,TRICARE,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,UNITED HEALTHCARE,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,UNITED HEALTHCARE,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,VA,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,VA TRICARE,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,WELLMED,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,HUMANA,MGD,203.1,,,,,,,per diem,203.1,203.1,"Per diem rate, code is bundled with other services"
BARIATRIC DEOP ARM COMMODE    ,33129507,CDM,279,RC,,,,,,Inpatient,,,203.1,203.1,HUMANA CHOICE PLUS,MGD,203.1,,,,,,,case rate,203.1,203.1,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,AETNA,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,BCBS,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,CIGNA,COM,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,TRICARE,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,UNITED HEALTHCARE,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,UNITED HEALTHCARE,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,VA,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,VA TRICARE,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,WELLMED,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,HUMANA,MGD,577.4,,,,,,,per diem,577.4,577.4,"Per diem rate, code is bundled with other services"
ICEMAN COOLER # 11-0494       ,33129536,CDM,279,RC,,,,,,Inpatient,,,577.4,577.4,HUMANA CHOICE PLUS,MGD,577.4,,,,,,,case rate,577.4,577.4,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,AETNA,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,CIGNA,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,TRICARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,UNITED HEALTHCARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,UNITED HEALTHCARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,VA,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,VA TRICARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,WELLMED,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,HUMANA,MGD,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129556,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,HUMANA CHOICE PLUS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,AETNA,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,BCBS,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,CIGNA,COM,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,TRICARE,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,UNITED HEALTHCARE,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,UNITED HEALTHCARE,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,VA,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,VA TRICARE,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,WELLMED,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,HUMANA,MGD,242.14,,,,,,,per diem,242.14,242.14,"Per diem rate, code is bundled with other services"
ROYLAM DURABLE UNIVERSAL BOOT ,33129558,CDM,270,RC,,,,,,Inpatient,,,242.14,242.14,HUMANA CHOICE PLUS,MGD,242.14,,,,,,,case rate,242.14,242.14,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,AETNA,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,BCBS,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,CIGNA,COM,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,TRICARE,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,UNITED HEALTHCARE,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,UNITED HEALTHCARE,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,VA,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,VA TRICARE,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,WELLMED,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,HUMANA,MGD,88.8,,,,,,,per diem,88.8,88.8,"Per diem rate, code is bundled with other services"
TRI PANEL KNEE IMMOBILIZER #55,33129572,CDM,270,RC,,,,,,Inpatient,,,88.8,88.8,HUMANA CHOICE PLUS,MGD,88.8,,,,,,,case rate,88.8,88.8,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,AETNA,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,BCBS,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,CIGNA,COM,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,TRICARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,UNITED HEALTHCARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,UNITED HEALTHCARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,VA,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,VA TRICARE,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,WELLMED,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,HUMANA,MGD,75.82,,,,,,,per diem,75.82,75.82,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129573,CDM,270,RC,,,,,,Inpatient,,,75.82,75.82,HUMANA CHOICE PLUS,MGD,75.82,,,,,,,case rate,75.82,75.82,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,AETNA,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,CIGNA,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,TRICARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,UNITED HEALTHCARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,UNITED HEALTHCARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,VA,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,VA TRICARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,WELLMED,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,HUMANA,MGD,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
ROLYAN UNIVERSAL KNEE IMMOBILI,33129574,CDM,270,RC,,,,,,Inpatient,,,85.62,85.62,HUMANA CHOICE PLUS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,AETNA,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,BCBS,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,CIGNA,COM,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,TRICARE,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,UNITED HEALTHCARE,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,UNITED HEALTHCARE,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,VA,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,VA TRICARE,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,WELLMED,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,HUMANA,MGD,66.91,,,,,,,per diem,66.91,66.91,"Per diem rate, code is bundled with other services"
SI BACK BELT MEDIUM #56298602 ,33129575,CDM,270,RC,,,,,,Inpatient,,,66.91,66.91,HUMANA CHOICE PLUS,MGD,66.91,,,,,,,case rate,66.91,66.91,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,AETNA,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,CIGNA,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,TRICARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,UNITED HEALTHCARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,UNITED HEALTHCARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,VA,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,VA TRICARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,WELLMED,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,HUMANA,MGD,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT X LARGE # 56,33129576,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,HUMANA CHOICE PLUS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,AETNA,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,BCBS,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,CIGNA,COM,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,TRICARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,UNITED HEALTHCARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,UNITED HEALTHCARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,VA,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,VA TRICARE,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,WELLMED,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,HUMANA,MGD,184.5,,,,,,,per diem,184.5,184.5,"Per diem rate, code is bundled with other services"
ROYLAN PODUS BOOT STANDARD # 5,33129577,CDM,270,RC,,,,,,Inpatient,,,184.5,184.5,HUMANA CHOICE PLUS,MGD,184.5,,,,,,,case rate,184.5,184.5,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,AETNA,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,BCBS,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,CIGNA,COM,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,TRICARE,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,UNITED HEALTHCARE,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,UNITED HEALTHCARE,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,VA,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,VA TRICARE,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,WELLMED,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,HUMANA,MGD,4.16,,,,,,,per diem,4.16,4.16,"Per diem rate, code is bundled with other services"
COLLAR TRACH LARGE 3 1/4 # 525,33129579,CDM,270,RC,,,,,,Inpatient,,,4.16,4.16,HUMANA CHOICE PLUS,MGD,4.16,,,,,,,case rate,4.16,4.16,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,AETNA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,CIGNA,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,VA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,VA TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,WELLMED,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA,MGD,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
POSEY VAIL BED DAILY RENTAL   ,33129588,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA CHOICE PLUS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,AETNA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,CIGNA,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,WELLMED,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA,MGD,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33129589,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA CHOICE PLUS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,AETNA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,CIGNA,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,VA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,VA TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,WELLMED,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,HUMANA,MGD,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33129590,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,HUMANA CHOICE PLUS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,AETNA,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,CIGNA,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,TRICARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,UNITED HEALTHCARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,UNITED HEALTHCARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,VA,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,VA TRICARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,WELLMED,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,HUMANA,MGD,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 700lb RENT  ,33129591,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,HUMANA CHOICE PLUS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,AETNA,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,BCBS,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,CIGNA,COM,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,TRICARE,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,UNITED HEALTHCARE,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,UNITED HEALTHCARE,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,VA,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,VA TRICARE,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,WELLMED,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,HUMANA,MGD,142.8,,,,,,,per diem,142.8,142.8,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33129592,CDM,279,RC,,,,,,Inpatient,,,142.8,142.8,HUMANA CHOICE PLUS,MGD,142.8,,,,,,,case rate,142.8,142.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,AETNA,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,BCBS,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,CIGNA,COM,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,TRICARE,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,UNITED HEALTHCARE,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,UNITED HEALTHCARE,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,VA,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,VA TRICARE,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,WELLMED,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,HUMANA,MGD,83.27,,,,,,,per diem,83.27,83.27,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33129593,CDM,279,RC,,,,,,Inpatient,,,83.27,83.27,HUMANA CHOICE PLUS,MGD,83.27,,,,,,,case rate,83.27,83.27,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,AETNA,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,CIGNA,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,TRICARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,UNITED HEALTHCARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,UNITED HEALTHCARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,VA,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,VA TRICARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,WELLMED,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,HUMANA,MGD,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33129594,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,HUMANA CHOICE PLUS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,AETNA,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,BCBS,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,CIGNA,COM,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,TRICARE,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,UNITED HEALTHCARE,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,UNITED HEALTHCARE,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,VA,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,VA TRICARE,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,WELLMED,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,HUMANA,MGD,168.16,,,,,,,per diem,168.16,168.16,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33129595,CDM,279,RC,,,,,,Inpatient,,,168.16,168.16,HUMANA CHOICE PLUS,MGD,168.16,,,,,,,case rate,168.16,168.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,AETNA,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,BCBS,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,CIGNA,COM,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,TRICARE,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,UNITED HEALTHCARE,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,UNITED HEALTHCARE,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,VA,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,VA TRICARE,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,WELLMED,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,HUMANA,MGD,38.2,,,,,,,per diem,38.2,38.2,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33129596,CDM,279,RC,,,,,,Inpatient,,,38.2,38.2,HUMANA CHOICE PLUS,MGD,38.2,,,,,,,case rate,38.2,38.2,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,AETNA,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,CIGNA,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,TRICARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,UNITED HEALTHCARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,UNITED HEALTHCARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,VA,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,VA TRICARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,WELLMED,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,HUMANA,MGD,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33129597,CDM,279,RC,,,,,,Inpatient,,,13.23,13.23,HUMANA CHOICE PLUS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,AETNA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,CIGNA,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,VA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,VA TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,WELLMED,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,HUMANA,MGD,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33129598,CDM,279,RC,,,,,,Inpatient,,,106.94,106.94,HUMANA CHOICE PLUS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,AETNA,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,BCBS,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,CIGNA,COM,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,TRICARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,UNITED HEALTHCARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,UNITED HEALTHCARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,VA,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,VA TRICARE,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,WELLMED,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,HUMANA,MGD,35.86,,,,,,,per diem,35.86,35.86,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33129599,CDM,279,RC,,,,,,Inpatient,,,35.86,35.86,HUMANA CHOICE PLUS,MGD,35.86,,,,,,,case rate,35.86,35.86,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,AETNA,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,BCBS,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,CIGNA,COM,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,TRICARE,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,UNITED HEALTHCARE,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,UNITED HEALTHCARE,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,VA,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,VA TRICARE,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,WELLMED,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,HUMANA,MGD,95.39,,,,,,,per diem,95.39,95.39,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33129600,CDM,279,RC,,,,,,Inpatient,,,95.39,95.39,HUMANA CHOICE PLUS,MGD,95.39,,,,,,,case rate,95.39,95.39,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,AETNA,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,BCBS,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,CIGNA,COM,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,TRICARE,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,UNITED HEALTHCARE,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,UNITED HEALTHCARE,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,VA,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,VA TRICARE,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,WELLMED,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,HUMANA,MGD,190.73,,,,,,,per diem,190.73,190.73,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33129602,CDM,279,RC,,,,,,Inpatient,,,190.73,190.73,HUMANA CHOICE PLUS,MGD,190.73,,,,,,,case rate,190.73,190.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,AETNA,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,CIGNA,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,TRICARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,UNITED HEALTHCARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,UNITED HEALTHCARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,VA,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,VA TRICARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,WELLMED,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,HUMANA,MGD,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33129603,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,HUMANA CHOICE PLUS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,AETNA,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,BCBS,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,CIGNA,COM,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,TRICARE,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,UNITED HEALTHCARE,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,UNITED HEALTHCARE,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,VA,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,VA TRICARE,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,WELLMED,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,HUMANA,MGD,23.73,,,,,,,per diem,23.73,23.73,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33129604,CDM,279,RC,,,,,,Inpatient,,,23.73,23.73,HUMANA CHOICE PLUS,MGD,23.73,,,,,,,case rate,23.73,23.73,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,AETNA,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,CIGNA,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,TRICARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,UNITED HEALTHCARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,UNITED HEALTHCARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,VA,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,VA TRICARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,WELLMED,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,HUMANA,MGD,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33129605,CDM,279,RC,,,,,,Inpatient,,,57.33,57.33,HUMANA CHOICE PLUS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,AETNA,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,BCBS,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,CIGNA,COM,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,TRICARE,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,UNITED HEALTHCARE,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,UNITED HEALTHCARE,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,VA,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,VA TRICARE,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,WELLMED,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,HUMANA,MGD,26.12,,,,,,,per diem,26.12,26.12,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33129606,CDM,279,RC,,,,,,Inpatient,,,26.12,26.12,HUMANA CHOICE PLUS,MGD,26.12,,,,,,,case rate,26.12,26.12,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,AETNA,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,BCBS,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,CIGNA,COM,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,TRICARE,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,UNITED HEALTHCARE,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,UNITED HEALTHCARE,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,VA,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,VA TRICARE,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,WELLMED,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,HUMANA,MGD,22.84,,,,,,,per diem,22.84,22.84,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33129607,CDM,279,RC,,,,,,Inpatient,,,22.84,22.84,HUMANA CHOICE PLUS,MGD,22.84,,,,,,,case rate,22.84,22.84,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,AETNA,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,BCBS,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,CIGNA,COM,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,TRICARE,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,UNITED HEALTHCARE,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,UNITED HEALTHCARE,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,VA,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,VA TRICARE,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,WELLMED,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,HUMANA,MGD,71.66,,,,,,,per diem,71.66,71.66,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33129608,CDM,279,RC,,,,,,Inpatient,,,71.66,71.66,HUMANA CHOICE PLUS,MGD,71.66,,,,,,,case rate,71.66,71.66,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,AETNA,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,BCBS,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,CIGNA,COM,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,TRICARE,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,UNITED HEALTHCARE,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,UNITED HEALTHCARE,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,VA,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,VA TRICARE,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,WELLMED,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,HUMANA,MGD,178.61,,,,,,,per diem,178.61,178.61,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33129610,CDM,279,RC,,,,,,Inpatient,,,178.61,178.61,HUMANA CHOICE PLUS,MGD,178.61,,,,,,,case rate,178.61,178.61,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,AETNA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,CIGNA,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,WELLMED,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA,MGD,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33129611,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA CHOICE PLUS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,AETNA,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,BCBS,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,CIGNA,COM,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,TRICARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,UNITED HEALTHCARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,UNITED HEALTHCARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,VA,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,VA TRICARE,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,WELLMED,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,HUMANA,MGD,19.32,,,,,,,per diem,19.32,19.32,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33129612,CDM,279,RC,,,,,,Inpatient,,,19.32,19.32,HUMANA CHOICE PLUS,MGD,19.32,,,,,,,case rate,19.32,19.32,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,AETNA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,CIGNA,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,VA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,VA TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,WELLMED,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA,MGD,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33129613,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA CHOICE PLUS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,AETNA,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,BCBS,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,CIGNA,COM,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,TRICARE,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,UNITED HEALTHCARE,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,UNITED HEALTHCARE,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,VA,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,VA TRICARE,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,WELLMED,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,HUMANA,MGD,8.3,,,,,,,per diem,8.3,8.3,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33129614,CDM,279,RC,,,,,,Inpatient,,,8.3,8.3,HUMANA CHOICE PLUS,MGD,8.3,,,,,,,case rate,8.3,8.3,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,AETNA,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,BCBS,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,CIGNA,COM,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,TRICARE,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,UNITED HEALTHCARE,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,UNITED HEALTHCARE,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,VA,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,VA TRICARE,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,WELLMED,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,HUMANA,MGD,183.59,,,,,,,per diem,183.59,183.59,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33129616,CDM,279,RC,,,,,,Inpatient,,,183.59,183.59,HUMANA CHOICE PLUS,MGD,183.59,,,,,,,case rate,183.59,183.59,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,AETNA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,CIGNA,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,VA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,VA TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,WELLMED,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA,MGD,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33129617,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA CHOICE PLUS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33129618,CDM,279,RC,,,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,AETNA,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,CIGNA,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,TRICARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,UNITED HEALTHCARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,UNITED HEALTHCARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,VA,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,VA TRICARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,WELLMED,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,HUMANA,MGD,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33129619,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,HUMANA CHOICE PLUS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,AETNA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,CIGNA,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,WELLMED,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA,MGD,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33129621,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA CHOICE PLUS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33129622,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,AETNA,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,BCBS,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,CIGNA,COM,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,TRICARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,UNITED HEALTHCARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,UNITED HEALTHCARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,VA,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,VA TRICARE,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,WELLMED,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,HUMANA,MGD,38.06,,,,,,,per diem,38.06,38.06,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33129623,CDM,279,RC,,,,,,Inpatient,,,38.06,38.06,HUMANA CHOICE PLUS,MGD,38.06,,,,,,,case rate,38.06,38.06,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,AETNA,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,BCBS,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,CIGNA,COM,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,TRICARE,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,UNITED HEALTHCARE,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,UNITED HEALTHCARE,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,VA,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,VA TRICARE,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,WELLMED,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,HUMANA,MGD,4.99,,,,,,,per diem,4.99,4.99,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33129624,CDM,279,RC,,,,,,Inpatient,,,4.99,4.99,HUMANA CHOICE PLUS,MGD,4.99,,,,,,,case rate,4.99,4.99,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,AETNA,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,BCBS,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,CIGNA,COM,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,TRICARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,UNITED HEALTHCARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,UNITED HEALTHCARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,VA,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,VA TRICARE,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,WELLMED,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,HUMANA,MGD,285.55,,,,,,,per diem,285.55,285.55,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33129625,CDM,279,RC,,,,,,Inpatient,,,285.55,285.55,HUMANA CHOICE PLUS,MGD,285.55,,,,,,,case rate,285.55,285.55,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,AETNA,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,CIGNA,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,TRICARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,UNITED HEALTHCARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,UNITED HEALTHCARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,VA,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,VA TRICARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,WELLMED,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,HUMANA,MGD,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33129626,CDM,279,RC,,,,,,Inpatient,,,60.64,60.64,HUMANA CHOICE PLUS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,AETNA,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,BCBS,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,CIGNA,COM,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,TRICARE,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,UNITED HEALTHCARE,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,UNITED HEALTHCARE,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,VA,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,VA TRICARE,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,WELLMED,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,HUMANA,MGD,571.67,,,,,,,per diem,571.67,571.67,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33129627,CDM,279,RC,,,,,,Inpatient,,,571.67,571.67,HUMANA CHOICE PLUS,MGD,571.67,,,,,,,case rate,571.67,571.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,AETNA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,CIGNA,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,WELLMED,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA,MGD,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33129628,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA CHOICE PLUS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,AETNA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,CIGNA,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,VA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,VA TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,WELLMED,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,HUMANA,MGD,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33129629,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,HUMANA CHOICE PLUS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,AETNA,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,BCBS,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,CIGNA,COM,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,TRICARE,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,UNITED HEALTHCARE,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,UNITED HEALTHCARE,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,VA,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,VA TRICARE,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,WELLMED,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,HUMANA,MGD,140.6,,,,,,,per diem,140.6,140.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33129630,CDM,279,RC,,,,,,Inpatient,,,140.6,140.6,HUMANA CHOICE PLUS,MGD,140.6,,,,,,,case rate,140.6,140.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,AETNA,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,BCBS,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,CIGNA,COM,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,TRICARE,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,UNITED HEALTHCARE,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,UNITED HEALTHCARE,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,VA,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,VA TRICARE,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,WELLMED,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,HUMANA,MGD,64.52,,,,,,,per diem,64.52,64.52,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33129631,CDM,279,RC,,,,,,Inpatient,,,64.52,64.52,HUMANA CHOICE PLUS,MGD,64.52,,,,,,,case rate,64.52,64.52,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,AETNA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,CIGNA,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,WELLMED,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,HUMANA,MGD,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33129632,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,HUMANA CHOICE PLUS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,AETNA,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,CIGNA,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,TRICARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,UNITED HEALTHCARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,UNITED HEALTHCARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,VA,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,VA TRICARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,WELLMED,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,HUMANA,MGD,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129633,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,HUMANA CHOICE PLUS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,AETNA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,BCBS,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,CIGNA,COM,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,UNITED HEALTHCARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,VA,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,VA TRICARE,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,WELLMED,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA,MGD,43,,,,,,,per diem,43,43,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129634,CDM,279,RC,,,,,,Inpatient,,,43,43,HUMANA CHOICE PLUS,MGD,43,,,,,,,case rate,43,43,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,AETNA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,CIGNA,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,VA TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,WELLMED,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA,MGD,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33129636,CDM,279,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA CHOICE PLUS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,AETNA,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,BCBS,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,CIGNA,COM,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,TRICARE,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,UNITED HEALTHCARE,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,UNITED HEALTHCARE,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,VA,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,VA TRICARE,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,WELLMED,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,HUMANA,MGD,89.3,,,,,,,per diem,89.3,89.3,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33129637,CDM,279,RC,,,,,,Inpatient,,,89.3,89.3,HUMANA CHOICE PLUS,MGD,89.3,,,,,,,case rate,89.3,89.3,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,AETNA,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,BCBS,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,CIGNA,COM,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,TRICARE,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,UNITED HEALTHCARE,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,UNITED HEALTHCARE,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,VA,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,VA TRICARE,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,WELLMED,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,HUMANA,MGD,61.74,,,,,,,per diem,61.74,61.74,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33129638,CDM,279,RC,,,,,,Inpatient,,,61.74,61.74,HUMANA CHOICE PLUS,MGD,61.74,,,,,,,case rate,61.74,61.74,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,AETNA,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,CIGNA,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,TRICARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,UNITED HEALTHCARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,UNITED HEALTHCARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,VA,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,VA TRICARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,WELLMED,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,HUMANA,MGD,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33129639,CDM,279,RC,,,,,,Inpatient,,,88.2,88.2,HUMANA CHOICE PLUS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,AETNA,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,BCBS,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,CIGNA,COM,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,TRICARE,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,UNITED HEALTHCARE,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,UNITED HEALTHCARE,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,VA,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,VA TRICARE,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,WELLMED,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,HUMANA,MGD,50.19,,,,,,,per diem,50.19,50.19,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33129640,CDM,279,RC,,,,,,Inpatient,,,50.19,50.19,HUMANA CHOICE PLUS,MGD,50.19,,,,,,,case rate,50.19,50.19,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,AETNA,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,BCBS,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,CIGNA,COM,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,TRICARE,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,UNITED HEALTHCARE,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,UNITED HEALTHCARE,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,VA,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,VA TRICARE,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,WELLMED,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,HUMANA,MGD,41.9,,,,,,,per diem,41.9,41.9,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33129642,CDM,279,RC,,,,,,Inpatient,,,41.9,41.9,HUMANA CHOICE PLUS,MGD,41.9,,,,,,,case rate,41.9,41.9,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,AETNA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,CIGNA,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,VA TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,WELLMED,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,HUMANA,MGD,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33129643,CDM,279,RC,,,,,,Inpatient,,,54.6,54.6,HUMANA CHOICE PLUS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,AETNA,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,BCBS,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,CIGNA,COM,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,TRICARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,UNITED HEALTHCARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,UNITED HEALTHCARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,VA,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,VA TRICARE,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,WELLMED,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,HUMANA,MGD,143.9,,,,,,,per diem,143.9,143.9,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33129644,CDM,279,RC,,,,,,Inpatient,,,143.9,143.9,HUMANA CHOICE PLUS,MGD,143.9,,,,,,,case rate,143.9,143.9,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,AETNA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,CIGNA,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,VA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,VA TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,WELLMED,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,HUMANA,MGD,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33129646,CDM,279,RC,,,,,,Inpatient,,,82.16,82.16,HUMANA CHOICE PLUS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,AETNA,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,BCBS,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,CIGNA,COM,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,TRICARE,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,UNITED HEALTHCARE,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,UNITED HEALTHCARE,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,VA,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,VA TRICARE,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,WELLMED,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,HUMANA,MGD,31.97,,,,,,,per diem,31.97,31.97,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33129647,CDM,279,RC,,,,,,Inpatient,,,31.97,31.97,HUMANA CHOICE PLUS,MGD,31.97,,,,,,,case rate,31.97,31.97,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,AETNA,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,CIGNA,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,TRICARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,UNITED HEALTHCARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,UNITED HEALTHCARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,VA,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,VA TRICARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,WELLMED,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,HUMANA,MGD,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33129649,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,HUMANA CHOICE PLUS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,AETNA,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,BCBS,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,CIGNA,COM,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,TRICARE,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,UNITED HEALTHCARE,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,UNITED HEALTHCARE,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,VA,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,VA TRICARE,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,WELLMED,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,HUMANA,MGD,229.32,,,,,,,per diem,229.32,229.32,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33129650,CDM,279,RC,,,,,,Inpatient,,,229.32,229.32,HUMANA CHOICE PLUS,MGD,229.32,,,,,,,case rate,229.32,229.32,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,AETNA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,CIGNA,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,VA TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,WELLMED,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA,MGD,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33129651,CDM,279,RC,,,,,,Inpatient,,,47.41,47.41,HUMANA CHOICE PLUS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,AETNA,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,BCBS,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,CIGNA,COM,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,TRICARE,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,UNITED HEALTHCARE,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,UNITED HEALTHCARE,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,VA,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,VA TRICARE,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,WELLMED,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,HUMANA,MGD,146.63,,,,,,,per diem,146.63,146.63,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33129653,CDM,279,RC,,,,,,Inpatient,,,146.63,146.63,HUMANA CHOICE PLUS,MGD,146.63,,,,,,,case rate,146.63,146.63,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,AETNA,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,BCBS,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,CIGNA,COM,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,TRICARE,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,UNITED HEALTHCARE,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,UNITED HEALTHCARE,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,VA,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,VA TRICARE,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,WELLMED,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,HUMANA,MGD,137.11,,,,,,,per diem,137.11,137.11,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33129654,CDM,279,RC,,,,,,Inpatient,,,137.11,137.11,HUMANA CHOICE PLUS,MGD,137.11,,,,,,,case rate,137.11,137.11,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,AETNA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,CIGNA,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,WELLMED,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA,MGD,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33129655,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA CHOICE PLUS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,AETNA,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,BCBS,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,CIGNA,COM,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,TRICARE,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,UNITED HEALTHCARE,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,UNITED HEALTHCARE,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,VA,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,VA TRICARE,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,WELLMED,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,HUMANA,MGD,189.41,,,,,,,per diem,189.41,189.41,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33129656,CDM,279,RC,,,,,,Inpatient,,,189.41,189.41,HUMANA CHOICE PLUS,MGD,189.41,,,,,,,case rate,189.41,189.41,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,AETNA,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,BCBS,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,CIGNA,COM,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,TRICARE,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,UNITED HEALTHCARE,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,UNITED HEALTHCARE,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,VA,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,VA TRICARE,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,WELLMED,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,HUMANA,MGD,154.93,,,,,,,per diem,154.93,154.93,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33129657,CDM,279,RC,,,,,,Inpatient,,,154.93,154.93,HUMANA CHOICE PLUS,MGD,154.93,,,,,,,case rate,154.93,154.93,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33129658,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,AETNA,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,BCBS,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,CIGNA,COM,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,TRICARE,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,UNITED HEALTHCARE,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,UNITED HEALTHCARE,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,VA,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,VA TRICARE,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,WELLMED,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,HUMANA,MGD,76.07,,,,,,,per diem,76.07,76.07,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY MEDPULSE DA  ,33129660,CDM,279,RC,,,,,,Inpatient,,,76.07,76.07,HUMANA CHOICE PLUS,MGD,76.07,,,,,,,case rate,76.07,76.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,AETNA,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,BCBS,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,CIGNA,COM,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,TRICARE,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,UNITED HEALTHCARE,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,UNITED HEALTHCARE,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,VA,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,VA TRICARE,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,WELLMED,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,HUMANA,MGD,49.07,,,,,,,per diem,49.07,49.07,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION DE,33129661,CDM,279,RC,,,,,,Inpatient,,,49.07,49.07,HUMANA CHOICE PLUS,MGD,49.07,,,,,,,case rate,49.07,49.07,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,AETNA,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,BCBS,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,CIGNA,COM,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,TRICARE,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,UNITED HEALTHCARE,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,UNITED HEALTHCARE,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,VA,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,VA TRICARE,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,WELLMED,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,HUMANA,MGD,744.19,,,,,,,per diem,744.19,744.19,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33129662,CDM,279,RC,,,,,,Inpatient,,,744.19,744.19,HUMANA CHOICE PLUS,MGD,744.19,,,,,,,case rate,744.19,744.19,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,AETNA,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,BCBS,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,CIGNA,COM,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,TRICARE,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,UNITED HEALTHCARE,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,UNITED HEALTHCARE,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,VA,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,VA TRICARE,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,WELLMED,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,HUMANA,MGD,12.13,,,,,,,per diem,12.13,12.13,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33129663,CDM,279,RC,,,,,,Inpatient,,,12.13,12.13,HUMANA CHOICE PLUS,MGD,12.13,,,,,,,case rate,12.13,12.13,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,AETNA,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,BCBS,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,CIGNA,COM,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,TRICARE,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,UNITED HEALTHCARE,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,UNITED HEALTHCARE,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,VA,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,VA TRICARE,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,WELLMED,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,HUMANA,MGD,3.89,,,,,,,per diem,3.89,3.89,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33129664,CDM,279,RC,,,,,,Inpatient,,,3.89,3.89,HUMANA CHOICE PLUS,MGD,3.89,,,,,,,case rate,3.89,3.89,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,AETNA,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,BCBS,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,CIGNA,COM,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,TRICARE,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,UNITED HEALTHCARE,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,UNITED HEALTHCARE,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,VA,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,VA TRICARE,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,WELLMED,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,HUMANA,MGD,166.48,,,,,,,per diem,166.48,166.48,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33129665,CDM,279,RC,,,,,,Inpatient,,,166.48,166.48,HUMANA CHOICE PLUS,MGD,166.48,,,,,,,case rate,166.48,166.48,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33129667,CDM,279,RC,,,,,,Inpatient,,,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33129668,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
ALTERNATE AIR MATTRESS # SFCT3,33129673,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC BED DAILY ,33129674,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,AETNA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,CIGNA,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,VA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,VA TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,WELLMED,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA,MGD,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
SIZE WISE BARIATRIC PULSE MATT,33129675,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA CHOICE PLUS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,AETNA,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,BCBS,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,CIGNA,COM,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,TRICARE,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,UNITED HEALTHCARE,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,UNITED HEALTHCARE,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,VA,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,VA TRICARE,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,WELLMED,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,HUMANA,MGD,10.82,,,,,,,per diem,10.82,10.82,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33129686,CDM,270,RC,,,,,,Inpatient,,,10.82,10.82,HUMANA CHOICE PLUS,MGD,10.82,,,,,,,case rate,10.82,10.82,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,AETNA,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,BCBS,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,CIGNA,COM,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,TRICARE,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,UNITED HEALTHCARE,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,UNITED HEALTHCARE,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,VA,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,VA TRICARE,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,WELLMED,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,HUMANA,MGD,62.63,,,,,,,per diem,62.63,62.63,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC           ,33129692,CDM,270,RC,,,,,,Inpatient,,,62.63,62.63,HUMANA CHOICE PLUS,MGD,62.63,,,,,,,case rate,62.63,62.63,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,AETNA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,BCBS,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,CIGNA,COM,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,UNITED HEALTHCARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,VA,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,VA TRICARE,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,WELLMED,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA,MGD,28.67,,,,,,,per diem,28.67,28.67,"Per diem rate, code is bundled with other services"
ORTHO FINGER SPLINT-A/S       ,33129728,CDM,270,RC,,,,,,Inpatient,,,28.67,28.67,HUMANA CHOICE PLUS,MGD,28.67,,,,,,,case rate,28.67,28.67,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,AETNA,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,BCBS,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,CIGNA,COM,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,TRICARE,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,UNITED HEALTHCARE,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,UNITED HEALTHCARE,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,VA,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,VA TRICARE,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,WELLMED,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,HUMANA,MGD,670.9,,,,,,,per diem,670.9,670.9,"Per diem rate, code is bundled with other services"
ORTHOSIS BRACE                ,33129729,CDM,270,RC,,,,,,Inpatient,,,670.9,670.9,HUMANA CHOICE PLUS,MGD,670.9,,,,,,,case rate,670.9,670.9,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,AETNA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,CIGNA,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,VA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,VA TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,WELLMED,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA,MGD,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
WRIST SPLINT FORM-FIT         ,33129731,CDM,270,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA CHOICE PLUS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,AETNA,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,BCBS,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,CIGNA,COM,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,TRICARE,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,UNITED HEALTHCARE,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,UNITED HEALTHCARE,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,VA,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,VA TRICARE,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,WELLMED,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,HUMANA,MGD,47.39,,,,,,,per diem,47.39,47.39,"Per diem rate, code is bundled with other services"
HAND HELP II                  ,33129735,CDM,270,RC,,,,,,Inpatient,,,47.39,47.39,HUMANA CHOICE PLUS,MGD,47.39,,,,,,,case rate,47.39,47.39,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,AETNA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,CIGNA,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,VA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,VA TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,WELLMED,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,HUMANA,MGD,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33129736,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,HUMANA CHOICE PLUS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,AETNA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,CIGNA,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,VA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,VA TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,WELLMED,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA,MGD,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WRIST HAND FNGR ORTHOSIS      ,33129756,CDM,274,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA CHOICE PLUS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,AETNA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,CIGNA,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,VA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,VA TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,WELLMED,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,HUMANA,MGD,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB                   ,33129757,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,HUMANA CHOICE PLUS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,AETNA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,CIGNA,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,VA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,VA TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,WELLMED,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,HUMANA,MGD,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHO                           ,33129758,CDM,274,RC,,,,,,Inpatient,,,136.71,136.71,HUMANA CHOICE PLUS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO PIP/DIP FLEX/EXT           ,33129759,CDM,274,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,AETNA,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,BCBS,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,CIGNA,COM,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,TRICARE,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,UNITED HEALTHCARE,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,UNITED HEALTHCARE,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,VA,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,VA TRICARE,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,WELLMED,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,HUMANA,MGD,238.14,,,,,,,per diem,238.14,238.14,"Per diem rate, code is bundled with other services"
"WHO, STATIC                   ",33129760,CDM,274,RC,,,,,,Inpatient,,,238.14,238.14,HUMANA CHOICE PLUS,MGD,238.14,,,,,,,case rate,238.14,238.14,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,AETNA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,CIGNA,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,VA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,VA TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,WELLMED,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA,MGD,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HFO                           ,33129761,CDM,274,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA CHOICE PLUS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,AETNA,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,BCBS,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,CIGNA,COM,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,TRICARE,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,UNITED HEALTHCARE,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,UNITED HEALTHCARE,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,VA,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,VA TRICARE,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,WELLMED,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,HUMANA,MGD,160.97,,,,,,,per diem,160.97,160.97,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33129762,CDM,270,RC,,,,,,Inpatient,,,160.97,160.97,HUMANA CHOICE PLUS,MGD,160.97,,,,,,,case rate,160.97,160.97,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,AETNA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,CIGNA,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,VA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,VA TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,WELLMED,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,HUMANA,MGD,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
LONG ARM STATIC PREFAB        ,33129763,CDM,270,RC,,,,,,Inpatient,,,357.21,357.21,HUMANA CHOICE PLUS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,AETNA,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,BCBS,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,CIGNA,COM,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,TRICARE,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,UNITED HEALTHCARE,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,UNITED HEALTHCARE,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,VA,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,VA TRICARE,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,WELLMED,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,HUMANA,MGD,388.08,,,,,,,per diem,388.08,388.08,"Per diem rate, code is bundled with other services"
HUMERAL FX PREFAB             ,33129764,CDM,270,RC,,,,,,Inpatient,,,388.08,388.08,HUMANA CHOICE PLUS,MGD,388.08,,,,,,,case rate,388.08,388.08,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
ORTH FINGER SPLINT A/S        ,33129767,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,AETNA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,CIGNA,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,VA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,VA TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,WELLMED,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA,MGD,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
WHFO WRIST THUMB SPICA        ,33129768,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA CHOICE PLUS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,AETNA,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,BCBS,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,CIGNA,COM,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,TRICARE,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,UNITED HEALTHCARE,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,UNITED HEALTHCARE,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,VA,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,VA TRICARE,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,WELLMED,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,HUMANA,MGD,116.29,,,,,,,per diem,116.29,116.29,"Per diem rate, code is bundled with other services"
FUNCTIONAL POSITION SPLINT    ,33129769,CDM,270,RC,,,,,,Inpatient,,,116.29,116.29,HUMANA CHOICE PLUS,MGD,116.29,,,,,,,case rate,116.29,116.29,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,AETNA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,CIGNA,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,VA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,VA TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,WELLMED,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,HUMANA,MGD,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WHFO PREFAB STATIC ORTHO      ,33129770,CDM,274,RC,L3807,CPT,,,,Inpatient,,,136.71,136.71,HUMANA CHOICE PLUS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
HFO STATIC PREFAB ORTHO       ,33129771,CDM,274,RC,L3923,CPT,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,AETNA,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,BCBS,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,CIGNA,COM,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,TRICARE,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,UNITED HEALTHCARE,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,UNITED HEALTHCARE,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,VA,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,VA TRICARE,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,WELLMED,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,HUMANA,MGD,386.98,,,,,,,per diem,386.98,386.98,"Per diem rate, code is bundled with other services"
HUMERAL FRACTURE PREFAB ORTHO ,33129772,CDM,274,RC,L3980,CPT,,,,Inpatient,,,386.98,386.98,HUMANA CHOICE PLUS,MGD,386.98,,,,,,,case rate,386.98,386.98,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,AETNA,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,BCBS,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,CIGNA,COM,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,TRICARE,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,UNITED HEALTHCARE,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,UNITED HEALTHCARE,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,VA,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,VA TRICARE,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,WELLMED,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,HUMANA,MGD,306.94,,,,,,,per diem,306.94,306.94,"Per diem rate, code is bundled with other services"
M-BRACE LG PELVIS 33-45CM     ,33129773,CDM,270,RC,,,,,,Inpatient,,,306.94,306.94,HUMANA CHOICE PLUS,MGD,306.94,,,,,,,case rate,306.94,306.94,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,AETNA,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,BCBS,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,CIGNA,COM,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,TRICARE,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,UNITED HEALTHCARE,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,UNITED HEALTHCARE,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,VA,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,VA TRICARE,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,WELLMED,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,HUMANA,MGD,223.27,,,,,,,per diem,223.27,223.27,"Per diem rate, code is bundled with other services"
RESTING PLATFORM SPLINT       ,33129783,CDM,270,RC,,,,,,Inpatient,,,223.27,223.27,HUMANA CHOICE PLUS,MGD,223.27,,,,,,,case rate,223.27,223.27,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,AETNA,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,CIGNA,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,TRICARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,UNITED HEALTHCARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,UNITED HEALTHCARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,VA,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,VA TRICARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,WELLMED,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,HUMANA,MGD,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - RIGHT LARGE  ,33129785,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,HUMANA CHOICE PLUS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,AETNA,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,BCBS,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,CIGNA,COM,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,TRICARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,UNITED HEALTHCARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,UNITED HEALTHCARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,VA,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,VA TRICARE,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,WELLMED,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,HUMANA,MGD,93.33,,,,,,,per diem,93.33,93.33,"Per diem rate, code is bundled with other services"
ANKLE ORTHOSIS - LEFT LARGE   ,33129786,CDM,270,RC,,,,,,Inpatient,,,93.33,93.33,HUMANA CHOICE PLUS,MGD,93.33,,,,,,,case rate,93.33,93.33,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
FO PIP/DIP STATIC OR RING TYPE,33129787,CDM,274,RC,L3927,CPT,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,AETNA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,CIGNA,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,VA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,VA TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,WELLMED,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,HUMANA,MGD,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB FITTED         ,33129788,CDM,274,RC,L3929,HCPCS,,,,Inpatient,,,157.5,157.5,HUMANA CHOICE PLUS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,AETNA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,CIGNA,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,VA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,VA TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,WELLMED,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,HUMANA,MGD,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
HFO DYN PREFAB NON FITTED     ,33129789,CDM,274,RC,L3930,HCPCS,,,,Inpatient,,,157.5,157.5,HUMANA CHOICE PLUS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33129799,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,AETNA,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,CIGNA,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,TRICARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,UNITED HEALTHCARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,UNITED HEALTHCARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,VA,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,VA TRICARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,WELLMED,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,HUMANA,MGD,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 36IN WIDE   ,33130001,CDM,279,RC,,,,,,Inpatient,,,28.54,28.54,HUMANA CHOICE PLUS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,AETNA,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,BCBS,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,CIGNA,COM,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,TRICARE,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,UNITED HEALTHCARE,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,UNITED HEALTHCARE,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,VA,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,VA TRICARE,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,WELLMED,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,HUMANA,MGD,36.34,,,,,,,per diem,36.34,36.34,"Per diem rate, code is bundled with other services"
LOW AIR LOSS MATT 42IN WIDE   ,33130002,CDM,279,RC,,,,,,Inpatient,,,36.34,36.34,HUMANA CHOICE PLUS,MGD,36.34,,,,,,,case rate,36.34,36.34,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,AETNA,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,BCBS,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,CIGNA,COM,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,TRICARE,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,UNITED HEALTHCARE,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,UNITED HEALTHCARE,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,VA,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,VA TRICARE,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,WELLMED,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,HUMANA,MGD,27.51,,,,,,,per diem,27.51,27.51,"Per diem rate, code is bundled with other services"
BARIATRIC BED WITH SCALE      ,33130003,CDM,279,RC,,,,,,Inpatient,,,27.51,27.51,HUMANA CHOICE PLUS,MGD,27.51,,,,,,,case rate,27.51,27.51,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,AETNA,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,BCBS,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,CIGNA,COM,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,TRICARE,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,UNITED HEALTHCARE,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,UNITED HEALTHCARE,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,VA,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,VA TRICARE,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,WELLMED,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,HUMANA,MGD,98.4,,,,,,,per diem,98.4,98.4,"Per diem rate, code is bundled with other services"
BARIATRIC LOW BED             ,33130004,CDM,279,RC,,,,,,Inpatient,,,98.4,98.4,HUMANA CHOICE PLUS,MGD,98.4,,,,,,,case rate,98.4,98.4,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,AETNA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,CIGNA,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,VA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,VA TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,WELLMED,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,HUMANA,MGD,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER 500-750 LBS  ,33130005,CDM,279,RC,,,,,,Inpatient,,,7.94,7.94,HUMANA CHOICE PLUS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,AETNA,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,BCBS,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,CIGNA,COM,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,TRICARE,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,UNITED HEALTHCARE,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,UNITED HEALTHCARE,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,VA,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,VA TRICARE,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,WELLMED,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,HUMANA,MGD,14.07,,,,,,,per diem,14.07,14.07,"Per diem rate, code is bundled with other services"
FOAM MATTRESS                 ,33130006,CDM,279,RC,,,,,,Inpatient,,,14.07,14.07,HUMANA CHOICE PLUS,MGD,14.07,,,,,,,case rate,14.07,14.07,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,AETNA,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,BCBS,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,CIGNA,COM,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,TRICARE,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,UNITED HEALTHCARE,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,UNITED HEALTHCARE,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,VA,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,VA TRICARE,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,WELLMED,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,HUMANA,MGD,18.89,,,,,,,per diem,18.89,18.89,"Per diem rate, code is bundled with other services"
C-PAP MACHINE - AUTO SET SPIRI,33130008,CDM,279,RC,,,,,,Inpatient,,,18.89,18.89,HUMANA CHOICE PLUS,MGD,18.89,,,,,,,case rate,18.89,18.89,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,AETNA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,CIGNA,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,WELLMED,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA,MGD,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAP MACHINE - FOCUS        ,33130009,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA CHOICE PLUS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,AETNA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,CIGNA,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,WELLMED,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA,MGD,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI PAT MACHINE - VISION       ,33130010,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA CHOICE PLUS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,AETNA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,CIGNA,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,VA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,VA TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,WELLMED,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA,MGD,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
CONTINUOUS PULSE OX MACHINE   ,33130012,CDM,279,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA CHOICE PLUS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - FREEDOM RENTAL    ,33130014,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
WOUND VAC - ULTA RENTAL       ,33130015,CDM,279,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,AETNA,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,BCBS,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,CIGNA,COM,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,TRICARE,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,UNITED HEALTHCARE,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,UNITED HEALTHCARE,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,VA,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,VA TRICARE,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,WELLMED,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,HUMANA,MGD,74.34,,,,,,,per diem,74.34,74.34,"Per diem rate, code is bundled with other services"
MATTRESS UMS 36X84X8-10       ,33130016,CDM,279,RC,,,,,,Inpatient,,,74.34,74.34,HUMANA CHOICE PLUS,MGD,74.34,,,,,,,case rate,74.34,74.34,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,AETNA,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,BCBS,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,CIGNA,COM,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,TRICARE,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,UNITED HEALTHCARE,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,UNITED HEALTHCARE,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,VA,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,VA TRICARE,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,WELLMED,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,HUMANA,MGD,195.68,,,,,,,per diem,195.68,195.68,"Per diem rate, code is bundled with other services"
ROTEC 1100SE BARIATRIC LOW BED,33130017,CDM,279,RC,,,,,,Inpatient,,,195.68,195.68,HUMANA CHOICE PLUS,MGD,195.68,,,,,,,case rate,195.68,195.68,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,AETNA,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,CIGNA,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,TRICARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,UNITED HEALTHCARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,UNITED HEALTHCARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,VA,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,VA TRICARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,WELLMED,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,HUMANA,MGD,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
RESIRONICS BIPAP AUTO RR      ,33130019,CDM,279,RC,,,,,,Inpatient,,,22.55,22.55,HUMANA CHOICE PLUS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,AETNA,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,BCBS,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,CIGNA,COM,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,TRICARE,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,UNITED HEALTHCARE,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,UNITED HEALTHCARE,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,VA,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,VA TRICARE,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,WELLMED,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,HUMANA,MGD,80.07,,,,,,,per diem,80.07,80.07,"Per diem rate, code is bundled with other services"
WAVE MATTREXX 48X80X10        ,33130020,CDM,279,RC,,,,,,Inpatient,,,80.07,80.07,HUMANA CHOICE PLUS,MGD,80.07,,,,,,,case rate,80.07,80.07,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,AETNA,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,BCBS,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,CIGNA,COM,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,TRICARE,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,UNITED HEALTHCARE,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,UNITED HEALTHCARE,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,VA,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,VA TRICARE,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,WELLMED,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,HUMANA,MGD,95.16,,,,,,,per diem,95.16,95.16,"Per diem rate, code is bundled with other services"
ROTEC V600- SE LOW BED        ,33130021,CDM,279,RC,,,,,,Inpatient,,,95.16,95.16,HUMANA CHOICE PLUS,MGD,95.16,,,,,,,case rate,95.16,95.16,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,AETNA,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,BCBS,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,CIGNA,COM,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,TRICARE,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,UNITED HEALTHCARE,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,UNITED HEALTHCARE,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,VA,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,VA TRICARE,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,WELLMED,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,HUMANA,MGD,268.44,,,,,,,per diem,268.44,268.44,"Per diem rate, code is bundled with other services"
WOUND VAC                     ,33130023,CDM,279,RC,,,,,,Inpatient,,,268.44,268.44,HUMANA CHOICE PLUS,MGD,268.44,,,,,,,case rate,268.44,268.44,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LONG BED EXTENDED             ,33130025,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR RENTAL             ,33130026,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,AETNA,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,CIGNA,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,TRICARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,UNITED HEALTHCARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,UNITED HEALTHCARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,VA,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,VA TRICARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,WELLMED,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,HUMANA,MGD,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
LAL MATTRESS                  ,33130032,CDM,279,RC,,,,,,Inpatient,,,123.84,123.84,HUMANA CHOICE PLUS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,AETNA,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,BCBS,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,CIGNA,COM,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,TRICARE,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,UNITED HEALTHCARE,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,UNITED HEALTHCARE,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,VA,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,VA TRICARE,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,WELLMED,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,HUMANA,MGD,40.44,,,,,,,per diem,40.44,40.44,"Per diem rate, code is bundled with other services"
BOOT AIR WALKER               ,33130037,CDM,270,RC,,,,,,Inpatient,,,40.44,40.44,HUMANA CHOICE PLUS,MGD,40.44,,,,,,,case rate,40.44,40.44,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,AETNA,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,BCBS,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,CIGNA,COM,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,TRICARE,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,UNITED HEALTHCARE,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,UNITED HEALTHCARE,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,VA,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,VA TRICARE,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,WELLMED,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,HUMANA,MGD,8.69,,,,,,,per diem,8.69,8.69,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER XXL 86-105   ,33130038,CDM,270,RC,,,,,,Inpatient,,,8.69,8.69,HUMANA CHOICE PLUS,MGD,8.69,,,,,,,case rate,8.69,8.69,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,AETNA,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,BCBS,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,CIGNA,COM,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,TRICARE,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,UNITED HEALTHCARE,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,UNITED HEALTHCARE,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,VA,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,VA TRICARE,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,WELLMED,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,HUMANA,MGD,37.85,,,,,,,per diem,37.85,37.85,"Per diem rate, code is bundled with other services"
WRAPAROUND HINGED KNEE BR - L ,33130039,CDM,270,RC,,,,,,Inpatient,,,37.85,37.85,HUMANA CHOICE PLUS,MGD,37.85,,,,,,,case rate,37.85,37.85,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,AETNA,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,BCBS,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,CIGNA,COM,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,TRICARE,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,UNITED HEALTHCARE,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,UNITED HEALTHCARE,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,VA,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,VA TRICARE,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,WELLMED,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,HUMANA,MGD,689.19,,,,,,,per diem,689.19,689.19,"Per diem rate, code is bundled with other services"
FLOOR CUSHION                 ,33132031,CDM,279,RC,,,,,,Inpatient,,,689.19,689.19,HUMANA CHOICE PLUS,MGD,689.19,,,,,,,case rate,689.19,689.19,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,AETNA,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,CIGNA,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,TRICARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,UNITED HEALTHCARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,UNITED HEALTHCARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,VA,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,VA TRICARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,WELLMED,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,HUMANA,MGD,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL    ,33132070,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,HUMANA CHOICE PLUS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,AETNA,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,BCBS,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,CIGNA,COM,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,TRICARE,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,UNITED HEALTHCARE,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,UNITED HEALTHCARE,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,VA,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,VA TRICARE,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,WELLMED,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,HUMANA,MGD,305.51,,,,,,,per diem,305.51,305.51,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL KNITTED GEL XL ,33132071,CDM,270,RC,,,,,,Inpatient,,,305.51,305.51,HUMANA CHOICE PLUS,MGD,305.51,,,,,,,case rate,305.51,305.51,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,AETNA,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,BCBS,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,CIGNA,COM,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,TRICARE,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,UNITED HEALTHCARE,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,UNITED HEALTHCARE,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,VA,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,VA TRICARE,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,WELLMED,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,HUMANA,MGD,1436.75,,,,,,,per diem,1436.75,1436.75,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE FOR SEIZURE P,33132072,CDM,279,RC,,,,,,Inpatient,,,1436.75,1436.75,HUMANA CHOICE PLUS,MGD,1436.75,,,,,,,case rate,1436.75,1436.75,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,AETNA,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,BCBS,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,CIGNA,COM,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,TRICARE,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,UNITED HEALTHCARE,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,UNITED HEALTHCARE,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,VA,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,VA TRICARE,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,WELLMED,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,HUMANA,MGD,4.02,,,,,,,per diem,4.02,4.02,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33132158,CDM,270,RC,,,,,,Inpatient,,,4.02,4.02,HUMANA CHOICE PLUS,MGD,4.02,,,,,,,case rate,4.02,4.02,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,AETNA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,CIGNA,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,VA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,VA TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,WELLMED,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,HUMANA,MGD,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
CAST PADDING 4X4              ,33132239,CDM,270,RC,,,,,,Inpatient,,,5.89,5.89,HUMANA CHOICE PLUS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,AETNA,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,BCBS,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,CIGNA,COM,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,TRICARE,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,UNITED HEALTHCARE,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,UNITED HEALTHCARE,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,VA,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,VA TRICARE,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,WELLMED,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,HUMANA,MGD,128.26,,,,,,,per diem,128.26,128.26,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33132258,CDM,270,RC,,,,,,Inpatient,,,128.26,128.26,HUMANA CHOICE PLUS,MGD,128.26,,,,,,,case rate,128.26,128.26,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,AETNA,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,BCBS,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,CIGNA,COM,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,TRICARE,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,UNITED HEALTHCARE,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,UNITED HEALTHCARE,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,VA,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,VA TRICARE,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,WELLMED,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,HUMANA,MGD,246.87,,,,,,,per diem,246.87,246.87,"Per diem rate, code is bundled with other services"
E-Z BOOT # 6188               ,33132263,CDM,270,RC,,,,,,Inpatient,,,246.87,246.87,HUMANA CHOICE PLUS,MGD,246.87,,,,,,,case rate,246.87,246.87,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,AETNA,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,BCBS,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,CIGNA,COM,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,TRICARE,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,UNITED HEALTHCARE,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,UNITED HEALTHCARE,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,VA,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,VA TRICARE,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,WELLMED,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,HUMANA,MGD,153.09,,,,,,,per diem,153.09,153.09,"Per diem rate, code is bundled with other services"
COMMODE                       ,33132275,CDM,279,RC,,,,,,Inpatient,,,153.09,153.09,HUMANA CHOICE PLUS,MGD,153.09,,,,,,,case rate,153.09,153.09,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,AETNA,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,CIGNA,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,TRICARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,UNITED HEALTHCARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,UNITED HEALTHCARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,VA,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,VA TRICARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,WELLMED,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,HUMANA,MGD,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER              ,33132283,CDM,270,RC,,,,,,Inpatient,,,25.17,25.17,HUMANA CHOICE PLUS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33132320,CDM,270,RC,,,,,,Inpatient,,,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,AETNA,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,BCBS,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,CIGNA,COM,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,TRICARE,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,UNITED HEALTHCARE,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,UNITED HEALTHCARE,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,VA,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,VA TRICARE,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,WELLMED,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,HUMANA,MGD,133.61,,,,,,,per diem,133.61,133.61,"Per diem rate, code is bundled with other services"
FOOT SCD # DJ3046             ,33132336,CDM,279,RC,,,,,,Inpatient,,,133.61,133.61,HUMANA CHOICE PLUS,MGD,133.61,,,,,,,case rate,133.61,133.61,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,AETNA,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,BCBS,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,CIGNA,COM,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,TRICARE,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,UNITED HEALTHCARE,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,UNITED HEALTHCARE,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,VA,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,VA TRICARE,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,WELLMED,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,HUMANA,MGD,215.54,,,,,,,per diem,215.54,215.54,"Per diem rate, code is bundled with other services"
BOOT PREVALON W/STABILIZER    ,33132349,CDM,270,RC,,,,,,Inpatient,,,215.54,215.54,HUMANA CHOICE PLUS,MGD,215.54,,,,,,,case rate,215.54,215.54,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,AETNA,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,BCBS,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,CIGNA,COM,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,TRICARE,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,UNITED HEALTHCARE,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,UNITED HEALTHCARE,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,VA,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,VA TRICARE,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,WELLMED,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,HUMANA,MGD,45.79,,,,,,,per diem,45.79,45.79,"Per diem rate, code is bundled with other services"
PILLOW REUSABLE CLOUD NINE    ,33132364,CDM,270,RC,,,,,,Inpatient,,,45.79,45.79,HUMANA CHOICE PLUS,MGD,45.79,,,,,,,case rate,45.79,45.79,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,AETNA,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,BCBS,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,CIGNA,COM,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,TRICARE,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,UNITED HEALTHCARE,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,UNITED HEALTHCARE,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,VA,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,VA TRICARE,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,WELLMED,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,HUMANA,MGD,347.28,,,,,,,per diem,347.28,347.28,"Per diem rate, code is bundled with other services"
ROOKE BOOT # HFS 102          ,33132365,CDM,270,RC,,,,,,Inpatient,,,347.28,347.28,HUMANA CHOICE PLUS,MGD,347.28,,,,,,,case rate,347.28,347.28,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,AETNA,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,BCBS,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,CIGNA,COM,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,TRICARE,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,UNITED HEALTHCARE,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,UNITED HEALTHCARE,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,VA,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,VA TRICARE,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,WELLMED,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,HUMANA,MGD,207.24,,,,,,,per diem,207.24,207.24,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33132456,CDM,279,RC,,,,,,Inpatient,,,207.24,207.24,HUMANA CHOICE PLUS,MGD,207.24,,,,,,,case rate,207.24,207.24,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,AETNA,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,BCBS,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,CIGNA,COM,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,TRICARE,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,UNITED HEALTHCARE,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,UNITED HEALTHCARE,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,VA,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,VA TRICARE,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,WELLMED,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,HUMANA,MGD,254.52,,,,,,,per diem,254.52,254.52,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33132468,CDM,279,RC,,,,,,Inpatient,,,254.52,254.52,HUMANA CHOICE PLUS,MGD,254.52,,,,,,,case rate,254.52,254.52,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
CPM APPLICATION DAILY RENTAL  ,33132472,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,AETNA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,CIGNA,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,VA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,VA TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,WELLMED,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,HUMANA,MGD,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33132494,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,HUMANA CHOICE PLUS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,AETNA,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,BCBS,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,CIGNA,COM,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,TRICARE,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,UNITED HEALTHCARE,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,UNITED HEALTHCARE,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,VA,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,VA TRICARE,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,WELLMED,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,HUMANA,MGD,33.24,,,,,,,per diem,33.24,33.24,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33132506,CDM,279,RC,,,,,,Inpatient,,,33.24,33.24,HUMANA CHOICE PLUS,MGD,33.24,,,,,,,case rate,33.24,33.24,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
HIGH FLOW NASAL CANNULA       ,33132560,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,AETNA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,CIGNA,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,VA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,VA TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,WELLMED,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA,MGD,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
SHORT ARM STATIC SPLINT       ,33132571,CDM,270,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA CHOICE PLUS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
ORTHO WEDGE SHOE LARGE        ,33132572,CDM,270,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,AETNA,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,BCBS,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,CIGNA,COM,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,TRICARE,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,UNITED HEALTHCARE,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,UNITED HEALTHCARE,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,VA,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,VA TRICARE,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,WELLMED,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,HUMANA,MGD,249.82,,,,,,,per diem,249.82,249.82,"Per diem rate, code is bundled with other services"
MULTI BOOT REGULAR            ,33132582,CDM,270,RC,,,,,,Inpatient,,,249.82,249.82,HUMANA CHOICE PLUS,MGD,249.82,,,,,,,case rate,249.82,249.82,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,AETNA,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,BCBS,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,CIGNA,COM,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,TRICARE,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,UNITED HEALTHCARE,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,UNITED HEALTHCARE,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,VA,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,VA TRICARE,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,WELLMED,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,HUMANA,MGD,281.95,,,,,,,per diem,281.95,281.95,"Per diem rate, code is bundled with other services"
MULTI BOOT XLARGE             ,33132583,CDM,270,RC,,,,,,Inpatient,,,281.95,281.95,HUMANA CHOICE PLUS,MGD,281.95,,,,,,,case rate,281.95,281.95,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,AETNA,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,BCBS,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,CIGNA,COM,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,TRICARE,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,UNITED HEALTHCARE,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,UNITED HEALTHCARE,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,VA,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,VA TRICARE,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,WELLMED,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,HUMANA,MGD,34.34,,,,,,,per diem,34.34,34.34,"Per diem rate, code is bundled with other services"
POSEY WRAP-AROUND             ,33132590,CDM,279,RC,,,,,,Inpatient,,,34.34,34.34,HUMANA CHOICE PLUS,MGD,34.34,,,,,,,case rate,34.34,34.34,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,AETNA,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,CIGNA,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,TRICARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,UNITED HEALTHCARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,UNITED HEALTHCARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,VA,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,VA TRICARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,WELLMED,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,HUMANA,MGD,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
SENTRY 1400 AIR MATTR AND PUMP,33132591,CDM,279,RC,,,,,,Inpatient,,,34.84,34.84,HUMANA CHOICE PLUS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,AETNA,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,BCBS,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,CIGNA,COM,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,TRICARE,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,UNITED HEALTHCARE,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,UNITED HEALTHCARE,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,VA,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,VA TRICARE,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,WELLMED,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,HUMANA,MGD,131.23,,,,,,,per diem,131.23,131.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED W AIR MATT/PUMP ,33132592,CDM,270,RC,,,,,,Inpatient,,,131.23,131.23,HUMANA CHOICE PLUS,MGD,131.23,,,,,,,case rate,131.23,131.23,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
LOW BED LTC                   ,33132593,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,AETNA,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,BCBS,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,CIGNA,COM,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,TRICARE,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,UNITED HEALTHCARE,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,UNITED HEALTHCARE,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,VA,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,VA TRICARE,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,WELLMED,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,HUMANA,MGD,16.97,,,,,,,per diem,16.97,16.97,"Per diem rate, code is bundled with other services"
SHOE CAST SOFTIE              ,33132594,CDM,270,RC,,,,,,Inpatient,,,16.97,16.97,HUMANA CHOICE PLUS,MGD,16.97,,,,,,,case rate,16.97,16.97,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,AETNA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,CIGNA,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,VA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,VA TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,WELLMED,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,HUMANA,MGD,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - MEDIUM   ,33132595,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,HUMANA CHOICE PLUS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,AETNA,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,BCBS,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,CIGNA,COM,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,TRICARE,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,UNITED HEALTHCARE,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,UNITED HEALTHCARE,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,VA,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,VA TRICARE,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,WELLMED,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,HUMANA,MGD,18.27,,,,,,,per diem,18.27,18.27,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - X LARGE  ,33132596,CDM,270,RC,,,,,,Inpatient,,,18.27,18.27,HUMANA CHOICE PLUS,MGD,18.27,,,,,,,case rate,18.27,18.27,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,AETNA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,CIGNA,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,VA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,VA TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,WELLMED,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,HUMANA,MGD,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
ENVELOPE ARM SLING - LARGE    ,33132597,CDM,270,RC,,,,,,Inpatient,,,18.65,18.65,HUMANA CHOICE PLUS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,AETNA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,CIGNA,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,WELLMED,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA,MGD,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT SMALL  ,33132599,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA CHOICE PLUS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT MED    ,33132600,CDM,270,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,AETNA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,CIGNA,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,WELLMED,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA,MGD,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - LT LARGE  ,33132601,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA CHOICE PLUS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,AETNA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,CIGNA,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,WELLMED,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA,MGD,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT SMALL  ,33132602,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA CHOICE PLUS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,AETNA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,CIGNA,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,WELLMED,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA,MGD,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT MEDIUM ,33132603,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA CHOICE PLUS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,AETNA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,BCBS,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,CIGNA,COM,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,UNITED HEALTHCARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,VA TRICARE,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,WELLMED,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA,MGD,77.14,,,,,,,per diem,77.14,77.14,"Per diem rate, code is bundled with other services"
FUNCT HAND SPLINT - RT LARGE  ,33132604,CDM,270,RC,,,,,,Inpatient,,,77.14,77.14,HUMANA CHOICE PLUS,MGD,77.14,,,,,,,case rate,77.14,77.14,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,AETNA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,CIGNA,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,WELLMED,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA,MGD,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-LARGE     ,33132607,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA CHOICE PLUS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,AETNA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,CIGNA,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,WELLMED,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA,MGD,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB LEFT-XLARGE    ,33132608,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA CHOICE PLUS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,AETNA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,CIGNA,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,VA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,VA TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,WELLMED,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA,MGD,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-LEFT       ,33132611,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA CHOICE PLUS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,AETNA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,CIGNA,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,VA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,VA TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,WELLMED,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA,MGD,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
COMPRESSION GLOVES-RIGHT      ,33132612,CDM,270,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA CHOICE PLUS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,AETNA,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,CIGNA,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,TRICARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,UNITED HEALTHCARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,UNITED HEALTHCARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,VA,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,VA TRICARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,WELLMED,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,HUMANA,MGD,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT SM/M     ,33132613,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,HUMANA CHOICE PLUS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,AETNA,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,BCBS,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,CIGNA,COM,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,TRICARE,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,UNITED HEALTHCARE,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,UNITED HEALTHCARE,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,VA,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,VA TRICARE,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,WELLMED,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,HUMANA,MGD,150.32,,,,,,,per diem,150.32,150.32,"Per diem rate, code is bundled with other services"
WALKER SPLINTS RIGHT LARGE    ,33132614,CDM,279,RC,,,,,,Inpatient,,,150.32,150.32,HUMANA CHOICE PLUS,MGD,150.32,,,,,,,case rate,150.32,150.32,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,AETNA,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,BCBS,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,CIGNA,COM,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,TRICARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,UNITED HEALTHCARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,UNITED HEALTHCARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,VA,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,VA TRICARE,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,WELLMED,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,HUMANA,MGD,143.92,,,,,,,per diem,143.92,143.92,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT SM/M      ,33132615,CDM,279,RC,,,,,,Inpatient,,,143.92,143.92,HUMANA CHOICE PLUS,MGD,143.92,,,,,,,case rate,143.92,143.92,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,AETNA,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,BCBS,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,CIGNA,COM,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,TRICARE,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,UNITED HEALTHCARE,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,UNITED HEALTHCARE,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,VA,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,VA TRICARE,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,WELLMED,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,HUMANA,MGD,144.02,,,,,,,per diem,144.02,144.02,"Per diem rate, code is bundled with other services"
WALKER SPLINTS LEFT LARGE     ,33132616,CDM,279,RC,,,,,,Inpatient,,,144.02,144.02,HUMANA CHOICE PLUS,MGD,144.02,,,,,,,case rate,144.02,144.02,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,AETNA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,CIGNA,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,WELLMED,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA,MGD,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-LARGE    ,33132621,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA CHOICE PLUS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,AETNA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,BCBS,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,CIGNA,COM,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,UNITED HEALTHCARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,VA TRICARE,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,WELLMED,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA,MGD,57.39,,,,,,,per diem,57.39,57.39,"Per diem rate, code is bundled with other services"
ENLARGED THUMB RIGHT-XLARGE   ,33132622,CDM,270,RC,,,,,,Inpatient,,,57.39,57.39,HUMANA CHOICE PLUS,MGD,57.39,,,,,,,case rate,57.39,57.39,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-SM       ,33132624,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-MED      ,33132625,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH LEFT-LARGE    ,33132626,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-SM      ,33132627,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-MED     ,33132628,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,AETNA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,BCBS,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,CIGNA,COM,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,UNITED HEALTHCARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,VA TRICARE,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,WELLMED,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA,MGD,104.3,,,,,,,per diem,104.3,104.3,"Per diem rate, code is bundled with other services"
ANKLE/FOOT ORTH RIGHT-LARGE   ,33132629,CDM,270,RC,,,,,,Inpatient,,,104.3,104.3,HUMANA CHOICE PLUS,MGD,104.3,,,,,,,case rate,104.3,104.3,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,AETNA,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,BCBS,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,CIGNA,COM,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,TRICARE,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,UNITED HEALTHCARE,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,UNITED HEALTHCARE,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,VA,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,VA TRICARE,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,WELLMED,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,HUMANA,MGD,89.9,,,,,,,per diem,89.9,89.9,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33132630,CDM,270,RC,,,,,,Inpatient,,,89.9,89.9,HUMANA CHOICE PLUS,MGD,89.9,,,,,,,case rate,89.9,89.9,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,AETNA,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,BCBS,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,CIGNA,COM,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,TRICARE,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,UNITED HEALTHCARE,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,UNITED HEALTHCARE,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,VA,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,VA TRICARE,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,WELLMED,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,HUMANA,MGD,96.89,,,,,,,per diem,96.89,96.89,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33132631,CDM,270,RC,,,,,,Inpatient,,,96.89,96.89,HUMANA CHOICE PLUS,MGD,96.89,,,,,,,case rate,96.89,96.89,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,AETNA,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,BCBS,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,CIGNA,COM,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,TRICARE,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,UNITED HEALTHCARE,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,UNITED HEALTHCARE,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,VA,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,VA TRICARE,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,WELLMED,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,HUMANA,MGD,100.14,,,,,,,per diem,100.14,100.14,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33132632,CDM,270,RC,,,,,,Inpatient,,,100.14,100.14,HUMANA CHOICE PLUS,MGD,100.14,,,,,,,case rate,100.14,100.14,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,AETNA,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,CIGNA,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,TRICARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,UNITED HEALTHCARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,UNITED HEALTHCARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,VA,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,VA TRICARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,WELLMED,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,HUMANA,MGD,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-RIGHT                 ,33132636,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,HUMANA CHOICE PLUS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,AETNA,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,BCBS,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,CIGNA,COM,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,TRICARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,UNITED HEALTHCARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,UNITED HEALTHCARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,VA,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,VA TRICARE,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,WELLMED,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,HUMANA,MGD,160.15,,,,,,,per diem,160.15,160.15,"Per diem rate, code is bundled with other services"
AIRCAST-LEFT                  ,33132637,CDM,270,RC,,,,,,Inpatient,,,160.15,160.15,HUMANA CHOICE PLUS,MGD,160.15,,,,,,,case rate,160.15,160.15,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-SM ,33132640,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-M  ,33132641,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT RIGHT-LG ,33132642,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-SM  ,33132643,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-M   ,33132644,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,AETNA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,BCBS,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,CIGNA,COM,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,UNITED HEALTHCARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,VA TRICARE,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,WELLMED,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA,MGD,66.56,,,,,,,per diem,66.56,66.56,"Per diem rate, code is bundled with other services"
COMFORT THUMB SPLINT LEFT-LG  ,33132645,CDM,270,RC,,,,,,Inpatient,,,66.56,66.56,HUMANA CHOICE PLUS,MGD,66.56,,,,,,,case rate,66.56,66.56,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,AETNA,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,BCBS,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,CIGNA,COM,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,TRICARE,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,UNITED HEALTHCARE,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,UNITED HEALTHCARE,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,VA,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,VA TRICARE,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,WELLMED,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,HUMANA,MGD,30.52,,,,,,,per diem,30.52,30.52,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33132657,CDM,270,RC,,,,,,Inpatient,,,30.52,30.52,HUMANA CHOICE PLUS,MGD,30.52,,,,,,,case rate,30.52,30.52,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,AETNA,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,BCBS,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,CIGNA,COM,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,TRICARE,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,UNITED HEALTHCARE,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,UNITED HEALTHCARE,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,VA,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,VA TRICARE,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,WELLMED,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,HUMANA,MGD,189.5,,,,,,,per diem,189.5,189.5,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33132662,CDM,270,RC,,,,,,Inpatient,,,189.5,189.5,HUMANA CHOICE PLUS,MGD,189.5,,,,,,,case rate,189.5,189.5,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,AETNA,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,BCBS,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,CIGNA,COM,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,TRICARE,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,UNITED HEALTHCARE,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,UNITED HEALTHCARE,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,VA,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,VA TRICARE,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,WELLMED,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,HUMANA,MGD,878.85,,,,,,,per diem,878.85,878.85,"Per diem rate, code is bundled with other services"
ROOKE PROTECTOR               ,33132696,CDM,270,RC,,,,,,Inpatient,,,878.85,878.85,HUMANA CHOICE PLUS,MGD,878.85,,,,,,,case rate,878.85,878.85,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,AETNA,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,BCBS,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,CIGNA,COM,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,TRICARE,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,UNITED HEALTHCARE,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,UNITED HEALTHCARE,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,VA,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,VA TRICARE,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,WELLMED,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,HUMANA,MGD,633.78,,,,,,,per diem,633.78,633.78,"Per diem rate, code is bundled with other services"
CPCAP HEATED HUMIDIFIER       ,33132699,CDM,279,RC,,,,,,Inpatient,,,633.78,633.78,HUMANA CHOICE PLUS,MGD,633.78,,,,,,,case rate,633.78,633.78,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
COLLAR SET CERV EX TL ADLT    ,33133104,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,AETNA,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,BCBS,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,CIGNA,COM,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,TRICARE,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,UNITED HEALTHCARE,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,UNITED HEALTHCARE,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,VA,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,VA TRICARE,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,WELLMED,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,HUMANA,MGD,173.64,,,,,,,per diem,173.64,173.64,"Per diem rate, code is bundled with other services"
ACCEL RECIP HAND PIECE        ,33133106,CDM,270,RC,,,,,,Inpatient,,,173.64,173.64,HUMANA CHOICE PLUS,MGD,173.64,,,,,,,case rate,173.64,173.64,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,AETNA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,CIGNA,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,WELLMED,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA,MGD,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
BINDER ABD UNIV               ,33133115,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA CHOICE PLUS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,AETNA,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,BCBS,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,CIGNA,COM,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,TRICARE,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,UNITED HEALTHCARE,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,UNITED HEALTHCARE,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,VA,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,VA TRICARE,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,WELLMED,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,HUMANA,MGD,100.11,,,,,,,per diem,100.11,100.11,"Per diem rate, code is bundled with other services"
PILLOW ABDUCTION SMALL        ,33133123,CDM,270,RC,,,,,,Inpatient,,,100.11,100.11,HUMANA CHOICE PLUS,MGD,100.11,,,,,,,case rate,100.11,100.11,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,AETNA,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,BCBS,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,CIGNA,COM,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,TRICARE,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,UNITED HEALTHCARE,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,UNITED HEALTHCARE,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,VA,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,VA TRICARE,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,WELLMED,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,HUMANA,MGD,71.28,,,,,,,per diem,71.28,71.28,"Per diem rate, code is bundled with other services"
KNEE SPREADER NC81006         ,33133130,CDM,270,RC,,,,,,Inpatient,,,71.28,71.28,HUMANA CHOICE PLUS,MGD,71.28,,,,,,,case rate,71.28,71.28,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 8"" X 7.5""       ",33133190,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL PAD 5"" X 9""         ",33133191,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,AETNA,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,BCBS,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,CIGNA,COM,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,TRICARE,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,UNITED HEALTHCARE,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,UNITED HEALTHCARE,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,VA,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,VA TRICARE,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,WELLMED,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,HUMANA,MGD,170.89,,,,,,,per diem,170.89,170.89,"Per diem rate, code is bundled with other services"
COMFY BOOT W/AMB PAD ADULT    ,33133264,CDM,270,RC,,,,,,Inpatient,,,170.89,170.89,HUMANA CHOICE PLUS,MGD,170.89,,,,,,,case rate,170.89,170.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,AETNA,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,BCBS,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,CIGNA,COM,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,TRICARE,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,UNITED HEALTHCARE,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,UNITED HEALTHCARE,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,VA,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,VA TRICARE,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,WELLMED,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,HUMANA,MGD,139.89,,,,,,,per diem,139.89,139.89,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL HEELMEDIX      ,33133265,CDM,270,RC,,,,,,Inpatient,,,139.89,139.89,HUMANA CHOICE PLUS,MGD,139.89,,,,,,,case rate,139.89,139.89,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,AETNA,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,BCBS,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,CIGNA,COM,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,TRICARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,UNITED HEALTHCARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,UNITED HEALTHCARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,VA,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,VA TRICARE,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,WELLMED,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,HUMANA,MGD,68.99,,,,,,,per diem,68.99,68.99,"Per diem rate, code is bundled with other services"
LONG ARM SPLINT               ,33133267,CDM,270,RC,,,,,,Inpatient,,,68.99,68.99,HUMANA CHOICE PLUS,MGD,68.99,,,,,,,case rate,68.99,68.99,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,AETNA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,CIGNA,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,WELLMED,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA,MGD,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM 2/PAD STRAP BLU XLG ,33133310,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA CHOICE PLUS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,AETNA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,CIGNA,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,VA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,VA TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,WELLMED,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,HUMANA,MGD,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
SLING ARM DELUXE XXS          ,33133311,CDM,270,RC,,,,,,Inpatient,,,8.47,8.47,HUMANA CHOICE PLUS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,AETNA,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,CIGNA,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,TRICARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,UNITED HEALTHCARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,UNITED HEALTHCARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,VA,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,VA TRICARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,WELLMED,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,HUMANA,MGD,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33133312,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,HUMANA CHOICE PLUS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,AETNA,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,BCBS,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,CIGNA,COM,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,TRICARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,UNITED HEALTHCARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,UNITED HEALTHCARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,VA,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,VA TRICARE,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,WELLMED,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,HUMANA,MGD,6.16,,,,,,,per diem,6.16,6.16,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33133313,CDM,270,RC,,,,,,Inpatient,,,6.16,6.16,HUMANA CHOICE PLUS,MGD,6.16,,,,,,,case rate,6.16,6.16,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,AETNA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,CIGNA,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,WELLMED,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA,MGD,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM PADDED STRAP LG     ,33133314,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA CHOICE PLUS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,AETNA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,CIGNA,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,VA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,VA TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,WELLMED,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,HUMANA,MGD,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS LG     ,33133315,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,HUMANA CHOICE PLUS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,AETNA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,CIGNA,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,VA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,VA TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,WELLMED,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,HUMANA,MGD,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
SLING ARM POUCH CANVAS MED    ,33133316,CDM,270,RC,,,,,,Inpatient,,,11.94,11.94,HUMANA CHOICE PLUS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,AETNA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,CIGNA,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,WELLMED,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA,MGD,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33133317,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA CHOICE PLUS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,AETNA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,CIGNA,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,WELLMED,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA,MGD,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33133318,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA CHOICE PLUS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,AETNA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,BCBS,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,CIGNA,COM,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,UNITED HEALTHCARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,VA TRICARE,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,WELLMED,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA,MGD,6.54,,,,,,,per diem,6.54,6.54,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU SM  ,33133319,CDM,270,RC,,,,,,Inpatient,,,6.54,6.54,HUMANA CHOICE PLUS,MGD,6.54,,,,,,,case rate,6.54,6.54,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,AETNA,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,BCBS,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,CIGNA,COM,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,TRICARE,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,UNITED HEALTHCARE,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,UNITED HEALTHCARE,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,VA,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,VA TRICARE,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,WELLMED,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,HUMANA,MGD,53.15,,,,,,,per diem,53.15,53.15,"Per diem rate, code is bundled with other services"
SPLINT BALL SOLID 1/8WHT LG EX,33133346,CDM,270,RC,,,,,,Inpatient,,,53.15,53.15,HUMANA CHOICE PLUS,MGD,53.15,,,,,,,case rate,53.15,53.15,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,AETNA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,CIGNA,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,VA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,VA TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,WELLMED,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,HUMANA,MGD,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33133551,CDM,279,RC,,,,,,Inpatient,,,15.12,15.12,HUMANA CHOICE PLUS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33133552,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,AETNA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,CIGNA,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,VA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,VA TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,WELLMED,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,HUMANA,MGD,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb) RENT,33133553,CDM,279,RC,,,,,,Inpatient,,,10.08,10.08,HUMANA CHOICE PLUS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33133554,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,AETNA,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,BCBS,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,CIGNA,COM,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,TRICARE,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,UNITED HEALTHCARE,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,UNITED HEALTHCARE,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,VA,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,VA TRICARE,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,WELLMED,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,HUMANA,MGD,88.83,,,,,,,per diem,88.83,88.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33133555,CDM,279,RC,,,,,,Inpatient,,,88.83,88.83,HUMANA CHOICE PLUS,MGD,88.83,,,,,,,case rate,88.83,88.83,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,AETNA,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,CIGNA,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,TRICARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,UNITED HEALTHCARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,UNITED HEALTHCARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,VA,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,VA TRICARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,WELLMED,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,HUMANA,MGD,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33133556,CDM,279,RC,,,,,,Inpatient,,,20.16,20.16,HUMANA CHOICE PLUS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,AETNA,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,BCBS,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,CIGNA,COM,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,TRICARE,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,UNITED HEALTHCARE,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,UNITED HEALTHCARE,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,VA,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,VA TRICARE,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,WELLMED,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,HUMANA,MGD,7,,,,,,,per diem,7,7,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33133557,CDM,279,RC,,,,,,Inpatient,,,7,7,HUMANA CHOICE PLUS,MGD,7,,,,,,,case rate,7,7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33133558,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33133559,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33133560,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33133561,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,AETNA,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,CIGNA,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,TRICARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,UNITED HEALTHCARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,UNITED HEALTHCARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,VA,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,VA TRICARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,WELLMED,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,HUMANA,MGD,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33133562,CDM,279,RC,,,,,,Inpatient,,,100.8,100.8,HUMANA CHOICE PLUS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,AETNA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,CIGNA,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,VA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,VA TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,WELLMED,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA,MGD,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33133563,CDM,279,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA CHOICE PLUS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33133564,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,AETNA,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,CIGNA,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,TRICARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,UNITED HEALTHCARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,UNITED HEALTHCARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,VA,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,VA TRICARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,WELLMED,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,HUMANA,MGD,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33133565,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,HUMANA CHOICE PLUS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,AETNA,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,BCBS,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,CIGNA,COM,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,TRICARE,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,UNITED HEALTHCARE,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,UNITED HEALTHCARE,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,VA,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,VA TRICARE,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,WELLMED,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,HUMANA,MGD,2.52,,,,,,,per diem,2.52,2.52,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33133566,CDM,279,RC,,,,,,Inpatient,,,2.52,2.52,HUMANA CHOICE PLUS,MGD,2.52,,,,,,,case rate,2.52,2.52,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,AETNA,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,BCBS,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,CIGNA,COM,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,TRICARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,UNITED HEALTHCARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,UNITED HEALTHCARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,VA,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,VA TRICARE,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,WELLMED,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,HUMANA,MGD,30.24,,,,,,,per diem,30.24,30.24,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33133567,CDM,279,RC,,,,,,Inpatient,,,30.24,30.24,HUMANA CHOICE PLUS,MGD,30.24,,,,,,,case rate,30.24,30.24,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,AETNA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,CIGNA,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,VA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,VA TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,WELLMED,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,HUMANA,MGD,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33133568,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,HUMANA CHOICE PLUS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,AETNA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,CIGNA,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,WELLMED,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA,MGD,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33133570,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA CHOICE PLUS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,AETNA,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,BCBS,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,CIGNA,COM,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,TRICARE,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,UNITED HEALTHCARE,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,UNITED HEALTHCARE,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,VA,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,VA TRICARE,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,WELLMED,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,HUMANA,MGD,97.21,,,,,,,per diem,97.21,97.21,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33133571,CDM,279,RC,,,,,,Inpatient,,,97.21,97.21,HUMANA CHOICE PLUS,MGD,97.21,,,,,,,case rate,97.21,97.21,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,AETNA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,CIGNA,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,VA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,VA TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,WELLMED,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,HUMANA,MGD,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33133572,CDM,279,RC,,,,,,Inpatient,,,22.68,22.68,HUMANA CHOICE PLUS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,AETNA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,CIGNA,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,VA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,VA TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,WELLMED,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA,MGD,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33133573,CDM,279,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA CHOICE PLUS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,AETNA,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,BCBS,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,CIGNA,COM,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,TRICARE,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,UNITED HEALTHCARE,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,UNITED HEALTHCARE,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,VA,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,VA TRICARE,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,WELLMED,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,HUMANA,MGD,15.02,,,,,,,per diem,15.02,15.02,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33133574,CDM,279,RC,,,,,,Inpatient,,,15.02,15.02,HUMANA CHOICE PLUS,MGD,15.02,,,,,,,case rate,15.02,15.02,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,AETNA,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,BCBS,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,CIGNA,COM,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,TRICARE,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,UNITED HEALTHCARE,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,UNITED HEALTHCARE,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,VA,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,VA TRICARE,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,WELLMED,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,HUMANA,MGD,32.76,,,,,,,per diem,32.76,32.76,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33133575,CDM,279,RC,,,,,,Inpatient,,,32.76,32.76,HUMANA CHOICE PLUS,MGD,32.76,,,,,,,case rate,32.76,32.76,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,AETNA,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,BCBS,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,CIGNA,COM,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,TRICARE,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,UNITED HEALTHCARE,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,UNITED HEALTHCARE,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,VA,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,VA TRICARE,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,WELLMED,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,HUMANA,MGD,121.41,,,,,,,per diem,121.41,121.41,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33133577,CDM,279,RC,,,,,,Inpatient,,,121.41,121.41,HUMANA CHOICE PLUS,MGD,121.41,,,,,,,case rate,121.41,121.41,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,AETNA,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,BCBS,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,CIGNA,COM,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,TRICARE,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,UNITED HEALTHCARE,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,UNITED HEALTHCARE,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,VA,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,VA TRICARE,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,WELLMED,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,HUMANA,MGD,28.2,,,,,,,per diem,28.2,28.2,"Per diem rate, code is bundled with other services"
WOUND VAC.                    ,33133592,CDM,279,RC,,,,,,Inpatient,,,28.2,28.2,HUMANA CHOICE PLUS,MGD,28.2,,,,,,,case rate,28.2,28.2,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,AETNA,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,CIGNA,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,TRICARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,UNITED HEALTHCARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,UNITED HEALTHCARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,VA,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,VA TRICARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,WELLMED,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,HUMANA,MGD,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
WOUND VAC.>50 SQ CM-RH        ,33133593,CDM,279,RC,,,,,,Inpatient,,,36.86,36.86,HUMANA CHOICE PLUS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,AETNA,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,BCBS,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,CIGNA,COM,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,TRICARE,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,UNITED HEALTHCARE,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,UNITED HEALTHCARE,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,VA,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,VA TRICARE,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,WELLMED,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,HUMANA,MGD,119.39,,,,,,,per diem,119.39,119.39,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,33133606,CDM,279,RC,,,,,,Inpatient,,,119.39,119.39,HUMANA CHOICE PLUS,MGD,119.39,,,,,,,case rate,119.39,119.39,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES SM,33133633,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES SM,33133634,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES M ,33133635,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES M ,33133636,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER OPEN FINGER GLOVES LG,33133637,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,AETNA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,BCBS,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,CIGNA,COM,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,UNITED HEALTHCARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,VA TRICARE,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,WELLMED,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA,MGD,40.1,,,,,,,per diem,40.1,40.1,"Per diem rate, code is bundled with other services"
ISOTONER FULL FINGER GLOVES LG,33133638,CDM,270,RC,,,,,,Inpatient,,,40.1,40.1,HUMANA CHOICE PLUS,MGD,40.1,,,,,,,case rate,40.1,40.1,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,AETNA,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,BCBS,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,CIGNA,COM,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,TRICARE,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,UNITED HEALTHCARE,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,UNITED HEALTHCARE,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,VA,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,VA TRICARE,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,WELLMED,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,HUMANA,MGD,64.61,,,,,,,per diem,64.61,64.61,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE XL      ,33133639,CDM,270,RC,,,,,,Inpatient,,,64.61,64.61,HUMANA CHOICE PLUS,MGD,64.61,,,,,,,case rate,64.61,64.61,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,AETNA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,CIGNA,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,VA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,VA TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,WELLMED,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,HUMANA,MGD,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE LARGE   ,33133640,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,HUMANA CHOICE PLUS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,AETNA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,CIGNA,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,VA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,VA TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,WELLMED,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,HUMANA,MGD,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
HATCH PARA PUSH GLOVE SMALL   ,33133641,CDM,270,RC,,,,,,Inpatient,,,67.22,67.22,HUMANA CHOICE PLUS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,AETNA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,CIGNA,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,WELLMED,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA,MGD,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT S/M          ,33133642,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA CHOICE PLUS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,AETNA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,CIGNA,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,WELLMED,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA,MGD,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT S/M         ,33133643,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA CHOICE PLUS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,AETNA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,CIGNA,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,WELLMED,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA,MGD,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE LEFT LG/XL        ,33133644,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA CHOICE PLUS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,AETNA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,CIGNA,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,VA TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,WELLMED,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA,MGD,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
WRIST BRACE RIGHT LG/XL       ,33133645,CDM,270,RC,,,,,,Inpatient,,,48.7,48.7,HUMANA CHOICE PLUS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,AETNA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,CIGNA,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,WELLMED,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA,MGD,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/M,33133650,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA CHOICE PLUS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,AETNA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,CIGNA,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,WELLMED,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA,MGD,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED ANTISPASTICITY LFT/L,33133651,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA CHOICE PLUS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,AETNA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,CIGNA,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,WELLMED,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA,MGD,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/MD,33133652,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA CHOICE PLUS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,AETNA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,BCBS,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,CIGNA,COM,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,UNITED HEALTHCARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,VA TRICARE,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,WELLMED,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA,MGD,119.51,,,,,,,per diem,119.51,119.51,"Per diem rate, code is bundled with other services"
PREFORMED BALL SPLINT RIGHT/LG,33133653,CDM,270,RC,,,,,,Inpatient,,,119.51,119.51,HUMANA CHOICE PLUS,MGD,119.51,,,,,,,case rate,119.51,119.51,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,AETNA,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,BCBS,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,CIGNA,COM,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,TRICARE,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,UNITED HEALTHCARE,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,UNITED HEALTHCARE,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,VA,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,VA TRICARE,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,WELLMED,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,HUMANA,MGD,51.28,,,,,,,per diem,51.28,51.28,"Per diem rate, code is bundled with other services"
ANTIMICROBIAL SILVER DRESSING ,33133655,CDM,270,RC,,,,,,Inpatient,,,51.28,51.28,HUMANA CHOICE PLUS,MGD,51.28,,,,,,,case rate,51.28,51.28,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,AETNA,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,CIGNA,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,TRICARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,UNITED HEALTHCARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,UNITED HEALTHCARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,VA,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,VA TRICARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,WELLMED,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,HUMANA,MGD,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
BINDER 9IN 3 PANEL 30IN T     ,33136209,CDM,270,RC,,,,,,Inpatient,,,17.45,17.45,HUMANA CHOICE PLUS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,AETNA,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,BCBS,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,CIGNA,COM,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,TRICARE,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,UNITED HEALTHCARE,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,UNITED HEALTHCARE,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,VA,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,VA TRICARE,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,WELLMED,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,HUMANA,MGD,14.34,,,,,,,per diem,14.34,14.34,"Per diem rate, code is bundled with other services"
COLLAR CERV SERPENTINE MED    ,33136210,CDM,270,RC,,,,,,Inpatient,,,14.34,14.34,HUMANA CHOICE PLUS,MGD,14.34,,,,,,,case rate,14.34,14.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,AETNA,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,BCBS,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,CIGNA,COM,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,TRICARE,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,UNITED HEALTHCARE,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,UNITED HEALTHCARE,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,VA,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,VA TRICARE,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,WELLMED,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,HUMANA,MGD,8.34,,,,,,,per diem,8.34,8.34,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL STANDARD ,33136223,CDM,270,RC,,,,,,Inpatient,,,8.34,8.34,HUMANA CHOICE PLUS,MGD,8.34,,,,,,,case rate,8.34,8.34,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,AETNA,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,BCBS,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,CIGNA,COM,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,TRICARE,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,UNITED HEALTHCARE,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,UNITED HEALTHCARE,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,VA,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,VA TRICARE,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,WELLMED,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,HUMANA,MGD,5.63,,,,,,,per diem,5.63,5.63,"Per diem rate, code is bundled with other services"
SET FEED GRAVITY EASY FEED 100,33136262,CDM,279,RC,,,,,,Inpatient,,,5.63,5.63,HUMANA CHOICE PLUS,MGD,5.63,,,,,,,case rate,5.63,5.63,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,AETNA,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,BCBS,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,CIGNA,COM,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,TRICARE,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,UNITED HEALTHCARE,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,UNITED HEALTHCARE,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,VA,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,VA TRICARE,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,WELLMED,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,HUMANA,MGD,118.85,,,,,,,per diem,118.85,118.85,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/G     ,33136276,CDM,279,RC,,,,,,Inpatient,,,118.85,118.85,HUMANA CHOICE PLUS,MGD,118.85,,,,,,,case rate,118.85,118.85,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,AETNA,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,BCBS,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,CIGNA,COM,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,TRICARE,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,UNITED HEALTHCARE,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,UNITED HEALTHCARE,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,VA,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,VA TRICARE,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,WELLMED,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,HUMANA,MGD,155.51,,,,,,,per diem,155.51,155.51,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33136279,CDM,270,RC,,,,,,Inpatient,,,155.51,155.51,HUMANA CHOICE PLUS,MGD,155.51,,,,,,,case rate,155.51,155.51,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,AETNA,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,BCBS,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,CIGNA,COM,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,TRICARE,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,UNITED HEALTHCARE,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,UNITED HEALTHCARE,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,VA,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,VA TRICARE,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,WELLMED,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,HUMANA,MGD,39.4,,,,,,,per diem,39.4,39.4,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33136303,CDM,270,RC,,,,,,Inpatient,,,39.4,39.4,HUMANA CHOICE PLUS,MGD,39.4,,,,,,,case rate,39.4,39.4,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,AETNA,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,BCBS,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,CIGNA,COM,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,TRICARE,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,UNITED HEALTHCARE,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,UNITED HEALTHCARE,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,VA,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,VA TRICARE,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,WELLMED,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,HUMANA,MGD,101.77,,,,,,,per diem,101.77,101.77,"Per diem rate, code is bundled with other services"
"COLLAR, ADULT REGULAR (ASPEN) ",33136341,CDM,270,RC,,,,,,Inpatient,,,101.77,101.77,HUMANA CHOICE PLUS,MGD,101.77,,,,,,,case rate,101.77,101.77,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,AETNA,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,BCBS,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,CIGNA,COM,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,TRICARE,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,UNITED HEALTHCARE,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,UNITED HEALTHCARE,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,VA,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,VA TRICARE,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,WELLMED,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,HUMANA,MGD,76.5,,,,,,,per diem,76.5,76.5,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 15"" 55-72""   ",33136343,CDM,270,RC,,,,,,Inpatient,,,76.5,76.5,HUMANA CHOICE PLUS,MGD,76.5,,,,,,,case rate,76.5,76.5,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,AETNA,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,CIGNA,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,TRICARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,UNITED HEALTHCARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,UNITED HEALTHCARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,VA,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,VA TRICARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,WELLMED,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,HUMANA,MGD,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
ARM SLING LRG                 ,33136352,CDM,270,RC,,,,,,Inpatient,,,10.61,10.61,HUMANA CHOICE PLUS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,AETNA,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,BCBS,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,CIGNA,COM,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,TRICARE,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,UNITED HEALTHCARE,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,UNITED HEALTHCARE,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,VA,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,VA TRICARE,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,WELLMED,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,HUMANA,MGD,61.41,,,,,,,per diem,61.41,61.41,"Per diem rate, code is bundled with other services"
KNEE BRACE ELEASTIC MUELL     ,33136360,CDM,270,RC,,,,,,Inpatient,,,61.41,61.41,HUMANA CHOICE PLUS,MGD,61.41,,,,,,,case rate,61.41,61.41,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JUVEN NUTRITION DRINK         ,33136397,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,AETNA,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,BCBS,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,CIGNA,COM,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,TRICARE,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,UNITED HEALTHCARE,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,UNITED HEALTHCARE,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,VA,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,VA TRICARE,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,WELLMED,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,HUMANA,MGD,301.06,,,,,,,per diem,301.06,301.06,"Per diem rate, code is bundled with other services"
SOFT SHELL HELMET 8OZ         ,33136442,CDM,270,RC,,,,,,Inpatient,,,301.06,301.06,HUMANA CHOICE PLUS,MGD,301.06,,,,,,,case rate,301.06,301.06,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,AETNA,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,CIGNA,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,TRICARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,UNITED HEALTHCARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,UNITED HEALTHCARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,VA,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,VA TRICARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,WELLMED,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,HUMANA,MGD,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33136451,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,HUMANA CHOICE PLUS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,AETNA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,CIGNA,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,VA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,VA TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,WELLMED,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,HUMANA,MGD,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33136452,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,HUMANA CHOICE PLUS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,AETNA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,CIGNA,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,VA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,VA TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,WELLMED,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA,MGD,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE (700lb)     ,33136453,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA CHOICE PLUS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,AETNA,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,BCBS,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,CIGNA,COM,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,TRICARE,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,UNITED HEALTHCARE,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,UNITED HEALTHCARE,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,VA,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,VA TRICARE,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,WELLMED,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,HUMANA,MGD,140.06,,,,,,,per diem,140.06,140.06,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33136454,CDM,279,RC,,,,,,Inpatient,,,140.06,140.06,HUMANA CHOICE PLUS,MGD,140.06,,,,,,,case rate,140.06,140.06,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,AETNA,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,CIGNA,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,TRICARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,UNITED HEALTHCARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,UNITED HEALTHCARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,VA,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,VA TRICARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,WELLMED,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,HUMANA,MGD,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33136455,CDM,279,RC,,,,,,Inpatient,,,81.66,81.66,HUMANA CHOICE PLUS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,AETNA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,CIGNA,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,VA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,VA TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,WELLMED,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,HUMANA,MGD,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33136456,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,HUMANA CHOICE PLUS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,AETNA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,CIGNA,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,VA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,VA TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,WELLMED,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA,MGD,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33136457,CDM,279,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA CHOICE PLUS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,AETNA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,CIGNA,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,VA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,VA TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,WELLMED,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA,MGD,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33136458,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA CHOICE PLUS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,AETNA,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,BCBS,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,CIGNA,COM,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,TRICARE,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,UNITED HEALTHCARE,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,UNITED HEALTHCARE,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,VA,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,VA TRICARE,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,WELLMED,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,HUMANA,MGD,12.98,,,,,,,per diem,12.98,12.98,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4      ,33136459,CDM,279,RC,,,,,,Inpatient,,,12.98,12.98,HUMANA CHOICE PLUS,MGD,12.98,,,,,,,case rate,12.98,12.98,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,AETNA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,CIGNA,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,VA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,VA TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,WELLMED,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,HUMANA,MGD,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33136460,CDM,279,RC,,,,,,Inpatient,,,104.91,104.91,HUMANA CHOICE PLUS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33136461,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,AETNA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,CIGNA,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,VA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,VA TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,WELLMED,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,HUMANA,MGD,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33136462,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,HUMANA CHOICE PLUS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,AETNA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,CIGNA,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,VA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,VA TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,WELLMED,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,HUMANA,MGD,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33136463,CDM,279,RC,,,,,,Inpatient,,,93.56,93.56,HUMANA CHOICE PLUS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33136464,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,AETNA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,CIGNA,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,VA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,VA TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,WELLMED,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA,MGD,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFR     ,33136465,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA CHOICE PLUS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,AETNA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,CIGNA,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,VA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,VA TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,WELLMED,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,HUMANA,MGD,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33136466,CDM,279,RC,,,,,,Inpatient,,,23.26,23.26,HUMANA CHOICE PLUS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,AETNA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,CIGNA,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,VA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,VA TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,WELLMED,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA,MGD,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER      ,33136467,CDM,279,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA CHOICE PLUS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,AETNA,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,CIGNA,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,TRICARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,UNITED HEALTHCARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,UNITED HEALTHCARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,VA,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,VA TRICARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,WELLMED,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,HUMANA,MGD,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33136468,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,HUMANA CHOICE PLUS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33136469,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,AETNA,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,BCBS,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,CIGNA,COM,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,TRICARE,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,UNITED HEALTHCARE,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,UNITED HEALTHCARE,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,VA,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,VA TRICARE,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,WELLMED,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,HUMANA,MGD,175.2,,,,,,,per diem,175.2,175.2,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33136472,CDM,279,RC,,,,,,Inpatient,,,175.2,175.2,HUMANA CHOICE PLUS,MGD,175.2,,,,,,,case rate,175.2,175.2,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33136473,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,AETNA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,BCBS,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,CIGNA,COM,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,UNITED HEALTHCARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,VA,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,VA TRICARE,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,WELLMED,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA,MGD,18.93,,,,,,,per diem,18.93,18.93,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33136474,CDM,279,RC,,,,,,Inpatient,,,18.93,18.93,HUMANA CHOICE PLUS,MGD,18.93,,,,,,,case rate,18.93,18.93,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,AETNA,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,CIGNA,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,TRICARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,UNITED HEALTHCARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,UNITED HEALTHCARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,VA,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,VA TRICARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,WELLMED,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,HUMANA,MGD,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33136475,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,HUMANA CHOICE PLUS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,AETNA,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,BCBS,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,CIGNA,COM,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,TRICARE,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,UNITED HEALTHCARE,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,UNITED HEALTHCARE,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,VA,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,VA TRICARE,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,WELLMED,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,HUMANA,MGD,7.57,,,,,,,per diem,7.57,7.57,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33136477,CDM,279,RC,,,,,,Inpatient,,,7.57,7.57,HUMANA CHOICE PLUS,MGD,7.57,,,,,,,case rate,7.57,7.57,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,AETNA,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,BCBS,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,CIGNA,COM,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,TRICARE,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,UNITED HEALTHCARE,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,UNITED HEALTHCARE,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,VA,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,VA TRICARE,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,WELLMED,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,HUMANA,MGD,180.08,,,,,,,per diem,180.08,180.08,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE      ,33136478,CDM,279,RC,,,,,,Inpatient,,,180.08,180.08,HUMANA CHOICE PLUS,MGD,180.08,,,,,,,case rate,180.08,180.08,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,AETNA,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,CIGNA,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,TRICARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,UNITED HEALTHCARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,UNITED HEALTHCARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,VA,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,VA TRICARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,WELLMED,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,HUMANA,MGD,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
SIZE WISE PULSE AIR MATTRESS  ,33136479,CDM,279,RC,,,,,,Inpatient,,,38.93,38.93,HUMANA CHOICE PLUS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33136480,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,AETNA,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,BCBS,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,CIGNA,COM,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,TRICARE,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,UNITED HEALTHCARE,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,UNITED HEALTHCARE,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,VA,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,VA TRICARE,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,WELLMED,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,HUMANA,MGD,8.12,,,,,,,per diem,8.12,8.12,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33136482,CDM,279,RC,,,,,,Inpatient,,,8.12,8.12,HUMANA CHOICE PLUS,MGD,8.12,,,,,,,case rate,8.12,8.12,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33136483,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,AETNA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,CIGNA,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,VA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,VA TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,WELLMED,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,HUMANA,MGD,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33136484,CDM,279,RC,,,,,,Inpatient,,,35.15,35.15,HUMANA CHOICE PLUS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,AETNA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,CIGNA,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,VA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,VA TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,WELLMED,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA,MGD,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS          ,33136485,CDM,279,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA CHOICE PLUS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,AETNA,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,BCBS,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,CIGNA,COM,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,TRICARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,UNITED HEALTHCARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,UNITED HEALTHCARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,VA,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,VA TRICARE,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,WELLMED,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,HUMANA,MGD,4.87,,,,,,,per diem,4.87,4.87,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33136486,CDM,279,RC,,,,,,Inpatient,,,4.87,4.87,HUMANA CHOICE PLUS,MGD,4.87,,,,,,,case rate,4.87,4.87,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,AETNA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,CIGNA,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,VA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,VA TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,WELLMED,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA,MGD,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33136487,CDM,279,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA CHOICE PLUS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,AETNA,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,BCBS,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,CIGNA,COM,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,TRICARE,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,UNITED HEALTHCARE,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,UNITED HEALTHCARE,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,VA,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,VA TRICARE,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,WELLMED,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,HUMANA,MGD,59.48,,,,,,,per diem,59.48,59.48,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33136488,CDM,279,RC,,,,,,Inpatient,,,59.48,59.48,HUMANA CHOICE PLUS,MGD,59.48,,,,,,,case rate,59.48,59.48,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,AETNA,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,BCBS,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,CIGNA,COM,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,TRICARE,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,UNITED HEALTHCARE,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,UNITED HEALTHCARE,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,VA,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,VA TRICARE,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,WELLMED,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,HUMANA,MGD,560.76,,,,,,,per diem,560.76,560.76,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33136489,CDM,279,RC,,,,,,Inpatient,,,560.76,560.76,HUMANA CHOICE PLUS,MGD,560.76,,,,,,,case rate,560.76,560.76,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,AETNA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,BCBS,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,CIGNA,COM,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,UNITED HEALTHCARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,VA TRICARE,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,WELLMED,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA,MGD,33.61,,,,,,,per diem,33.61,33.61,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33136490,CDM,279,RC,,,,,,Inpatient,,,33.61,33.61,HUMANA CHOICE PLUS,MGD,33.61,,,,,,,case rate,33.61,33.61,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,AETNA,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,CIGNA,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,TRICARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,UNITED HEALTHCARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,UNITED HEALTHCARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,VA,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,VA TRICARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,WELLMED,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,HUMANA,MGD,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33136491,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,HUMANA CHOICE PLUS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,AETNA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,CIGNA,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,VA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,VA TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,WELLMED,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,HUMANA,MGD,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33136492,CDM,279,RC,,,,,,Inpatient,,,137.9,137.9,HUMANA CHOICE PLUS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,AETNA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,CIGNA,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,VA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,VA TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,WELLMED,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,HUMANA,MGD,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33136493,CDM,279,RC,,,,,,Inpatient,,,63.27,63.27,HUMANA CHOICE PLUS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,AETNA,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,CIGNA,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,TRICARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,UNITED HEALTHCARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,UNITED HEALTHCARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,VA,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,VA TRICARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,WELLMED,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,HUMANA,MGD,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136494,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,HUMANA CHOICE PLUS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,AETNA,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,CIGNA,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,TRICARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,UNITED HEALTHCARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,UNITED HEALTHCARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,VA,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,VA TRICARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,WELLMED,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,HUMANA,MGD,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136495,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,HUMANA CHOICE PLUS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,AETNA,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,BCBS,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,CIGNA,COM,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,TRICARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,UNITED HEALTHCARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,UNITED HEALTHCARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,VA,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,VA TRICARE,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,WELLMED,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,HUMANA,MGD,42.18,,,,,,,per diem,42.18,42.18,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33136496,CDM,279,RC,,,,,,Inpatient,,,42.18,42.18,HUMANA CHOICE PLUS,MGD,42.18,,,,,,,case rate,42.18,42.18,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,AETNA,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,BCBS,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,CIGNA,COM,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,TRICARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,UNITED HEALTHCARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,UNITED HEALTHCARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,VA,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,VA TRICARE,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,WELLMED,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,HUMANA,MGD,28.12,,,,,,,per diem,28.12,28.12,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33136497,CDM,279,RC,,,,,,Inpatient,,,28.12,28.12,HUMANA CHOICE PLUS,MGD,28.12,,,,,,,case rate,28.12,28.12,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,AETNA,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,BCBS,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,CIGNA,COM,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,TRICARE,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,UNITED HEALTHCARE,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,UNITED HEALTHCARE,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,VA,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,VA TRICARE,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,WELLMED,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,HUMANA,MGD,87.6,,,,,,,per diem,87.6,87.6,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33136498,CDM,279,RC,,,,,,Inpatient,,,87.6,87.6,HUMANA CHOICE PLUS,MGD,87.6,,,,,,,case rate,87.6,87.6,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33136499,CDM,279,RC,,,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,AETNA,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,CIGNA,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,TRICARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,UNITED HEALTHCARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,UNITED HEALTHCARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,VA,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,VA TRICARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,WELLMED,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,HUMANA,MGD,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33136500,CDM,279,RC,,,,,,Inpatient,,,86.52,86.52,HUMANA CHOICE PLUS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,AETNA,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,BCBS,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,CIGNA,COM,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,TRICARE,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,UNITED HEALTHCARE,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,UNITED HEALTHCARE,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,VA,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,VA TRICARE,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,WELLMED,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,HUMANA,MGD,49.21,,,,,,,per diem,49.21,49.21,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33136501,CDM,279,RC,,,,,,Inpatient,,,49.21,49.21,HUMANA CHOICE PLUS,MGD,49.21,,,,,,,case rate,49.21,49.21,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,AETNA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,CIGNA,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,VA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,VA TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,WELLMED,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,HUMANA,MGD,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
AV IMPULSE SYSTEM FOOT PUMP   ,33136503,CDM,279,RC,,,,,,Inpatient,,,41.1,41.1,HUMANA CHOICE PLUS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,AETNA,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,BCBS,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,CIGNA,COM,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,TRICARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,UNITED HEALTHCARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,UNITED HEALTHCARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,VA,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,VA TRICARE,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,WELLMED,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,HUMANA,MGD,53.54,,,,,,,per diem,53.54,53.54,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33136504,CDM,279,RC,,,,,,Inpatient,,,53.54,53.54,HUMANA CHOICE PLUS,MGD,53.54,,,,,,,case rate,53.54,53.54,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,AETNA,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,BCBS,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,CIGNA,COM,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,TRICARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,UNITED HEALTHCARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,UNITED HEALTHCARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,VA,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,VA TRICARE,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,WELLMED,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,HUMANA,MGD,141.14,,,,,,,per diem,141.14,141.14,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33136505,CDM,279,RC,,,,,,Inpatient,,,141.14,141.14,HUMANA CHOICE PLUS,MGD,141.14,,,,,,,case rate,141.14,141.14,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,AETNA,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,BCBS,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,CIGNA,COM,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,TRICARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,UNITED HEALTHCARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,UNITED HEALTHCARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,VA,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,VA TRICARE,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,WELLMED,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,HUMANA,MGD,80.58,,,,,,,per diem,80.58,80.58,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33136507,CDM,279,RC,,,,,,Inpatient,,,80.58,80.58,HUMANA CHOICE PLUS,MGD,80.58,,,,,,,case rate,80.58,80.58,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,AETNA,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,BCBS,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,CIGNA,COM,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,TRICARE,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,UNITED HEALTHCARE,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,UNITED HEALTHCARE,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,VA,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,VA TRICARE,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,WELLMED,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,HUMANA,MGD,31.36,,,,,,,per diem,31.36,31.36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33136508,CDM,279,RC,,,,,,Inpatient,,,31.36,31.36,HUMANA CHOICE PLUS,MGD,31.36,,,,,,,case rate,31.36,31.36,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,AETNA,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,BCBS,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,CIGNA,COM,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,TRICARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,UNITED HEALTHCARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,UNITED HEALTHCARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,VA,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,VA TRICARE,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,WELLMED,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,HUMANA,MGD,377.75,,,,,,,per diem,377.75,377.75,"Per diem rate, code is bundled with other services"
SPECIAL ORDER BEDS/MATTRESS   ,33136510,CDM,279,RC,,,,,,Inpatient,,,377.75,377.75,HUMANA CHOICE PLUS,MGD,377.75,,,,,,,case rate,377.75,377.75,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,AETNA,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,BCBS,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,CIGNA,COM,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,TRICARE,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,UNITED HEALTHCARE,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,UNITED HEALTHCARE,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,VA,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,VA TRICARE,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,WELLMED,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,HUMANA,MGD,224.95,,,,,,,per diem,224.95,224.95,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33136511,CDM,279,RC,,,,,,Inpatient,,,224.95,224.95,HUMANA CHOICE PLUS,MGD,224.95,,,,,,,case rate,224.95,224.95,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33136512,CDM,279,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,AETNA,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,BCBS,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,CIGNA,COM,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,TRICARE,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,UNITED HEALTHCARE,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,UNITED HEALTHCARE,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,VA,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,VA TRICARE,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,WELLMED,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,HUMANA,MGD,143.84,,,,,,,per diem,143.84,143.84,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33136514,CDM,279,RC,,,,,,Inpatient,,,143.84,143.84,HUMANA CHOICE PLUS,MGD,143.84,,,,,,,case rate,143.84,143.84,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,AETNA,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,BCBS,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,CIGNA,COM,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,TRICARE,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,UNITED HEALTHCARE,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,UNITED HEALTHCARE,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,VA,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,VA TRICARE,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,WELLMED,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,HUMANA,MGD,78.95,,,,,,,per diem,78.95,78.95,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33136515,CDM,279,RC,,,,,,Inpatient,,,78.95,78.95,HUMANA CHOICE PLUS,MGD,78.95,,,,,,,case rate,78.95,78.95,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,AETNA,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,CIGNA,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,TRICARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,UNITED HEALTHCARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,UNITED HEALTHCARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,VA,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,VA TRICARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,WELLMED,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,HUMANA,MGD,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33136516,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,HUMANA CHOICE PLUS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,AETNA,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,BCBS,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,CIGNA,COM,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,TRICARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,UNITED HEALTHCARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,UNITED HEALTHCARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,VA,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,VA TRICARE,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,WELLMED,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,HUMANA,MGD,169.26,,,,,,,per diem,169.26,169.26,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33136517,CDM,279,RC,,,,,,Inpatient,,,169.26,169.26,HUMANA CHOICE PLUS,MGD,169.26,,,,,,,case rate,169.26,169.26,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,AETNA,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,BCBS,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,CIGNA,COM,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,TRICARE,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,UNITED HEALTHCARE,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,UNITED HEALTHCARE,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,VA,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,VA TRICARE,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,WELLMED,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,HUMANA,MGD,151.96,,,,,,,per diem,151.96,151.96,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33136518,CDM,279,RC,,,,,,Inpatient,,,151.96,151.96,HUMANA CHOICE PLUS,MGD,151.96,,,,,,,case rate,151.96,151.96,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,AETNA,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,BCBS,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,CIGNA,COM,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,TRICARE,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,UNITED HEALTHCARE,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,UNITED HEALTHCARE,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,VA,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,VA TRICARE,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,WELLMED,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,HUMANA,MGD,17.3,,,,,,,per diem,17.3,17.3,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33136519,CDM,279,RC,,,,,,Inpatient,,,17.3,17.3,HUMANA CHOICE PLUS,MGD,17.3,,,,,,,case rate,17.3,17.3,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,AETNA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,CIGNA,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,VA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,VA TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,WELLMED,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,HUMANA,MGD,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33136521,CDM,279,RC,,,,,,Inpatient,,,74.62,74.62,HUMANA CHOICE PLUS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,AETNA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,CIGNA,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,VA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,VA TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,WELLMED,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,HUMANA,MGD,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33136522,CDM,279,RC,,,,,,Inpatient,,,11.56,11.56,HUMANA CHOICE PLUS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,AETNA,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,BCBS,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,CIGNA,COM,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,TRICARE,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,UNITED HEALTHCARE,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,UNITED HEALTHCARE,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,VA,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,VA TRICARE,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,WELLMED,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,HUMANA,MGD,730.01,,,,,,,per diem,730.01,730.01,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33136523,CDM,279,RC,,,,,,Inpatient,,,730.01,730.01,HUMANA CHOICE PLUS,MGD,730.01,,,,,,,case rate,730.01,730.01,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,AETNA,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,CIGNA,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,TRICARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,UNITED HEALTHCARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,UNITED HEALTHCARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,VA,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,VA TRICARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,WELLMED,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,HUMANA,MGD,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONTINU,33136524,CDM,279,RC,,,,,,Inpatient,,,11.9,11.9,HUMANA CHOICE PLUS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,AETNA,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,BCBS,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,CIGNA,COM,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,TRICARE,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,UNITED HEALTHCARE,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,UNITED HEALTHCARE,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,VA,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,VA TRICARE,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,WELLMED,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,HUMANA,MGD,3.79,,,,,,,per diem,3.79,3.79,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER      ,33136525,CDM,279,RC,,,,,,Inpatient,,,3.79,3.79,HUMANA CHOICE PLUS,MGD,3.79,,,,,,,case rate,3.79,3.79,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,AETNA,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,CIGNA,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,TRICARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,UNITED HEALTHCARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,UNITED HEALTHCARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,VA,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,VA TRICARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,WELLMED,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,HUMANA,MGD,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33136526,CDM,279,RC,,,,,,Inpatient,,,163.31,163.31,HUMANA CHOICE PLUS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,AETNA,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,CIGNA,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,TRICARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,UNITED HEALTHCARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,UNITED HEALTHCARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,VA,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,VA TRICARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,WELLMED,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,HUMANA,MGD,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
IPPB AP5 RESPIRATORY MACHINE  ,33136528,CDM,279,RC,,,,,,Inpatient,,,6.49,6.49,HUMANA CHOICE PLUS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,AETNA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,CIGNA,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,VA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,VA TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,WELLMED,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,HUMANA,MGD,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
VISION BI-PAP MACHINE RENTAL  ,33136529,CDM,279,RC,,,,,,Inpatient,,,58.95,58.95,HUMANA CHOICE PLUS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,AETNA,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,BCBS,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,CIGNA,COM,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,TRICARE,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,UNITED HEALTHCARE,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,UNITED HEALTHCARE,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,VA,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,VA TRICARE,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,WELLMED,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,HUMANA,MGD,64.89,,,,,,,per diem,64.89,64.89,"Per diem rate, code is bundled with other services"
PULSATE AIR MATTRESS          ,33136534,CDM,279,RC,,,,,,Inpatient,,,64.89,64.89,HUMANA CHOICE PLUS,MGD,64.89,,,,,,,case rate,64.89,64.89,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
VAIL/ENCLOSURE BED            ,33136535,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY                ,33136538,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,AETNA,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,BCBS,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,CIGNA,COM,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,TRICARE,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,UNITED HEALTHCARE,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,UNITED HEALTHCARE,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,VA,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,VA TRICARE,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,WELLMED,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,HUMANA,MGD,45.52,,,,,,,per diem,45.52,45.52,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136544,CDM,270,RC,,,,,,Inpatient,,,45.52,45.52,HUMANA CHOICE PLUS,MGD,45.52,,,,,,,case rate,45.52,45.52,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,AETNA,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,BCBS,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,CIGNA,COM,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,TRICARE,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UNITED HEALTHCARE,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,UNITED HEALTHCARE,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,VA,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,VA TRICARE,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,WELLMED,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,HUMANA,MGD,176.28,,,,,,,per diem,176.28,176.28,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136582,CDM,270,RC,,,,,,Inpatient,,,176.28,176.28,HUMANA CHOICE PLUS,MGD,176.28,,,,,,,case rate,176.28,176.28,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,AETNA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,CIGNA,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,VA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,VA TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,WELLMED,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,HUMANA,MGD,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHERS 32IN                 ,33136584,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,HUMANA CHOICE PLUS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,AETNA,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,BCBS,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,CIGNA,COM,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,TRICARE,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,UNITED HEALTHCARE,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,UNITED HEALTHCARE,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,VA,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,VA TRICARE,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,WELLMED,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,HUMANA,MGD,98.96,,,,,,,per diem,98.96,98.96,"Per diem rate, code is bundled with other services"
KNEE ABDUCTION WEDGE W/STRAP  ,33136585,CDM,270,RC,,,,,,Inpatient,,,98.96,98.96,HUMANA CHOICE PLUS,MGD,98.96,,,,,,,case rate,98.96,98.96,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,AETNA,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,CIGNA,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,TRICARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,UNITED HEALTHCARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,UNITED HEALTHCARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,VA,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,VA TRICARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,WELLMED,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,HUMANA,MGD,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES (AP,33136589,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,HUMANA CHOICE PLUS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,AETNA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,CIGNA,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,VA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,VA TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,WELLMED,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA,MGD,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 14IN         ,33136596,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA CHOICE PLUS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,AETNA,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,BCBS,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,CIGNA,COM,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,TRICARE,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,UNITED HEALTHCARE,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,UNITED HEALTHCARE,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,VA,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,VA TRICARE,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,WELLMED,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,HUMANA,MGD,40.02,,,,,,,per diem,40.02,40.02,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 16IN         ,33136597,CDM,270,RC,,,,,,Inpatient,,,40.02,40.02,HUMANA CHOICE PLUS,MGD,40.02,,,,,,,case rate,40.02,40.02,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,AETNA,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,CIGNA,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,TRICARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,UNITED HEALTHCARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,UNITED HEALTHCARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,VA,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,VA TRICARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,WELLMED,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,HUMANA,MGD,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 20IN         ,33136598,CDM,270,RC,,,,,,Inpatient,,,45.42,45.42,HUMANA CHOICE PLUS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,AETNA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,CIGNA,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,VA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,VA TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,WELLMED,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,HUMANA,MGD,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
KNEE IMMOBILIZER 24IN         ,33136599,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,HUMANA CHOICE PLUS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,AETNA,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,BCBS,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,CIGNA,COM,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,TRICARE,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,UNITED HEALTHCARE,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,UNITED HEALTHCARE,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,VA,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,VA TRICARE,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,WELLMED,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,HUMANA,MGD,48.13,,,,,,,per diem,48.13,48.13,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33136637,CDM,270,RC,,,,,,Inpatient,,,48.13,48.13,HUMANA CHOICE PLUS,MGD,48.13,,,,,,,case rate,48.13,48.13,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,AETNA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,CIGNA,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,VA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,VA TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,WELLMED,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,HUMANA,MGD,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
ORTHO BUNNY BOOT-EACH         ,33136638,CDM,270,RC,,,,,,Inpatient,,,187.43,187.43,HUMANA CHOICE PLUS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,AETNA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,CIGNA,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,VA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,VA TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,WELLMED,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,HUMANA,MGD,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
ORTHO CERVICAL COLLAR-A/S     ,33136639,CDM,270,RC,,,,,,Inpatient,,,137.9,137.9,HUMANA CHOICE PLUS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
ORTHO POSTOP SHOE-A/S         ,33136640,CDM,270,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,AETNA,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,CIGNA,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,TRICARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,UNITED HEALTHCARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,UNITED HEALTHCARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,VA,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,VA TRICARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,WELLMED,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,HUMANA,MGD,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
ORTHO SHOULDER IMMOBIL- A/S   ,33136641,CDM,270,RC,,,,,,Inpatient,,,142.76,142.76,HUMANA CHOICE PLUS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,AETNA,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,CIGNA,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,TRICARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,UNITED HEALTHCARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,UNITED HEALTHCARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,VA,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,VA TRICARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,WELLMED,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,HUMANA,MGD,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33136642,CDM,270,RC,,,,,,Inpatient,,,102.74,102.74,HUMANA CHOICE PLUS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,AETNA,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,BCBS,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,CIGNA,COM,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,TRICARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,UNITED HEALTHCARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,UNITED HEALTHCARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,VA,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,VA TRICARE,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,WELLMED,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,HUMANA,MGD,36.24,,,,,,,per diem,36.24,36.24,"Per diem rate, code is bundled with other services"
ALL PURPOSE BOOT ALL SIZES    ,33136648,CDM,270,RC,,,,,,Inpatient,,,36.24,36.24,HUMANA CHOICE PLUS,MGD,36.24,,,,,,,case rate,36.24,36.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,AETNA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,BCBS,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,CIGNA,COM,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,UNITED HEALTHCARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,VA,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,VA TRICARE,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,WELLMED,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA,MGD,56.24,,,,,,,per diem,56.24,56.24,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 14""          ",33136655,CDM,270,RC,,,,,,Inpatient,,,56.24,56.24,HUMANA CHOICE PLUS,MGD,56.24,,,,,,,case rate,56.24,56.24,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,AETNA,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,BCBS,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,CIGNA,COM,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,TRICARE,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,UNITED HEALTHCARE,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,UNITED HEALTHCARE,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,VA,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,VA TRICARE,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,WELLMED,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,HUMANA,MGD,87.07,,,,,,,per diem,87.07,87.07,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16""          ",33136656,CDM,270,RC,,,,,,Inpatient,,,87.07,87.07,HUMANA CHOICE PLUS,MGD,87.07,,,,,,,case rate,87.07,87.07,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,AETNA,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,CIGNA,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,TRICARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,UNITED HEALTHCARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,UNITED HEALTHCARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,VA,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,VA TRICARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,WELLMED,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,HUMANA,MGD,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 20""          ",33136657,CDM,270,RC,,,,,,Inpatient,,,89.76,89.76,HUMANA CHOICE PLUS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,AETNA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,CIGNA,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,VA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,VA TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,WELLMED,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,HUMANA,MGD,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
"KNEWW IMMOBILIZER 24""         ",33136658,CDM,270,RC,,,,,,Inpatient,,,51.38,51.38,HUMANA CHOICE PLUS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,AETNA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,BCBS,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,CIGNA,COM,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,UNITED HEALTHCARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,VA,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,VA TRICARE,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,WELLMED,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA,MGD,280.11,,,,,,,per diem,280.11,280.11,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 21"" BARIATRIC",33136665,CDM,270,RC,,,,,,Inpatient,,,280.11,280.11,HUMANA CHOICE PLUS,MGD,280.11,,,,,,,case rate,280.11,280.11,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,AETNA,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,CIGNA,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,TRICARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,UNITED HEALTHCARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,UNITED HEALTHCARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,VA,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,VA TRICARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,WELLMED,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,HUMANA,MGD,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
FIG-8 ANKLE BRACE XXL         ,33136666,CDM,270,RC,,,,,,Inpatient,,,86.59,86.59,HUMANA CHOICE PLUS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33139018,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,AETNA,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,BCBS,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,CIGNA,COM,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,TRICARE,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,UNITED HEALTHCARE,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,UNITED HEALTHCARE,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,VA,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,VA TRICARE,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,WELLMED,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,HUMANA,MGD,589.58,,,,,,,per diem,589.58,589.58,"Per diem rate, code is bundled with other services"
JAC-EXCEL MIDSIZE UNIT W/HN   ,33139053,CDM,279,RC,,,,,,Inpatient,,,589.58,589.58,HUMANA CHOICE PLUS,MGD,589.58,,,,,,,case rate,589.58,589.58,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,AETNA,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,CIGNA,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,TRICARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,UNITED HEALTHCARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,UNITED HEALTHCARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,VA,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,VA TRICARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,WELLMED,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,HUMANA,MGD,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33139221,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,HUMANA CHOICE PLUS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33139229,CDM,270,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33139238,CDM,270,RC,,,,,,Inpatient,,,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,AETNA,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,BCBS,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,CIGNA,COM,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,TRICARE,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,UNITED HEALTHCARE,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,UNITED HEALTHCARE,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,VA,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,VA TRICARE,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,WELLMED,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,HUMANA,MGD,594.3,,,,,,,per diem,594.3,594.3,"Per diem rate, code is bundled with other services"
VAC FREEDOM CANNISTER W/GEL 5/,33139300,CDM,279,RC,,,,,,Inpatient,,,594.3,594.3,HUMANA CHOICE PLUS,MGD,594.3,,,,,,,case rate,594.3,594.3,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,AETNA,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,CIGNA,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,TRICARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,UNITED HEALTHCARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,UNITED HEALTHCARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,VA,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,VA TRICARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,WELLMED,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,HUMANA,MGD,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33139303,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,HUMANA CHOICE PLUS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,AETNA,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,CIGNA,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,TRICARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,UNITED HEALTHCARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,UNITED HEALTHCARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,VA,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,VA TRICARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,WELLMED,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,HUMANA,MGD,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER 10""          ",33139327,CDM,270,RC,,,,,,Inpatient,,,41.21,41.21,HUMANA CHOICE PLUS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,AETNA,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,CIGNA,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,TRICARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,UNITED HEALTHCARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,UNITED HEALTHCARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,VA,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,VA TRICARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,WELLMED,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,HUMANA,MGD,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
"CERVICAL COLLAR,SEMI-RIGID, TH",33139358,CDM,270,RC,,,,,,Inpatient,,,321.3,321.3,HUMANA CHOICE PLUS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,AETNA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,CIGNA,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,VA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,VA TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,WELLMED,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,HUMANA,MGD,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33139361,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,HUMANA CHOICE PLUS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,AETNA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,CIGNA,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,VA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,VA TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,WELLMED,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA,MGD,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
"PODOUS BOOT, REG              ",33139362,CDM,270,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA CHOICE PLUS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33139375,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,AETNA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,CIGNA,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,WELLMED,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA,MGD,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED CONTOURA 880 R  ,33139376,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA CHOICE PLUS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,AETNA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,CIGNA,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,VA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,VA TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,WELLMED,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,HUMANA,MGD,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL 700l ,33139377,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,HUMANA CHOICE PLUS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33139378,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,AETNA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,CIGNA,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,VA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,VA TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,WELLMED,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA,MGD,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33139379,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA CHOICE PLUS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33139380,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33139381,CDM,279,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,AETNA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,CIGNA,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,WELLMED,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA,MGD,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33139382,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA CHOICE PLUS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,AETNA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,CIGNA,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,VA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,VA TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,WELLMED,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,HUMANA,MGD,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33139383,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,HUMANA CHOICE PLUS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,AETNA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,CIGNA,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,WELLMED,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA,MGD,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33139384,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA CHOICE PLUS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33139385,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT RECLIN,33139386,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33139387,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,AETNA,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,CIGNA,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,TRICARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,UNITED HEALTHCARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,UNITED HEALTHCARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,VA,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,VA TRICARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,WELLMED,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,HUMANA,MGD,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33139388,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,HUMANA CHOICE PLUS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,AETNA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,CIGNA,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,WELLMED,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA,MGD,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33139389,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA CHOICE PLUS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY DA,33139390,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,AETNA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,CIGNA,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,WELLMED,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA,MGD,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33139391,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA CHOICE PLUS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,AETNA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,CIGNA,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,WELLMED,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA,MGD,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33139392,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA CHOICE PLUS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,AETNA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,CIGNA,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,WELLMED,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA,MGD,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33139393,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA CHOICE PLUS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33139395,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,AETNA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,CIGNA,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,WELLMED,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA,MGD,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33139396,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA CHOICE PLUS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33139397,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,AETNA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,CIGNA,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,VA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,VA TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,WELLMED,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,HUMANA,MGD,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33139398,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,HUMANA CHOICE PLUS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33139399,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33139401,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,AETNA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,CIGNA,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,VA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,VA TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,WELLMED,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA,MGD,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33139402,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA CHOICE PLUS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33139403,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33139404,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33139406,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33139407,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33139408,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,AETNA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,CIGNA,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,WELLMED,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA,MGD,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33139409,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA CHOICE PLUS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,AETNA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,CIGNA,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,VA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,VA TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,WELLMED,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,HUMANA,MGD,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33139410,CDM,279,RC,,,,,,Inpatient,,,14.18,14.18,HUMANA CHOICE PLUS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,AETNA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,CIGNA,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,WELLMED,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA,MGD,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33139411,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA CHOICE PLUS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,AETNA,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,CIGNA,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,TRICARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,UNITED HEALTHCARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,UNITED HEALTHCARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,VA,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,VA TRICARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,WELLMED,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,HUMANA,MGD,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33139412,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,HUMANA CHOICE PLUS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,AETNA,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,CIGNA,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,TRICARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,UNITED HEALTHCARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,UNITED HEALTHCARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,VA,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,VA TRICARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,WELLMED,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,HUMANA,MGD,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33139413,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,HUMANA CHOICE PLUS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL FREEDOM   ,33139414,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33139415,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,AETNA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,CIGNA,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,WELLMED,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA,MGD,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139416,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA CHOICE PLUS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139417,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139418,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139419,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33139420,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33139421,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,AETNA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,CIGNA,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,VA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,VA TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,WELLMED,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA,MGD,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33139422,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA CHOICE PLUS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33139423,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33139424,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,AETNA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,CIGNA,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,VA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,VA TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,WELLMED,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,HUMANA,MGD,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33139425,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,HUMANA CHOICE PLUS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,AETNA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,CIGNA,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,WELLMED,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA,MGD,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33139426,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA CHOICE PLUS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33139427,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33139428,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33139429,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33139430,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33139431,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,AETNA,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,CIGNA,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,TRICARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,UNITED HEALTHCARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,UNITED HEALTHCARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,VA,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,VA TRICARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,WELLMED,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,HUMANA,MGD,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33139433,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,HUMANA CHOICE PLUS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33139434,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,AETNA,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,CIGNA,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,TRICARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,UNITED HEALTHCARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,UNITED HEALTHCARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,VA,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,VA TRICARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,WELLMED,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,HUMANA,MGD,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33139436,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,HUMANA CHOICE PLUS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,AETNA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,CIGNA,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,WELLMED,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA,MGD,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33139437,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA CHOICE PLUS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33139438,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,AETNA,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,CIGNA,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,TRICARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,UNITED HEALTHCARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,UNITED HEALTHCARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,VA,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,VA TRICARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,WELLMED,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,HUMANA,MGD,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33139439,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,HUMANA CHOICE PLUS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33139440,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33139441,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33139443,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,AETNA,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,CIGNA,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,TRICARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,UNITED HEALTHCARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,UNITED HEALTHCARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,VA,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,VA TRICARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,WELLMED,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,HUMANA,MGD,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33139444,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,HUMANA CHOICE PLUS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,AETNA,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,CIGNA,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,TRICARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,UNITED HEALTHCARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,UNITED HEALTHCARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,VA,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,VA TRICARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,WELLMED,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,HUMANA,MGD,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33139445,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,HUMANA CHOICE PLUS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33139446,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,AETNA,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,CIGNA,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,TRICARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,UNITED HEALTHCARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,UNITED HEALTHCARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,VA,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,VA TRICARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,WELLMED,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,HUMANA,MGD,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33139447,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,HUMANA CHOICE PLUS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33139448,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,AETNA,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,CIGNA,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,TRICARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,UNITED HEALTHCARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,UNITED HEALTHCARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,VA,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,VA TRICARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,WELLMED,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,HUMANA,MGD,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33139449,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,HUMANA CHOICE PLUS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,AETNA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,CIGNA,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,WELLMED,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA,MGD,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33139450,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA CHOICE PLUS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33139451,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33139452,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,AETNA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,CIGNA,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,VA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,VA TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,WELLMED,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA,MGD,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33139453,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA CHOICE PLUS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,AETNA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,CIGNA,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,WELLMED,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA,MGD,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33139454,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA CHOICE PLUS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33139455,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,AETNA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,CIGNA,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,WELLMED,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA,MGD,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33139456,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA CHOICE PLUS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,AETNA,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,BCBS,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,CIGNA,COM,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,TRICARE,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,UNITED HEALTHCARE,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,UNITED HEALTHCARE,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,VA,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,VA TRICARE,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,WELLMED,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,HUMANA,MGD,36.32,,,,,,,per diem,36.32,36.32,"Per diem rate, code is bundled with other services"
GERI SLEEVES                  ,33139469,CDM,270,RC,,,,,,Inpatient,,,36.32,36.32,HUMANA CHOICE PLUS,MGD,36.32,,,,,,,case rate,36.32,36.32,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,AETNA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,CIGNA,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,VA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,VA TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,WELLMED,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA,MGD,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
ARM SLING                     ,33139525,CDM,270,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA CHOICE PLUS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,AETNA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,CIGNA,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,VA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,VA TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,WELLMED,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA,MGD,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
PRAFO BOOT                    ,33139526,CDM,270,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA CHOICE PLUS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,AETNA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,CIGNA,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,VA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,VA TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,WELLMED,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,HUMANA,MGD,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR               ,33139527,CDM,270,RC,,,,,,Inpatient,,,8.88,8.88,HUMANA CHOICE PLUS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,AETNA,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,CIGNA,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,TRICARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,UNITED HEALTHCARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,UNITED HEALTHCARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,VA,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,VA TRICARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,WELLMED,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,HUMANA,MGD,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
ABD BINDER                    ,33139528,CDM,270,RC,,,,,,Inpatient,,,41.14,41.14,HUMANA CHOICE PLUS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
MATTRESS RENT - CUST CARE UHS ,33139542,CDM,279,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS RENT - ST1400 BOL UHS,33139543,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - DOLPHIN UHS   ,33139544,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
MATTRESS RENT - BARIAT UHS    ,33139545,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BARIATRIC BED RENT UHS        ,33139546,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HI/LOW BED RENT UHS           ,33139548,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,AETNA,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,BCBS,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,CIGNA,COM,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,TRICARE,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,UNITED HEALTHCARE,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,UNITED HEALTHCARE,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,VA,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,VA TRICARE,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,WELLMED,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,HUMANA,MGD,280.54,,,,,,,per diem,280.54,280.54,"Per diem rate, code is bundled with other services"
"SPLINT, DYNAPRO FINGER FLEX   ",33139551,CDM,270,RC,,,,,,Inpatient,,,280.54,280.54,HUMANA CHOICE PLUS,MGD,280.54,,,,,,,case rate,280.54,280.54,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,AETNA,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,BCBS,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,CIGNA,COM,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,TRICARE,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,UNITED HEALTHCARE,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,UNITED HEALTHCARE,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,VA,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,VA TRICARE,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,WELLMED,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,HUMANA,MGD,293.49,,,,,,,per diem,293.49,293.49,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EZ FORM        ",33139552,CDM,270,RC,,,,,,Inpatient,,,293.49,293.49,HUMANA CHOICE PLUS,MGD,293.49,,,,,,,case rate,293.49,293.49,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,AETNA,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,CIGNA,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,TRICARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,UNITED HEALTHCARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,UNITED HEALTHCARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,VA,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,VA TRICARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,WELLMED,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,HUMANA,MGD,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
"SPLINT, POSTERIOR-PREFAB      ",33139553,CDM,270,RC,,,,,,Inpatient,,,89.18,89.18,HUMANA CHOICE PLUS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,AETNA,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,BCBS,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,CIGNA,COM,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,TRICARE,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,UNITED HEALTHCARE,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,UNITED HEALTHCARE,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,VA,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,VA TRICARE,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,WELLMED,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,HUMANA,MGD,88.29,,,,,,,per diem,88.29,88.29,"Per diem rate, code is bundled with other services"
"SPLINT, WRIST/THUMB- D RING   ",33139554,CDM,270,RC,,,,,,Inpatient,,,88.29,88.29,HUMANA CHOICE PLUS,MGD,88.29,,,,,,,case rate,88.29,88.29,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,AETNA,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,BCBS,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,CIGNA,COM,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,TRICARE,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,UNITED HEALTHCARE,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,UNITED HEALTHCARE,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,VA,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,VA TRICARE,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,WELLMED,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,HUMANA,MGD,192.65,,,,,,,per diem,192.65,192.65,"Per diem rate, code is bundled with other services"
"SPLINT, HAND, RESTING AIRSOFT ",33139555,CDM,270,RC,,,,,,Inpatient,,,192.65,192.65,HUMANA CHOICE PLUS,MGD,192.65,,,,,,,case rate,192.65,192.65,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,AETNA,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,BCBS,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,CIGNA,COM,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,TRICARE,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,UNITED HEALTHCARE,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,UNITED HEALTHCARE,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,VA,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,VA TRICARE,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,WELLMED,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,HUMANA,MGD,85.11,,,,,,,per diem,85.11,85.11,"Per diem rate, code is bundled with other services"
"SPLINT, ROLYAN EXTRA FLEX PS  ",33139556,CDM,270,RC,,,,,,Inpatient,,,85.11,85.11,HUMANA CHOICE PLUS,MGD,85.11,,,,,,,case rate,85.11,85.11,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,AETNA,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,BCBS,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,CIGNA,COM,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,TRICARE,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,UNITED HEALTHCARE,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,UNITED HEALTHCARE,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,VA,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,VA TRICARE,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,WELLMED,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,HUMANA,MGD,331.57,,,,,,,per diem,331.57,331.57,"Per diem rate, code is bundled with other services"
"SLING, KNEE                   ",33139558,CDM,270,RC,,,,,,Inpatient,,,331.57,331.57,HUMANA CHOICE PLUS,MGD,331.57,,,,,,,case rate,331.57,331.57,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,AETNA,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,BCBS,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,CIGNA,COM,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,TRICARE,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,UNITED HEALTHCARE,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,UNITED HEALTHCARE,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,VA,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,VA TRICARE,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,WELLMED,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,HUMANA,MGD,204.4,,,,,,,per diem,204.4,204.4,"Per diem rate, code is bundled with other services"
"SPLINT, WHFO                  ",33139559,CDM,270,RC,,,,,,Inpatient,,,204.4,204.4,HUMANA CHOICE PLUS,MGD,204.4,,,,,,,case rate,204.4,204.4,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,AETNA,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,BCBS,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,CIGNA,COM,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,TRICARE,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,UNITED HEALTHCARE,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,UNITED HEALTHCARE,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,VA,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,VA TRICARE,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,WELLMED,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,HUMANA,MGD,90.28,,,,,,,per diem,90.28,90.28,"Per diem rate, code is bundled with other services"
"SPLINT, PAN MITT, RESTING     ",33139562,CDM,270,RC,,,,,,Inpatient,,,90.28,90.28,HUMANA CHOICE PLUS,MGD,90.28,,,,,,,case rate,90.28,90.28,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,AETNA,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,BCBS,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,CIGNA,COM,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,TRICARE,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,UNITED HEALTHCARE,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,UNITED HEALTHCARE,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,VA,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,VA TRICARE,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,WELLMED,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,HUMANA,MGD,21.7,,,,,,,per diem,21.7,21.7,"Per diem rate, code is bundled with other services"
"GLOVE, EDEMA                  ",33139569,CDM,270,RC,,,,,,Inpatient,,,21.7,21.7,HUMANA CHOICE PLUS,MGD,21.7,,,,,,,case rate,21.7,21.7,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,AETNA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,CIGNA,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,VA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,VA TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,WELLMED,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,HUMANA,MGD,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
REACHER                       ,33139573,CDM,270,RC,,,,,,Inpatient,,,9.99,9.99,HUMANA CHOICE PLUS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,AETNA,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,BCBS,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,CIGNA,COM,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,TRICARE,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,UNITED HEALTHCARE,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,UNITED HEALTHCARE,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,VA,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,VA TRICARE,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,WELLMED,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,HUMANA,MGD,2059.06,,,,,,,per diem,2059.06,2059.06,"Per diem rate, code is bundled with other services"
CUSTOM AFO                    ,33139578,CDM,270,RC,,,,,,Inpatient,,,2059.06,2059.06,HUMANA CHOICE PLUS,MGD,2059.06,,,,,,,case rate,2059.06,2059.06,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,AETNA,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,BCBS,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,CIGNA,COM,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,TRICARE,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,UNITED HEALTHCARE,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,UNITED HEALTHCARE,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,VA,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,VA TRICARE,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,WELLMED,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,HUMANA,MGD,192.12,,,,,,,per diem,192.12,192.12,"Per diem rate, code is bundled with other services"
HAND SPLING-RESTING           ,33139581,CDM,270,RC,,,,,,Inpatient,,,192.12,192.12,HUMANA CHOICE PLUS,MGD,192.12,,,,,,,case rate,192.12,192.12,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
CPM DAILY RENTAL              ,33139607,CDM,279,RC,,,,,,Inpatient,,,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
RENTAL BED W/SCALE DAILY      ,33139608,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,AETNA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,CIGNA,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,VA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,VA TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,WELLMED,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA,MGD,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ARMBOARD ADULT 18 DISP 100/CS ,33140016,CDM,270,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA CHOICE PLUS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,AETNA,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,BCBS,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,CIGNA,COM,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,TRICARE,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,UNITED HEALTHCARE,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,UNITED HEALTHCARE,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,VA,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,VA TRICARE,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,WELLMED,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,HUMANA,MGD,1.35,,,,,,,per diem,1.35,1.35,"Per diem rate, code is bundled with other services"
ARMBOARD WRIST 3X9 DISP 100/CS,33140017,CDM,270,RC,,,,,,Inpatient,,,1.35,1.35,HUMANA CHOICE PLUS,MGD,1.35,,,,,,,case rate,1.35,1.35,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,AETNA,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,BCBS,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,CIGNA,COM,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,TRICARE,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,UNITED HEALTHCARE,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,UNITED HEALTHCARE,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,VA,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,VA TRICARE,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,WELLMED,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,HUMANA,MGD,41.74,,,,,,,per diem,41.74,41.74,"Per diem rate, code is bundled with other services"
BASKET LG WHITE WA767007      ,33140027,CDM,270,RC,,,,,,Inpatient,,,41.74,41.74,HUMANA CHOICE PLUS,MGD,41.74,,,,,,,case rate,41.74,41.74,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,AETNA,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,BCBS,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,CIGNA,COM,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,TRICARE,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,UNITED HEALTHCARE,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,UNITED HEALTHCARE,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,VA,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,VA TRICARE,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,WELLMED,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,HUMANA,MGD,20.28,,,,,,,per diem,20.28,20.28,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 3 PANEL      ,33140037,CDM,270,RC,,,,,,Inpatient,,,20.28,20.28,HUMANA CHOICE PLUS,MGD,20.28,,,,,,,case rate,20.28,20.28,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,AETNA,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,BCBS,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,CIGNA,COM,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,TRICARE,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,UNITED HEALTHCARE,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,UNITED HEALTHCARE,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,VA,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,VA TRICARE,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,WELLMED,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,HUMANA,MGD,17.03,,,,,,,per diem,17.03,17.03,"Per diem rate, code is bundled with other services"
PROTECT HEEL &ELBOW LG 12PR/BX,33140101,CDM,270,RC,,,,,,Inpatient,,,17.03,17.03,HUMANA CHOICE PLUS,MGD,17.03,,,,,,,case rate,17.03,17.03,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,AETNA,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,BCBS,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,CIGNA,COM,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,TRICARE,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,UNITED HEALTHCARE,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,UNITED HEALTHCARE,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,VA,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,VA TRICARE,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,WELLMED,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,HUMANA,MGD,347.69,,,,,,,per diem,347.69,347.69,"Per diem rate, code is bundled with other services"
ROLLATOR TALL ADULT MIDNIGHT B,33140109,CDM,279,RC,,,,,,Inpatient,,,347.69,347.69,HUMANA CHOICE PLUS,MGD,347.69,,,,,,,case rate,347.69,347.69,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,AETNA,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,BCBS,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,CIGNA,COM,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,TRICARE,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,UNITED HEALTHCARE,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,UNITED HEALTHCARE,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,VA,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,VA TRICARE,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,WELLMED,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,HUMANA,MGD,240.59,,,,,,,per diem,240.59,240.59,"Per diem rate, code is bundled with other services"
COMMODE 3N1 DROP ARM SILVER   ,33140172,CDM,279,RC,,,,,,Inpatient,,,240.59,240.59,HUMANA CHOICE PLUS,MGD,240.59,,,,,,,case rate,240.59,240.59,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,AETNA,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,BCBS,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,CIGNA,COM,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,TRICARE,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,UNITED HEALTHCARE,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,UNITED HEALTHCARE,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,VA,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,VA TRICARE,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,WELLMED,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,HUMANA,MGD,79.41,,,,,,,per diem,79.41,79.41,"Per diem rate, code is bundled with other services"
COMMODE ALL IN ONE COATED 4/CA,33140173,CDM,279,RC,,,,,,Inpatient,,,79.41,79.41,HUMANA CHOICE PLUS,MGD,79.41,,,,,,,case rate,79.41,79.41,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,AETNA,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,BCBS,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,CIGNA,COM,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,TRICARE,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,UNITED HEALTHCARE,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,UNITED HEALTHCARE,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,VA,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,VA TRICARE,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,WELLMED,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,HUMANA,MGD,333.96,,,,,,,per diem,333.96,333.96,"Per diem rate, code is bundled with other services"
COMMODE DROP ARM W/PAD SEAT EA,33140175,CDM,279,RC,,,,,,Inpatient,,,333.96,333.96,HUMANA CHOICE PLUS,MGD,333.96,,,,,,,case rate,333.96,333.96,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,AETNA,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,BCBS,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,CIGNA,COM,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,TRICARE,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,UNITED HEALTHCARE,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,UNITED HEALTHCARE,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,VA,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,VA TRICARE,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,WELLMED,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,HUMANA,MGD,415.76,,,,,,,per diem,415.76,415.76,"Per diem rate, code is bundled with other services"
COMMODE EXTRA WIDE W/ARMS     ,33140176,CDM,279,RC,,,,,,Inpatient,,,415.76,415.76,HUMANA CHOICE PLUS,MGD,415.76,,,,,,,case rate,415.76,415.76,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,AETNA,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,BCBS,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,CIGNA,COM,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,TRICARE,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,UNITED HEALTHCARE,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,UNITED HEALTHCARE,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,VA,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,VA TRICARE,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,WELLMED,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,HUMANA,MGD,656.96,,,,,,,per diem,656.96,656.96,"Per diem rate, code is bundled with other services"
COMMODE OVERSIZED DROPARM 650L,33140177,CDM,279,RC,,,,,,Inpatient,,,656.96,656.96,HUMANA CHOICE PLUS,MGD,656.96,,,,,,,case rate,656.96,656.96,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,AETNA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,CIGNA,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,WELLMED,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA,MGD,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPPORT     ,33140272,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA CHOICE PLUS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,AETNA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,CIGNA,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,WELLMED,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA,MGD,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
TRI-PANEL KNEE IMMOBILIZER    ,33140279,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA CHOICE PLUS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,AETNA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,CIGNA,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,VA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,VA TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,WELLMED,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,HUMANA,MGD,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
PRE-MOIST WIPES 8/PK 12PK/CASE,33140283,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,HUMANA CHOICE PLUS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,AETNA,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,BCBS,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,CIGNA,COM,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,TRICARE,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,UNITED HEALTHCARE,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,UNITED HEALTHCARE,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,VA,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,VA TRICARE,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,WELLMED,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,HUMANA,MGD,32.75,,,,,,,per diem,32.75,32.75,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER STANDARD     ,33140284,CDM,270,RC,,,,,,Inpatient,,,32.75,32.75,HUMANA CHOICE PLUS,MGD,32.75,,,,,,,case rate,32.75,32.75,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,AETNA,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,BCBS,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,CIGNA,COM,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,TRICARE,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,UNITED HEALTHCARE,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,UNITED HEALTHCARE,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,VA,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,VA TRICARE,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,WELLMED,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,HUMANA,MGD,33.67,,,,,,,per diem,33.67,33.67,"Per diem rate, code is bundled with other services"
"KNEE IMMOBILIZER 16"" UNIV     ",33140290,CDM,270,RC,,,,,,Inpatient,,,33.67,33.67,HUMANA CHOICE PLUS,MGD,33.67,,,,,,,case rate,33.67,33.67,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-S),33140296,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-S),33140297,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-M),33140298,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-M),33140299,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (L-L),33140300,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
FOREARM COMP FULL FINGER (R-L),33140301,CDM,270,RC,,,,,,Inpatient,,,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"IMMOBILIZER KNEE CUT AWAY 19"" ",33140303,CDM,270,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,AETNA,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,BCBS,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,CIGNA,COM,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,TRICARE,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,UNITED HEALTHCARE,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,UNITED HEALTHCARE,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,VA,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,VA TRICARE,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,WELLMED,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,HUMANA,MGD,61.46,,,,,,,per diem,61.46,61.46,"Per diem rate, code is bundled with other services"
COLLAR PAD REPLCMNT MIAMI J   ,33140308,CDM,270,RC,,,,,,Inpatient,,,61.46,61.46,HUMANA CHOICE PLUS,MGD,61.46,,,,,,,case rate,61.46,61.46,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,AETNA,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,BCBS,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,CIGNA,COM,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,TRICARE,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,UNITED HEALTHCARE,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,UNITED HEALTHCARE,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,VA,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,VA TRICARE,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,WELLMED,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,HUMANA,MGD,79.38,,,,,,,per diem,79.38,79.38,"Per diem rate, code is bundled with other services"
WRIST SUPPORT L/XL 593-UWS    ,33140335,CDM,270,RC,,,,,,Inpatient,,,79.38,79.38,HUMANA CHOICE PLUS,MGD,79.38,,,,,,,case rate,79.38,79.38,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,AETNA,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,CIGNA,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,TRICARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,UNITED HEALTHCARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,UNITED HEALTHCARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,VA,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,VA TRICARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,WELLMED,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,HUMANA,MGD,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
WRIST SPLINT W THUMB STABILIZR,33140336,CDM,270,RC,,,,,,Inpatient,,,27.58,27.58,HUMANA CHOICE PLUS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,AETNA,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,BCBS,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,CIGNA,COM,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,TRICARE,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,UNITED HEALTHCARE,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,UNITED HEALTHCARE,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,VA,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,VA TRICARE,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,WELLMED,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,HUMANA,MGD,174.31,,,,,,,per diem,174.31,174.31,"Per diem rate, code is bundled with other services"
CHAIR SHOWER CAREGUARD TOOLESS,33140433,CDM,279,RC,,,,,,Inpatient,,,174.31,174.31,HUMANA CHOICE PLUS,MGD,174.31,,,,,,,case rate,174.31,174.31,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,AETNA,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,BCBS,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,CIGNA,COM,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,TRICARE,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,UNITED HEALTHCARE,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,UNITED HEALTHCARE,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,VA,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,VA TRICARE,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,WELLMED,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,HUMANA,MGD,2996.16,,,,,,,per diem,2996.16,2996.16,"Per diem rate, code is bundled with other services"
CHAIR SHOWER COMMODE HEVY DUTY,33140434,CDM,279,RC,,,,,,Inpatient,,,2996.16,2996.16,HUMANA CHOICE PLUS,MGD,2996.16,,,,,,,case rate,2996.16,2996.16,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,AETNA,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,BCBS,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,CIGNA,COM,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,TRICARE,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,UNITED HEALTHCARE,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,UNITED HEALTHCARE,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,VA,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,VA TRICARE,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,WELLMED,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,HUMANA,MGD,268.19,,,,,,,per diem,268.19,268.19,"Per diem rate, code is bundled with other services"
CHAIR SHOWER IVC I W/BACK 2/CT,33140435,CDM,279,RC,,,,,,Inpatient,,,268.19,268.19,HUMANA CHOICE PLUS,MGD,268.19,,,,,,,case rate,268.19,268.19,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,AETNA,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,BCBS,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,CIGNA,COM,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,TRICARE,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,UNITED HEALTHCARE,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,UNITED HEALTHCARE,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,VA,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,VA TRICARE,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,WELLMED,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,HUMANA,MGD,88.55,,,,,,,per diem,88.55,88.55,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM DELX MED 1PR/CA,33140437,CDM,270,RC,,,,,,Inpatient,,,88.55,88.55,HUMANA CHOICE PLUS,MGD,88.55,,,,,,,case rate,88.55,88.55,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
CRUTCH FOREARM TALL ADULT STEE,33140438,CDM,270,RC,,,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WALKER ADULT DUAL RELEASE 4/CS,33140459,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,AETNA,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,CIGNA,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,TRICARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,UNITED HEALTHCARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,UNITED HEALTHCARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,VA,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,VA TRICARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,WELLMED,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,HUMANA,MGD,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR ADLT W/5 WHEELS DUAL 4/CS,33140460,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,HUMANA CHOICE PLUS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,AETNA,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,BCBS,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,CIGNA,COM,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,TRICARE,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,UNITED HEALTHCARE,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,UNITED HEALTHCARE,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,VA,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,VA TRICARE,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,WELLMED,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,HUMANA,MGD,91.42,,,,,,,per diem,91.42,91.42,"Per diem rate, code is bundled with other services"
WALKER FOLD DUAL RELEASE 4/CA ,33140461,CDM,279,RC,,,,,,Inpatient,,,91.42,91.42,HUMANA CHOICE PLUS,MGD,91.42,,,,,,,case rate,91.42,91.42,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,AETNA,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,BCBS,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,CIGNA,COM,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,TRICARE,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,UNITED HEALTHCARE,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,UNITED HEALTHCARE,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,VA,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,VA TRICARE,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,WELLMED,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,HUMANA,MGD,211.71,,,,,,,per diem,211.71,211.71,"Per diem rate, code is bundled with other services"
WALKER FOREARM ATTACHMENT PR  ,33140462,CDM,279,RC,,,,,,Inpatient,,,211.71,211.71,HUMANA CHOICE PLUS,MGD,211.71,,,,,,,case rate,211.71,211.71,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,AETNA,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,BCBS,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,CIGNA,COM,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,TRICARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,UNITED HEALTHCARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,UNITED HEALTHCARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,VA,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,VA TRICARE,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,WELLMED,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,HUMANA,MGD,411.92,,,,,,,per diem,411.92,411.92,"Per diem rate, code is bundled with other services"
WLKR JR DUAL REL W/WHEELS 4/CA,33140463,CDM,279,RC,,,,,,Inpatient,,,411.92,411.92,HUMANA CHOICE PLUS,MGD,411.92,,,,,,,case rate,411.92,411.92,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,AETNA,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,BCBS,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,CIGNA,COM,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,TRICARE,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,UNITED HEALTHCARE,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,UNITED HEALTHCARE,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,VA,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,VA TRICARE,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,WELLMED,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,HUMANA,MGD,288.58,,,,,,,per diem,288.58,288.58,"Per diem rate, code is bundled with other services"
WLKR SINGLE XWIDE DUAL REL 2/B,33140464,CDM,279,RC,,,,,,Inpatient,,,288.58,288.58,HUMANA CHOICE PLUS,MGD,288.58,,,,,,,case rate,288.58,288.58,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,AETNA,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,BCBS,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,CIGNA,COM,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,TRICARE,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,UNITED HEALTHCARE,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,UNITED HEALTHCARE,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,VA,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,VA TRICARE,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,WELLMED,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,HUMANA,MGD,42.34,,,,,,,per diem,42.34,42.34,"Per diem rate, code is bundled with other services"
WHEEL 5 FIXED BARIATRIC WALKER,33140465,CDM,279,RC,,,,,,Inpatient,,,42.34,42.34,HUMANA CHOICE PLUS,MGD,42.34,,,,,,,case rate,42.34,42.34,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,AETNA,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,CIGNA,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,TRICARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,UNITED HEALTHCARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,UNITED HEALTHCARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,VA,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,VA TRICARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,WELLMED,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,HUMANA,MGD,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 20X20 W/FOOTREST,33140466,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,HUMANA CHOICE PLUS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,AETNA,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,BCBS,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,CIGNA,COM,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,TRICARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,UNITED HEALTHCARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,UNITED HEALTHCARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,VA,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,VA TRICARE,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,WELLMED,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,HUMANA,MGD,988.94,,,,,,,per diem,988.94,988.94,"Per diem rate, code is bundled with other services"
WHEELCHAIR HD 24X20 W/FTREST I,33140467,CDM,279,RC,,,,,,Inpatient,,,988.94,988.94,HUMANA CHOICE PLUS,MGD,988.94,,,,,,,case rate,988.94,988.94,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,AETNA,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,BCBS,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,CIGNA,COM,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,TRICARE,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,UNITED HEALTHCARE,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,UNITED HEALTHCARE,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,VA,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,VA TRICARE,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,WELLMED,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,HUMANA,MGD,1967.01,,,,,,,per diem,1967.01,1967.01,"Per diem rate, code is bundled with other services"
WHLCHAIR RECLIN 20X20 SEAT SLN,33140468,CDM,279,RC,,,,,,Inpatient,,,1967.01,1967.01,HUMANA CHOICE PLUS,MGD,1967.01,,,,,,,case rate,1967.01,1967.01,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,AETNA,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,BCBS,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,CIGNA,COM,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,TRICARE,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,UNITED HEALTHCARE,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,UNITED HEALTHCARE,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,VA,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,VA TRICARE,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,WELLMED,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,HUMANA,MGD,1259.23,,,,,,,per diem,1259.23,1259.23,"Per diem rate, code is bundled with other services"
WHLCH RECLIN BACK 18X18 FTREST,33140469,CDM,279,RC,,,,,,Inpatient,,,1259.23,1259.23,HUMANA CHOICE PLUS,MGD,1259.23,,,,,,,case rate,1259.23,1259.23,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,AETNA,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,CIGNA,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,TRICARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,UNITED HEALTHCARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,UNITED HEALTHCARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,VA,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,VA TRICARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,WELLMED,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,HUMANA,MGD,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 16X16 W/FTREST ,33140470,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,HUMANA CHOICE PLUS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,AETNA,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,BCBS,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,CIGNA,COM,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,TRICARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,UNITED HEALTHCARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,UNITED HEALTHCARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,VA,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,VA TRICARE,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,WELLMED,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,HUMANA,MGD,357.07,,,,,,,per diem,357.07,357.07,"Per diem rate, code is bundled with other services"
WHEELCHAIR STD 18X18 W/FTREST ,33140471,CDM,279,RC,,,,,,Inpatient,,,357.07,357.07,HUMANA CHOICE PLUS,MGD,357.07,,,,,,,case rate,357.07,357.07,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,AETNA,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,CIGNA,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,TRICARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,UNITED HEALTHCARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,UNITED HEALTHCARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,VA,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,VA TRICARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,WELLMED,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,HUMANA,MGD,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
WHEELS WALKER 3 FIXED 1 GF6036,33140472,CDM,279,RC,,,,,,Inpatient,,,21.17,21.17,HUMANA CHOICE PLUS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,AETNA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,BCBS,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,CIGNA,COM,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,UNITED HEALTHCARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,VA TRICARE,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,WELLMED,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA,MGD,99.23,,,,,,,per diem,99.23,99.23,"Per diem rate, code is bundled with other services"
WRAP AROUND KNEE SUPPORT LG/XL,33140473,CDM,270,RC,,,,,,Inpatient,,,99.23,99.23,HUMANA CHOICE PLUS,MGD,99.23,,,,,,,case rate,99.23,99.23,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,AETNA,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,BCBS,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,CIGNA,COM,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,TRICARE,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,UNITED HEALTHCARE,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,UNITED HEALTHCARE,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,VA,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,VA TRICARE,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,WELLMED,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,HUMANA,MGD,42.4,,,,,,,per diem,42.4,42.4,"Per diem rate, code is bundled with other services"
KNEE SUPPORT ADJUST MICROBAN  ,33140475,CDM,270,RC,,,,,,Inpatient,,,42.4,42.4,HUMANA CHOICE PLUS,MGD,42.4,,,,,,,case rate,42.4,42.4,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,AETNA,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,BCBS,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,CIGNA,COM,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,TRICARE,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,UNITED HEALTHCARE,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,UNITED HEALTHCARE,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,VA,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,VA TRICARE,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,WELLMED,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,HUMANA,MGD,8.43,,,,,,,per diem,8.43,8.43,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET SMALL   ,33140481,CDM,270,RC,,,,,,Inpatient,,,8.43,8.43,HUMANA CHOICE PLUS,MGD,8.43,,,,,,,case rate,8.43,8.43,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,AETNA,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,CIGNA,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,TRICARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,UNITED HEALTHCARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,UNITED HEALTHCARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,VA,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,VA TRICARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,WELLMED,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,HUMANA,MGD,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET MEDIUM  ,33140482,CDM,270,RC,,,,,,Inpatient,,,9.32,9.32,HUMANA CHOICE PLUS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,AETNA,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,BCBS,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,CIGNA,COM,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,TRICARE,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,UNITED HEALTHCARE,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,UNITED HEALTHCARE,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,VA,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,VA TRICARE,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,WELLMED,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,HUMANA,MGD,10.75,,,,,,,per diem,10.75,10.75,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET LARGE   ,33140483,CDM,270,RC,,,,,,Inpatient,,,10.75,10.75,HUMANA CHOICE PLUS,MGD,10.75,,,,,,,case rate,10.75,10.75,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,AETNA,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,BCBS,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,CIGNA,COM,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,TRICARE,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,UNITED HEALTHCARE,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,UNITED HEALTHCARE,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,VA,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,VA TRICARE,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,WELLMED,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,HUMANA,MGD,10.26,,,,,,,per diem,10.26,10.26,"Per diem rate, code is bundled with other services"
SLING ARM DEEP POCKET XLARGE  ,33140484,CDM,270,RC,,,,,,Inpatient,,,10.26,10.26,HUMANA CHOICE PLUS,MGD,10.26,,,,,,,case rate,10.26,10.26,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,AETNA,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,CIGNA,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,TRICARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,UNITED HEALTHCARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,UNITED HEALTHCARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,VA,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,VA TRICARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,WELLMED,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,HUMANA,MGD,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
SET FEEDING PUMP W/PIERCING PI,33140559,CDM,279,RC,,,,,,Inpatient,,,16.44,16.44,HUMANA CHOICE PLUS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,AETNA,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,CIGNA,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,TRICARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,UNITED HEALTHCARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,UNITED HEALTHCARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,VA,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,VA TRICARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,WELLMED,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,HUMANA,MGD,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
MICROFOAM TAPE FOAM 2 6RL/BX  ,33140587,CDM,270,RC,,,,,,Inpatient,,,16.54,16.54,HUMANA CHOICE PLUS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,AETNA,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,BCBS,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,CIGNA,COM,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,TRICARE,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,UNITED HEALTHCARE,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,UNITED HEALTHCARE,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,VA,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,VA TRICARE,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,WELLMED,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,HUMANA,MGD,57.84,,,,,,,per diem,57.84,57.84,"Per diem rate, code is bundled with other services"
"PROTECTOR MITT, FINGER CLOSED ",33140641,CDM,270,RC,,,,,,Inpatient,,,57.84,57.84,HUMANA CHOICE PLUS,MGD,57.84,,,,,,,case rate,57.84,57.84,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
FALL MAT                      ,33140650,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,AETNA,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,BCBS,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,CIGNA,COM,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,TRICARE,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,UNITED HEALTHCARE,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,UNITED HEALTHCARE,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,VA,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,VA TRICARE,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,WELLMED,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,HUMANA,MGD,31.3,,,,,,,per diem,31.3,31.3,"Per diem rate, code is bundled with other services"
SCD MACHINE RENTAL DAILY      ,33140738,CDM,279,RC,,,,,,Inpatient,,,31.3,31.3,HUMANA CHOICE PLUS,MGD,31.3,,,,,,,case rate,31.3,31.3,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,AETNA,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,BCBS,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,CIGNA,COM,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,TRICARE,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,UNITED HEALTHCARE,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,UNITED HEALTHCARE,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,VA,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,VA TRICARE,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,WELLMED,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,HUMANA,MGD,34.03,,,,,,,per diem,34.03,34.03,"Per diem rate, code is bundled with other services"
CPM MACHINE RENTAL DAILY      ,33140739,CDM,279,RC,,,,,,Inpatient,,,34.03,34.03,HUMANA CHOICE PLUS,MGD,34.03,,,,,,,case rate,34.03,34.03,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,AETNA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,CIGNA,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,VA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,VA TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,WELLMED,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,HUMANA,MGD,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
T-PUMP (K PAD) DAILY RENTAL   ,33140741,CDM,279,RC,,,,,,Inpatient,,,6.02,6.02,HUMANA CHOICE PLUS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
AIR MATTRESS DAILY RENTAL     ,33140742,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,AETNA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,CIGNA,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,VA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,VA TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,WELLMED,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA,MGD,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
ICE MACHINE DAILY RENTAL      ,33140744,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA CHOICE PLUS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,AETNA,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,BCBS,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,CIGNA,COM,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,TRICARE,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,UNITED HEALTHCARE,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,UNITED HEALTHCARE,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,VA,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,VA TRICARE,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,WELLMED,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,HUMANA,MGD,161.31,,,,,,,per diem,161.31,161.31,"Per diem rate, code is bundled with other services"
BARIATRIC BED DAILY RENTAL    ,33140745,CDM,279,RC,,,,,,Inpatient,,,161.31,161.31,HUMANA CHOICE PLUS,MGD,161.31,,,,,,,case rate,161.31,161.31,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,AETNA,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,BCBS,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,CIGNA,COM,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,TRICARE,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,UNITED HEALTHCARE,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,UNITED HEALTHCARE,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,VA,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,VA TRICARE,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,WELLMED,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,HUMANA,MGD,181.91,,,,,,,per diem,181.91,181.91,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFORM-1000LB ,33140746,CDM,279,RC,,,,,,Inpatient,,,181.91,181.91,HUMANA CHOICE PLUS,MGD,181.91,,,,,,,case rate,181.91,181.91,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,AETNA,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,BCBS,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,CIGNA,COM,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,TRICARE,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,UNITED HEALTHCARE,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,UNITED HEALTHCARE,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,VA,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,VA TRICARE,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,WELLMED,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,HUMANA,MGD,46.6,,,,,,,per diem,46.6,46.6,"Per diem rate, code is bundled with other services"
TRIFLEX II TRAPEZE DAILY RENT ,33140747,CDM,279,RC,,,,,,Inpatient,,,46.6,46.6,HUMANA CHOICE PLUS,MGD,46.6,,,,,,,case rate,46.6,46.6,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,AETNA,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,CIGNA,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,TRICARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,UNITED HEALTHCARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,UNITED HEALTHCARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,VA,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,VA TRICARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,WELLMED,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,HUMANA,MGD,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
STAGE IV BARIATRIC MATTRESS-48,33140748,CDM,279,RC,,,,,,Inpatient,,,82.69,82.69,HUMANA CHOICE PLUS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,AETNA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,CIGNA,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,VA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,VA TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,WELLMED,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,HUMANA,MGD,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
CONVERTIBLE WHEELCHAIR DAILY R,33140749,CDM,279,RC,,,,,,Inpatient,,,66.15,66.15,HUMANA CHOICE PLUS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,AETNA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,CIGNA,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,WELLMED,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA,MGD,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
WOUND VAC PUMP DAILY RENTAL   ,33140750,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA CHOICE PLUS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,AETNA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,BCBS,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,CIGNA,COM,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,UNITED HEALTHCARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,VA,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,VA TRICARE,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,WELLMED,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA,MGD,33.08,,,,,,,per diem,33.08,33.08,"Per diem rate, code is bundled with other services"
"REGENCY XL 2000 WHEELCHAIR 32""",33140752,CDM,279,RC,,,,,,Inpatient,,,33.08,33.08,HUMANA CHOICE PLUS,MGD,33.08,,,,,,,case rate,33.08,33.08,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE 26x20 RENTAL,33140753,CDM,279,RC,,,,,,Inpatient,,,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,AETNA,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,BCBS,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,CIGNA,COM,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,TRICARE,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,UNITED HEALTHCARE,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,UNITED HEALTHCARE,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,VA,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,VA TRICARE,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,WELLMED,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,HUMANA,MGD,200.61,,,,,,,per diem,200.61,200.61,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33140757,CDM,270,RC,,,,,,Inpatient,,,200.61,200.61,HUMANA CHOICE PLUS,MGD,200.61,,,,,,,case rate,200.61,200.61,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,AETNA,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,BCBS,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,CIGNA,COM,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,TRICARE,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,UNITED HEALTHCARE,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,UNITED HEALTHCARE,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,VA,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,VA TRICARE,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,WELLMED,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,HUMANA,MGD,204.05,,,,,,,per diem,204.05,204.05,"Per diem rate, code is bundled with other services"
REST HAND ORHTO SM RIGHT      ,33140758,CDM,270,RC,,,,,,Inpatient,,,204.05,204.05,HUMANA CHOICE PLUS,MGD,204.05,,,,,,,case rate,204.05,204.05,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,AETNA,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,BCBS,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,CIGNA,COM,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,TRICARE,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,UNITED HEALTHCARE,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,UNITED HEALTHCARE,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,VA,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,VA TRICARE,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,WELLMED,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,HUMANA,MGD,23.68,,,,,,,per diem,23.68,23.68,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REG L LEFT      ,33140767,CDM,270,RC,,,,,,Inpatient,,,23.68,23.68,HUMANA CHOICE PLUS,MGD,23.68,,,,,,,case rate,23.68,23.68,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,AETNA,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,BCBS,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,CIGNA,COM,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,TRICARE,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,UNITED HEALTHCARE,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,UNITED HEALTHCARE,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,VA,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,VA TRICARE,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,WELLMED,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,HUMANA,MGD,29.36,,,,,,,per diem,29.36,29.36,"Per diem rate, code is bundled with other services"
DRSG HEMOSTATIC IV 1          ,33140820,CDM,272,RC,,,,,,Inpatient,,,29.36,29.36,HUMANA CHOICE PLUS,MGD,29.36,,,,,,,case rate,29.36,29.36,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,AETNA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,CIGNA,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,WELLMED,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA,MGD,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS             ,33140857,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA CHOICE PLUS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,AETNA,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,BCBS,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,CIGNA,COM,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,TRICARE,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,UNITED HEALTHCARE,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,UNITED HEALTHCARE,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,VA,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,VA TRICARE,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,WELLMED,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,HUMANA,MGD,1082.11,,,,,,,per diem,1082.11,1082.11,"Per diem rate, code is bundled with other services"
LEFT AFO                      ,33140858,CDM,274,RC,,,,,,Inpatient,,,1082.11,1082.11,HUMANA CHOICE PLUS,MGD,1082.11,,,,,,,case rate,1082.11,1082.11,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,AETNA,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,BCBS,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,CIGNA,COM,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,TRICARE,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UNITED HEALTHCARE,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,UNITED HEALTHCARE,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,VA,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,VA TRICARE,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,WELLMED,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,HUMANA,MGD,214.99,,,,,,,per diem,214.99,214.99,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED          ,33140863,CDM,274,RC,,,,,,Inpatient,,,214.99,214.99,HUMANA CHOICE PLUS,MGD,214.99,,,,,,,case rate,214.99,214.99,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,AETNA,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,CIGNA,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,TRICARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,UNITED HEALTHCARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,UNITED HEALTHCARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,VA,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,VA TRICARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,WELLMED,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,HUMANA,MGD,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG          ,33140864,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,HUMANA CHOICE PLUS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,AETNA,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,BCBS,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,CIGNA,COM,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,TRICARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,UNITED HEALTHCARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,UNITED HEALTHCARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,VA,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,VA TRICARE,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,WELLMED,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,HUMANA,MGD,225.74,,,,,,,per diem,225.74,225.74,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG         ,33140865,CDM,274,RC,,,,,,Inpatient,,,225.74,225.74,HUMANA CHOICE PLUS,MGD,225.74,,,,,,,case rate,225.74,225.74,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,AETNA,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,BCBS,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,CIGNA,COM,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,TRICARE,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,UNITED HEALTHCARE,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,UNITED HEALTHCARE,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,VA,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,VA TRICARE,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,WELLMED,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,HUMANA,MGD,204.79,,,,,,,per diem,204.79,204.79,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS         ,33140866,CDM,274,RC,,,,,,Inpatient,,,204.79,204.79,HUMANA CHOICE PLUS,MGD,204.79,,,,,,,case rate,204.79,204.79,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,AETNA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,CIGNA,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,VA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,VA TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,WELLMED,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA,MGD,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140867,CDM,274,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA CHOICE PLUS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,AETNA,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,BCBS,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,CIGNA,COM,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,TRICARE,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,UNITED HEALTHCARE,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,UNITED HEALTHCARE,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,VA,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,VA TRICARE,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,WELLMED,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,HUMANA,MGD,900.9,,,,,,,per diem,900.9,900.9,"Per diem rate, code is bundled with other services"
LUMBAR BRACE                  ,33140868,CDM,274,RC,,,,,,Inpatient,,,900.9,900.9,HUMANA CHOICE PLUS,MGD,900.9,,,,,,,case rate,900.9,900.9,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,AETNA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,CIGNA,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,WELLMED,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA,MGD,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO MED RT     ,33140869,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA CHOICE PLUS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,AETNA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,CIGNA,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,WELLMED,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA,MGD,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  RT     ,33140870,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA CHOICE PLUS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,AETNA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,BCBS,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,CIGNA,COM,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,UNITED HEALTHCARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,VA TRICARE,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,WELLMED,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA,MGD,165.38,,,,,,,per diem,165.38,165.38,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHO LG  LT     ,33140871,CDM,274,RC,,,,,,Inpatient,,,165.38,165.38,HUMANA CHOICE PLUS,MGD,165.38,,,,,,,case rate,165.38,165.38,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,AETNA,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,BCBS,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,CIGNA,COM,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,TRICARE,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,UNITED HEALTHCARE,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,UNITED HEALTHCARE,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,VA,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,VA TRICARE,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,WELLMED,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,HUMANA,MGD,158.76,,,,,,,per diem,158.76,158.76,"Per diem rate, code is bundled with other services"
BOOT                          ,33140872,CDM,274,RC,,,,,,Inpatient,,,158.76,158.76,HUMANA CHOICE PLUS,MGD,158.76,,,,,,,case rate,158.76,158.76,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,AETNA,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,BCBS,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,CIGNA,COM,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,TRICARE,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,UNITED HEALTHCARE,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,UNITED HEALTHCARE,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,VA,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,VA TRICARE,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,WELLMED,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,HUMANA,MGD,181.68,,,,,,,per diem,181.68,181.68,"Per diem rate, code is bundled with other services"
ASPEN COLLAR                  ,33140873,CDM,274,RC,,,,,,Inpatient,,,181.68,181.68,HUMANA CHOICE PLUS,MGD,181.68,,,,,,,case rate,181.68,181.68,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,AETNA,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,BCBS,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,CIGNA,COM,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,TRICARE,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,UNITED HEALTHCARE,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,UNITED HEALTHCARE,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,VA,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,VA TRICARE,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,WELLMED,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,HUMANA,MGD,175.3,,,,,,,per diem,175.3,175.3,"Per diem rate, code is bundled with other services"
ROOKE BOOT LG                 ,33140874,CDM,274,RC,,,,,,Inpatient,,,175.3,175.3,HUMANA CHOICE PLUS,MGD,175.3,,,,,,,case rate,175.3,175.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,AETNA,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,BCBS,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,CIGNA,COM,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,TRICARE,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,UNITED HEALTHCARE,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,UNITED HEALTHCARE,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,VA,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,VA TRICARE,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,WELLMED,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,HUMANA,MGD,39.86,,,,,,,per diem,39.86,39.86,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE CUT AWAY 12IN,33140879,CDM,270,RC,,,,,,Inpatient,,,39.86,39.86,HUMANA CHOICE PLUS,MGD,39.86,,,,,,,case rate,39.86,39.86,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140881,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140882,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140883,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140884,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED     ,33140885,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140886,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140887,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140888,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,AETNA,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,CIGNA,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,TRICARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UNITED HEALTHCARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UNITED HEALTHCARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,VA,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,VA TRICARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,WELLMED,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,HUMANA,MGD,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140893,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,HUMANA CHOICE PLUS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,AETNA,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,CIGNA,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,TRICARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,UNITED HEALTHCARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,UNITED HEALTHCARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,VA,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,VA TRICARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,WELLMED,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,HUMANA,MGD,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140894,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,HUMANA CHOICE PLUS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,AETNA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,CIGNA,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,WELLMED,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA,MGD,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140895,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA CHOICE PLUS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,AETNA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,CIGNA,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,WELLMED,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA,MGD,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE   ,33140896,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA CHOICE PLUS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140897,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED     ,33140898,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140899,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140900,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,AETNA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,CIGNA,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,VA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,VA TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,WELLMED,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,HUMANA,MGD,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR          ,33140901,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,HUMANA CHOICE PLUS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,AETNA,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,CIGNA,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,TRICARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,UNITED HEALTHCARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,UNITED HEALTHCARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,VA,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,VA TRICARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,WELLMED,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,HUMANA,MGD,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140902,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,HUMANA CHOICE PLUS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,AETNA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,CIGNA,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,WELLMED,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA,MGD,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140903,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA CHOICE PLUS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,AETNA,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,CIGNA,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,TRICARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,UNITED HEALTHCARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,UNITED HEALTHCARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,VA,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,VA TRICARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,WELLMED,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,HUMANA,MGD,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE    ,33140904,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,HUMANA CHOICE PLUS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,AETNA,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,CIGNA,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,TRICARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,UNITED HEALTHCARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,UNITED HEALTHCARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,VA,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,VA TRICARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,WELLMED,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,HUMANA,MGD,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140905,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,HUMANA CHOICE PLUS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL RIGHT,33140923,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS XL LEFT ,33140924,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG RIGHT,33140925,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS LG LEFT ,33140926,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED RIGH,33140927,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS MED LEFT,33140928,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM RIGHT,33140929,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,AETNA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,BCBS,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,CIGNA,COM,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,UNITED HEALTHCARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,VA TRICARE,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,WELLMED,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA,MGD,171.99,,,,,,,per diem,171.99,171.99,"Per diem rate, code is bundled with other services"
RESTING HAND ORTHOSIS SM LEFT ,33140930,CDM,270,RC,,,,,,Inpatient,,,171.99,171.99,HUMANA CHOICE PLUS,MGD,171.99,,,,,,,case rate,171.99,171.99,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,AETNA,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,BCBS,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,CIGNA,COM,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,TRICARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UNITED HEALTHCARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,UNITED HEALTHCARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,VA,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,VA TRICARE,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,WELLMED,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,HUMANA,MGD,17.4,,,,,,,per diem,17.4,17.4,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL LEFT ,33140935,CDM,270,RC,,,,,,Inpatient,,,17.4,17.4,HUMANA CHOICE PLUS,MGD,17.4,,,,,,,case rate,17.4,17.4,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,AETNA,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,BCBS,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,CIGNA,COM,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,TRICARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,UNITED HEALTHCARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,UNITED HEALTHCARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,VA,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,VA TRICARE,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,WELLMED,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,HUMANA,MGD,23.42,,,,,,,per diem,23.42,23.42,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR XL RIGHT,33140936,CDM,270,RC,,,,,,Inpatient,,,23.42,23.42,HUMANA CHOICE PLUS,MGD,23.42,,,,,,,case rate,23.42,23.42,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,AETNA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,CIGNA,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,WELLMED,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA,MGD,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE LE,33140937,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA CHOICE PLUS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,AETNA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,BCBS,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,CIGNA,COM,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,UNITED HEALTHCARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,VA TRICARE,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,WELLMED,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA,MGD,15.91,,,,,,,per diem,15.91,15.91,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR LARGE RI,33140938,CDM,270,RC,,,,,,Inpatient,,,15.91,15.91,HUMANA CHOICE PLUS,MGD,15.91,,,,,,,case rate,15.91,15.91,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED LEFT,33140939,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR MED RIGH,33140940,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM LEFT ,33140941,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,AETNA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,BCBS,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,CIGNA,COM,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,UNITED HEALTHCARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,VA TRICARE,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,WELLMED,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA,MGD,16.51,,,,,,,per diem,16.51,16.51,"Per diem rate, code is bundled with other services"
WRIST SPLINTS REGULAR SM RIGHT,33140942,CDM,270,RC,,,,,,Inpatient,,,16.51,16.51,HUMANA CHOICE PLUS,MGD,16.51,,,,,,,case rate,16.51,16.51,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,AETNA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,CIGNA,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,VA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,VA TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,WELLMED,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,HUMANA,MGD,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
SOFT CERVICAL COLLAR ORT130105,33140943,CDM,270,RC,,,,,,Inpatient,,,9.23,9.23,HUMANA CHOICE PLUS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,AETNA,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,BCBS,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,CIGNA,COM,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,TRICARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,UNITED HEALTHCARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,UNITED HEALTHCARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,VA,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,VA TRICARE,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,WELLMED,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,HUMANA,MGD,48.69,,,,,,,per diem,48.69,48.69,"Per diem rate, code is bundled with other services"
ASPEN COLLAR PADS REPLACEMENT ,33140944,CDM,270,RC,,,,,,Inpatient,,,48.69,48.69,HUMANA CHOICE PLUS,MGD,48.69,,,,,,,case rate,48.69,48.69,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,AETNA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,CIGNA,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,WELLMED,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA,MGD,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT MED 09MP-M   ,33140945,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA CHOICE PLUS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,AETNA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,CIGNA,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,WELLMED,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA,MGD,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT LRG 09MP-L   ,33140946,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA CHOICE PLUS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,AETNA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,BCBS,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,CIGNA,COM,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,UNITED HEALTHCARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,VA TRICARE,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,WELLMED,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA,MGD,213.34,,,,,,,per diem,213.34,213.34,"Per diem rate, code is bundled with other services"
MULTI PODUS BOOT XLRG 09MP-XL ,33140947,CDM,270,RC,,,,,,Inpatient,,,213.34,213.34,HUMANA CHOICE PLUS,MGD,213.34,,,,,,,case rate,213.34,213.34,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,AETNA,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,BCBS,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,CIGNA,COM,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,TRICARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,UNITED HEALTHCARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,UNITED HEALTHCARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,VA,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,VA TRICARE,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,WELLMED,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,HUMANA,MGD,294.37,,,,,,,per diem,294.37,294.37,"Per diem rate, code is bundled with other services"
CONTROL FIT LSO BACK BRACE 451,33140948,CDM,270,RC,,,,,,Inpatient,,,294.37,294.37,HUMANA CHOICE PLUS,MGD,294.37,,,,,,,case rate,294.37,294.37,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,AETNA,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,BCBS,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,CIGNA,COM,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,TRICARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,UNITED HEALTHCARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,UNITED HEALTHCARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,VA,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,VA TRICARE,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,WELLMED,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,HUMANA,MGD,102.5,,,,,,,per diem,102.5,102.5,"Per diem rate, code is bundled with other services"
ASPEN COLLAR SDJ7983287       ,33140949,CDM,270,RC,,,,,,Inpatient,,,102.5,102.5,HUMANA CHOICE PLUS,MGD,102.5,,,,,,,case rate,102.5,102.5,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,AETNA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,CIGNA,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,VA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,VA TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,WELLMED,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA,MGD,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE SML-MED  ,33142067,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA CHOICE PLUS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,AETNA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,BCBS,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,CIGNA,COM,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,UNITED HEALTHCARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,VA,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,VA TRICARE,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,WELLMED,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA,MGD,42.86,,,,,,,per diem,42.86,42.86,"Per diem rate, code is bundled with other services"
PROTECTIVE SURE CARE LGE      ,33142068,CDM,270,RC,,,,,,Inpatient,,,42.86,42.86,HUMANA CHOICE PLUS,MGD,42.86,,,,,,,case rate,42.86,42.86,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,AETNA,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,BCBS,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,CIGNA,COM,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,TRICARE,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,UNITED HEALTHCARE,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,UNITED HEALTHCARE,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,VA,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,VA TRICARE,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,WELLMED,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,HUMANA,MGD,4.1,,,,,,,per diem,4.1,4.1,"Per diem rate, code is bundled with other services"
ARMBOARD DISP ADULT           ,33142086,CDM,270,RC,,,,,,Inpatient,,,4.1,4.1,HUMANA CHOICE PLUS,MGD,4.1,,,,,,,case rate,4.1,4.1,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,AETNA,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,BCBS,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,CIGNA,COM,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,TRICARE,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,UNITED HEALTHCARE,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,UNITED HEALTHCARE,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,VA,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,VA TRICARE,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,WELLMED,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,HUMANA,MGD,130.77,,,,,,,per diem,130.77,130.77,"Per diem rate, code is bundled with other services"
COLLAR SET ASPEN ADULT REGULAR,33142145,CDM,270,RC,,,,,,Inpatient,,,130.77,130.77,HUMANA CHOICE PLUS,MGD,130.77,,,,,,,case rate,130.77,130.77,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,AETNA,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,BCBS,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,CIGNA,COM,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,TRICARE,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,UNITED HEALTHCARE,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,UNITED HEALTHCARE,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,VA,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,VA TRICARE,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,WELLMED,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,HUMANA,MGD,19.93,,,,,,,per diem,19.93,19.93,"Per diem rate, code is bundled with other services"
"ABDOMINAL BINDER XL 46-62""    ",33142154,CDM,270,RC,,,,,,Inpatient,,,19.93,19.93,HUMANA CHOICE PLUS,MGD,19.93,,,,,,,case rate,19.93,19.93,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMBS WOOL # 617582           ,33142175,CDM,270,RC,,,,,,Inpatient,,,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,AETNA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,CIGNA,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,VA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,VA TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,WELLMED,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,HUMANA,MGD,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
"FOOTWEAR, BARIATRIC CARDINAL  ",33142192,CDM,270,RC,,,,,,Inpatient,,,5.73,5.73,HUMANA CHOICE PLUS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,AETNA,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,BCBS,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,CIGNA,COM,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,TRICARE,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,UNITED HEALTHCARE,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,UNITED HEALTHCARE,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,VA,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,VA TRICARE,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,WELLMED,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,HUMANA,MGD,25.66,,,,,,,per diem,25.66,25.66,"Per diem rate, code is bundled with other services"
ABD BINDER 62IN-74IN CARDINAL ,33142193,CDM,270,RC,,,,,,Inpatient,,,25.66,25.66,HUMANA CHOICE PLUS,MGD,25.66,,,,,,,case rate,25.66,25.66,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,AETNA,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,BCBS,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,CIGNA,COM,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,TRICARE,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,UNITED HEALTHCARE,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,UNITED HEALTHCARE,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,VA,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,VA TRICARE,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,WELLMED,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,HUMANA,MGD,141.41,,,,,,,per diem,141.41,141.41,"Per diem rate, code is bundled with other services"
2XL SLING                     ,33142203,CDM,270,RC,,,,,,Inpatient,,,141.41,141.41,HUMANA CHOICE PLUS,MGD,141.41,,,,,,,case rate,141.41,141.41,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,AETNA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,CIGNA,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,VA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,VA TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,WELLMED,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,HUMANA,MGD,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
CHAIR PAD ALARM               ,33142256,CDM,270,RC,,,,,,Inpatient,,,113.4,113.4,HUMANA CHOICE PLUS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,AETNA,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,BCBS,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,CIGNA,COM,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,TRICARE,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,UNITED HEALTHCARE,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,UNITED HEALTHCARE,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,VA,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,VA TRICARE,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,WELLMED,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,HUMANA,MGD,99.65,,,,,,,per diem,99.65,99.65,"Per diem rate, code is bundled with other services"
HEEL PROTECTOR                ,33142299,CDM,270,RC,,,,,,Inpatient,,,99.65,99.65,HUMANA CHOICE PLUS,MGD,99.65,,,,,,,case rate,99.65,99.65,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,AETNA,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,BCBS,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,CIGNA,COM,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,TRICARE,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,UNITED HEALTHCARE,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,UNITED HEALTHCARE,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,VA,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,VA TRICARE,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,WELLMED,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,HUMANA,MGD,93.09,,,,,,,per diem,93.09,93.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL                ,33142300,CDM,270,RC,,,,,,Inpatient,,,93.09,93.09,HUMANA CHOICE PLUS,MGD,93.09,,,,,,,case rate,93.09,93.09,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,AETNA,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,BCBS,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,CIGNA,COM,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,TRICARE,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,UNITED HEALTHCARE,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,UNITED HEALTHCARE,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,VA,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,VA TRICARE,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,WELLMED,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,HUMANA,MGD,5.46,,,,,,,per diem,5.46,5.46,"Per diem rate, code is bundled with other services"
KENDALL SAFE T VAC 12 # 31279 ,33142319,CDM,279,RC,,,,,,Inpatient,,,5.46,5.46,HUMANA CHOICE PLUS,MGD,5.46,,,,,,,case rate,5.46,5.46,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,AETNA,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,BCBS,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,CIGNA,COM,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,TRICARE,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,UNITED HEALTHCARE,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,UNITED HEALTHCARE,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,VA,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,VA TRICARE,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,WELLMED,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,HUMANA,MGD,31.67,,,,,,,per diem,31.67,31.67,"Per diem rate, code is bundled with other services"
F&P CIRCUIT # RT202           ,33142324,CDM,279,RC,,,,,,Inpatient,,,31.67,31.67,HUMANA CHOICE PLUS,MGD,31.67,,,,,,,case rate,31.67,31.67,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,AETNA,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,BCBS,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,CIGNA,COM,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,TRICARE,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,UNITED HEALTHCARE,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,UNITED HEALTHCARE,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,VA,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,VA TRICARE,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,WELLMED,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,HUMANA,MGD,195.47,,,,,,,per diem,195.47,195.47,"Per diem rate, code is bundled with other services"
DAYS BARIATRIC QUAD CANE      ,33142406,CDM,279,RC,,,,,,Inpatient,,,195.47,195.47,HUMANA CHOICE PLUS,MGD,195.47,,,,,,,case rate,195.47,195.47,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,AETNA,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,BCBS,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,CIGNA,COM,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,TRICARE,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,UNITED HEALTHCARE,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,UNITED HEALTHCARE,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,VA,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,VA TRICARE,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,WELLMED,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,HUMANA,MGD,22.11,,,,,,,per diem,22.11,22.11,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 30-45IN      ,33142410,CDM,270,RC,,,,,,Inpatient,,,22.11,22.11,HUMANA CHOICE PLUS,MGD,22.11,,,,,,,case rate,22.11,22.11,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,AETNA,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,BCBS,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,CIGNA,COM,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,TRICARE,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,UNITED HEALTHCARE,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,UNITED HEALTHCARE,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,VA,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,VA TRICARE,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,WELLMED,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,HUMANA,MGD,190.55,,,,,,,per diem,190.55,190.55,"Per diem rate, code is bundled with other services"
BARIATRIC QUAD CANE LARGE BASE,33142444,CDM,279,RC,,,,,,Inpatient,,,190.55,190.55,HUMANA CHOICE PLUS,MGD,190.55,,,,,,,case rate,190.55,190.55,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,AETNA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,CIGNA,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,WELLMED,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA,MGD,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LS   ",33142446,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA CHOICE PLUS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,AETNA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,CIGNA,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,WELLMED,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA,MGD,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RS   ",33142447,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA CHOICE PLUS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,AETNA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,CIGNA,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,VA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,VA TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,WELLMED,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,HUMANA,MGD,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142448,CDM,270,RC,,,,,,Inpatient,,,12.69,12.69,HUMANA CHOICE PLUS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,AETNA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,CIGNA,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,WELLMED,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA,MGD,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LM   ",33142449,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA CHOICE PLUS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,AETNA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,CIGNA,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,WELLMED,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA,MGD,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST LL   ",33142450,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA CHOICE PLUS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,AETNA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,BCBS,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,CIGNA,COM,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,UNITED HEALTHCARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,VA TRICARE,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,WELLMED,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA,MGD,23.75,,,,,,,per diem,23.75,23.75,"Per diem rate, code is bundled with other services"
"COMPRESSION GLOVE, WRIST RL   ",33142451,CDM,270,RC,,,,,,Inpatient,,,23.75,23.75,HUMANA CHOICE PLUS,MGD,23.75,,,,,,,case rate,23.75,23.75,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,AETNA,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,BCBS,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,CIGNA,COM,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,TRICARE,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,UNITED HEALTHCARE,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,UNITED HEALTHCARE,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,VA,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,VA TRICARE,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,WELLMED,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,HUMANA,MGD,2.46,,,,,,,per diem,2.46,2.46,"Per diem rate, code is bundled with other services"
T-PUMP W/CLIK TITE CONNECTOR  ,33142454,CDM,279,RC,,,,,,Inpatient,,,2.46,2.46,HUMANA CHOICE PLUS,MGD,2.46,,,,,,,case rate,2.46,2.46,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,AETNA,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,BCBS,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,CIGNA,COM,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,TRICARE,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,UNITED HEALTHCARE,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,UNITED HEALTHCARE,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,VA,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,VA TRICARE,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,WELLMED,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,HUMANA,MGD,2.73,,,,,,,per diem,2.73,2.73,"Per diem rate, code is bundled with other services"
T-PUMP CLASSIC #TP25          ,33142459,CDM,279,RC,,,,,,Inpatient,,,2.73,2.73,HUMANA CHOICE PLUS,MGD,2.73,,,,,,,case rate,2.73,2.73,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,AETNA,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,BCBS,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,CIGNA,COM,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,TRICARE,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,UNITED HEALTHCARE,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,UNITED HEALTHCARE,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,VA,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,VA TRICARE,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,WELLMED,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,HUMANA,MGD,476.93,,,,,,,per diem,476.93,476.93,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB #4621001601 ,33142460,CDM,279,RC,,,,,,Inpatient,,,476.93,476.93,HUMANA CHOICE PLUS,MGD,476.93,,,,,,,case rate,476.93,476.93,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,AETNA,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,BCBS,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,CIGNA,COM,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,TRICARE,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,UNITED HEALTHCARE,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,UNITED HEALTHCARE,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,VA,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,VA TRICARE,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,WELLMED,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,HUMANA,MGD,3.55,,,,,,,per diem,3.55,3.55,"Per diem rate, code is bundled with other services"
T-PUMP PROFESSIONAL #TP700    ,33142461,CDM,279,RC,,,,,,Inpatient,,,3.55,3.55,HUMANA CHOICE PLUS,MGD,3.55,,,,,,,case rate,3.55,3.55,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,AETNA,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,BCBS,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,CIGNA,COM,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,TRICARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,UNITED HEALTHCARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,UNITED HEALTHCARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,VA,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,VA TRICARE,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,WELLMED,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,HUMANA,MGD,85.18,,,,,,,per diem,85.18,85.18,"Per diem rate, code is bundled with other services"
AIR 2 LAL/PULSATE MATTRESS    ,33142462,CDM,279,RC,,,,,,Inpatient,,,85.18,85.18,HUMANA CHOICE PLUS,MGD,85.18,,,,,,,case rate,85.18,85.18,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
BED EXTENDER FOR S3 BED #     ,33142463,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,AETNA,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,CIGNA,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,TRICARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,UNITED HEALTHCARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,UNITED HEALTHCARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,VA,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,VA TRICARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,WELLMED,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,HUMANA,MGD,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM >MONTH R,33142464,CDM,279,RC,,,,,,Inpatient,,,15.29,15.29,HUMANA CHOICE PLUS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,AETNA,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,BCBS,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,CIGNA,COM,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,TRICARE,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,UNITED HEALTHCARE,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,UNITED HEALTHCARE,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,VA,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,VA TRICARE,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,WELLMED,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,HUMANA,MGD,19.11,,,,,,,per diem,19.11,19.11,"Per diem rate, code is bundled with other services"
OPTIMA LOWER LIMB CPM DAILY RE,33142465,CDM,279,RC,,,,,,Inpatient,,,19.11,19.11,HUMANA CHOICE PLUS,MGD,19.11,,,,,,,case rate,19.11,19.11,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,AETNA,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,BCBS,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,CIGNA,COM,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,TRICARE,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,UNITED HEALTHCARE,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,UNITED HEALTHCARE,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,VA,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,VA TRICARE,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,WELLMED,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,HUMANA,MGD,452.91,,,,,,,per diem,452.91,452.91,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY RE,33142466,CDM,279,RC,,,,,,Inpatient,,,452.91,452.91,HUMANA CHOICE PLUS,MGD,452.91,,,,,,,case rate,452.91,452.91,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,AETNA,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,BCBS,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,CIGNA,COM,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,TRICARE,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,UNITED HEALTHCARE,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,UNITED HEALTHCARE,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,VA,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,VA TRICARE,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,WELLMED,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,HUMANA,MGD,1643.46,,,,,,,per diem,1643.46,1643.46,"Per diem rate, code is bundled with other services"
BIPAP MACHINE RENTAL DAILY    ,33142468,CDM,279,RC,,,,,,Inpatient,,,1643.46,1643.46,HUMANA CHOICE PLUS,MGD,1643.46,,,,,,,case rate,1643.46,1643.46,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
BIPAP HUMIDIFER RENTAL        ,33142469,CDM,279,RC,,,,,,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,AETNA,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,BCBS,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,CIGNA,COM,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,TRICARE,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,UNITED HEALTHCARE,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,UNITED HEALTHCARE,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,VA,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,VA TRICARE,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,WELLMED,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,HUMANA,MGD,283.97,,,,,,,per diem,283.97,283.97,"Per diem rate, code is bundled with other services"
CPAP MACHINE RENTAL           ,33142471,CDM,279,RC,,,,,,Inpatient,,,283.97,283.97,HUMANA CHOICE PLUS,MGD,283.97,,,,,,,case rate,283.97,283.97,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,AETNA,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,BCBS,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,CIGNA,COM,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,TRICARE,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,UNITED HEALTHCARE,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,UNITED HEALTHCARE,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,VA,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,VA TRICARE,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,WELLMED,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,HUMANA,MGD,194.65,,,,,,,per diem,194.65,194.65,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFER                ,33142472,CDM,279,RC,,,,,,Inpatient,,,194.65,194.65,HUMANA CHOICE PLUS,MGD,194.65,,,,,,,case rate,194.65,194.65,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,AETNA,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,BCBS,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,CIGNA,COM,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,TRICARE,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,UNITED HEALTHCARE,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,UNITED HEALTHCARE,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,VA,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,VA TRICARE,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,WELLMED,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,HUMANA,MGD,44.23,,,,,,,per diem,44.23,44.23,"Per diem rate, code is bundled with other services"
MULTIPAD TP200 13X8           ,33142473,CDM,270,RC,,,,,,Inpatient,,,44.23,44.23,HUMANA CHOICE PLUS,MGD,44.23,,,,,,,case rate,44.23,44.23,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,AETNA,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,BCBS,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,CIGNA,COM,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,TRICARE,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,UNITED HEALTHCARE,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,UNITED HEALTHCARE,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,VA,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,VA TRICARE,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,WELLMED,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,HUMANA,MGD,1407,,,,,,,per diem,1407,1407,"Per diem rate, code is bundled with other services"
AFO PLASTIC W ANK JNT CUSTOM  ,33142478,CDM,279,RC,L1970,HCPCS,,,,Inpatient,,,1407,1407,HUMANA CHOICE PLUS,MGD,1407,,,,,,,case rate,1407,1407,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,AETNA,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,BCBS,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,CIGNA,COM,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,TRICARE,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,UNITED HEALTHCARE,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,UNITED HEALTHCARE,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,VA,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,VA TRICARE,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,WELLMED,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,HUMANA,MGD,1150.8,,,,,,,per diem,1150.8,1150.8,"Per diem rate, code is bundled with other services"
AFO SOLID POSTERIOR ANK CUSTOM,33142479,CDM,279,RC,L1960,HCPCS,,,,Inpatient,,,1150.8,1150.8,HUMANA CHOICE PLUS,MGD,1150.8,,,,,,,case rate,1150.8,1150.8,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,AETNA,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,BCBS,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,CIGNA,COM,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,TRICARE,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,UNITED HEALTHCARE,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,UNITED HEALTHCARE,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,VA,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,VA TRICARE,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,WELLMED,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,HUMANA,MGD,1581.3,,,,,,,per diem,1581.3,1581.3,"Per diem rate, code is bundled with other services"
AFO SPIRAL PLAST/OTHER PREFAB ,33142480,CDM,279,RC,L1951,HCPCS,,,,Inpatient,,,1581.3,1581.3,HUMANA CHOICE PLUS,MGD,1581.3,,,,,,,case rate,1581.3,1581.3,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,AETNA,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,BCBS,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,CIGNA,COM,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,TRICARE,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,UNITED HEALTHCARE,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,UNITED HEALTHCARE,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,VA,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,VA TRICARE,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,WELLMED,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,HUMANA,MGD,96.69,,,,,,,per diem,96.69,96.69,"Per diem rate, code is bundled with other services"
SHOE LIFT HEEL/SOLE NEO INCH  ,33142481,CDM,279,RC,L3310,CPT,L3310,HCPCS,,Inpatient,,,96.69,96.69,HUMANA CHOICE PLUS,MGD,96.69,,,,,,,case rate,96.69,96.69,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,AETNA,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,BCBS,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,CIGNA,COM,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,TRICARE,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,UNITED HEALTHCARE,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,UNITED HEALTHCARE,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,VA,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,VA TRICARE,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,WELLMED,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,HUMANA,MGD,622.22,,,,,,,per diem,622.22,622.22,"Per diem rate, code is bundled with other services"
KO DBL UPRT JNT MLDED PREFB   ,33142482,CDM,274,RC,L1845,HCPCS,,,,Inpatient,,,622.22,622.22,HUMANA CHOICE PLUS,MGD,622.22,,,,,,,case rate,622.22,622.22,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,AETNA,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,BCBS,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,CIGNA,COM,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,TRICARE,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,UNITED HEALTHCARE,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,UNITED HEALTHCARE,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,VA,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,VA TRICARE,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,WELLMED,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,HUMANA,MGD,458.33,,,,,,,per diem,458.33,458.33,"Per diem rate, code is bundled with other services"
AFO/PRAFO STATIC              ,33142483,CDM,279,RC,L4396,CPT,L4396,HCPCS,,Inpatient,,,458.33,458.33,HUMANA CHOICE PLUS,MGD,458.33,,,,,,,case rate,458.33,458.33,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,AETNA,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,BCBS,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,CIGNA,COM,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,TRICARE,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,UNITED HEALTHCARE,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,UNITED HEALTHCARE,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,VA,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,VA TRICARE,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,WELLMED,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,HUMANA,MGD,68.18,,,,,,,per diem,68.18,68.18,"Per diem rate, code is bundled with other services"
"CERV COLLAR, MIAMI J/ASPEN    ",33142485,CDM,274,RC,E1399,CPT,E1399,HCPCS,,Inpatient,,,68.18,68.18,HUMANA CHOICE PLUS,MGD,68.18,,,,,,,case rate,68.18,68.18,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,AETNA,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,BCBS,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,CIGNA,COM,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,TRICARE,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,UNITED HEALTHCARE,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,UNITED HEALTHCARE,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,VA,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,VA TRICARE,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,WELLMED,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,HUMANA,MGD,116.87,,,,,,,per diem,116.87,116.87,"Per diem rate, code is bundled with other services"
"HEADMASTER COLLER, PER EA, OTS",33142486,CDM,274,RC,L0160,CPT,L0160,HCPCS,,Inpatient,,,116.87,116.87,HUMANA CHOICE PLUS,MGD,116.87,,,,,,,case rate,116.87,116.87,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,AETNA,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,BCBS,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,CIGNA,COM,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,TRICARE,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,UNITED HEALTHCARE,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,UNITED HEALTHCARE,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,VA,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,VA TRICARE,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,WELLMED,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,HUMANA,MGD,1932,,,,,,,per diem,1932,1932,"Per diem rate, code is bundled with other services"
PREFAB CARBON FIB AFO W/ANT   ,33142487,CDM,274,RC,L1932,CPT,L1932,HCPCS,,Inpatient,,,1932,1932,HUMANA CHOICE PLUS,MGD,1932,,,,,,,case rate,1932,1932,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,AETNA,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,BCBS,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,CIGNA,COM,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,TRICARE,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,UNITED HEALTHCARE,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,UNITED HEALTHCARE,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,VA,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,VA TRICARE,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,WELLMED,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,HUMANA,MGD,106.21,,,,,,,per diem,106.21,106.21,"Per diem rate, code is bundled with other services"
SHOE/BOOT SURG POST OP AMBULTR,33142489,CDM,274,RC,L3260,CPT,L3260,HCPCS,,Inpatient,,,106.21,106.21,HUMANA CHOICE PLUS,MGD,106.21,,,,,,,case rate,106.21,106.21,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,AETNA,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,BCBS,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,CIGNA,COM,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,TRICARE,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,UNITED HEALTHCARE,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,UNITED HEALTHCARE,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,VA,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,VA TRICARE,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,WELLMED,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,HUMANA,MGD,19.48,,,,,,,per diem,19.48,19.48,"Per diem rate, code is bundled with other services"
REPLACEMENT PAD ASPEN         ,33142490,CDM,274,RC,L4210,CPT,L4210,HCPCS,,Inpatient,,,19.48,19.48,HUMANA CHOICE PLUS,MGD,19.48,,,,,,,case rate,19.48,19.48,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,AETNA,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,BCBS,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,CIGNA,COM,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,TRICARE,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,UNITED HEALTHCARE,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,UNITED HEALTHCARE,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,VA,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,VA TRICARE,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,WELLMED,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,HUMANA,MGD,78.28,,,,,,,per diem,78.28,78.28,"Per diem rate, code is bundled with other services"
"SPLINT, FOOT, METAL ALL SIZES ",33142491,CDM,274,RC,,,,,,Inpatient,,,78.28,78.28,HUMANA CHOICE PLUS,MGD,78.28,,,,,,,case rate,78.28,78.28,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,AETNA,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,BCBS,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,CIGNA,COM,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,TRICARE,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,UNITED HEALTHCARE,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,UNITED HEALTHCARE,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,VA,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,VA TRICARE,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,WELLMED,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,HUMANA,MGD,433.65,,,,,,,per diem,433.65,433.65,"Per diem rate, code is bundled with other services"
AFO PLASTIC - OTHER CUSTOM    ,33142494,CDM,274,RC,L1940,CPT,L1940,HCPCS,,Inpatient,,,433.65,433.65,HUMANA CHOICE PLUS,MGD,433.65,,,,,,,case rate,433.65,433.65,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,AETNA,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,BCBS,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,CIGNA,COM,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,TRICARE,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,UNITED HEALTHCARE,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,UNITED HEALTHCARE,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,VA,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,VA TRICARE,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,WELLMED,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,HUMANA,MGD,22.26,,,,,,,per diem,22.26,22.26,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 3 PANEL      ,33144027,CDM,270,RC,,,,,,Inpatient,,,22.26,22.26,HUMANA CHOICE PLUS,MGD,22.26,,,,,,,case rate,22.26,22.26,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,AETNA,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,CIGNA,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,TRICARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,UNITED HEALTHCARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,UNITED HEALTHCARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,VA,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,VA TRICARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,WELLMED,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,HUMANA,MGD,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 4 PANEL      ,33144028,CDM,270,RC,,,,,,Inpatient,,,23.88,23.88,HUMANA CHOICE PLUS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,AETNA,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,BCBS,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,CIGNA,COM,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,TRICARE,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,UNITED HEALTHCARE,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,UNITED HEALTHCARE,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,VA,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,VA TRICARE,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,WELLMED,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,HUMANA,MGD,72.54,,,,,,,per diem,72.54,72.54,"Per diem rate, code is bundled with other services"
SEAT CUSHION WAFFLE           ,33144050,CDM,279,RC,,,,,,Inpatient,,,72.54,72.54,HUMANA CHOICE PLUS,MGD,72.54,,,,,,,case rate,72.54,72.54,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,AETNA,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,BCBS,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,CIGNA,COM,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,TRICARE,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,UNITED HEALTHCARE,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,UNITED HEALTHCARE,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,VA,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,VA TRICARE,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,WELLMED,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,HUMANA,MGD,144.09,,,,,,,per diem,144.09,144.09,"Per diem rate, code is bundled with other services"
PODUS BOOT                    ,33144088,CDM,270,RC,,,,,,Inpatient,,,144.09,144.09,HUMANA CHOICE PLUS,MGD,144.09,,,,,,,case rate,144.09,144.09,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,AETNA,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,CIGNA,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,TRICARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,UNITED HEALTHCARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,UNITED HEALTHCARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,VA,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,VA TRICARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,WELLMED,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,HUMANA,MGD,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE W/PUMP        ,33144092,CDM,279,RC,,,,,,Inpatient,,,99.5,99.5,HUMANA CHOICE PLUS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,AETNA,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,CIGNA,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,TRICARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UNITED HEALTHCARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UNITED HEALTHCARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,VA,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,VA TRICARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,WELLMED,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,HUMANA,MGD,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOE SEMI RIGID       ,33144093,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,HUMANA CHOICE PLUS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,AETNA,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,BCBS,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,CIGNA,COM,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,TRICARE,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,UNITED HEALTHCARE,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,UNITED HEALTHCARE,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,VA,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,VA TRICARE,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,WELLMED,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,HUMANA,MGD,306.06,,,,,,,per diem,306.06,306.06,"Per diem rate, code is bundled with other services"
BOOT WAFFLE                   ,33144094,CDM,270,RC,,,,,,Inpatient,,,306.06,306.06,HUMANA CHOICE PLUS,MGD,306.06,,,,,,,case rate,306.06,306.06,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,AETNA,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,BCBS,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,CIGNA,COM,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,TRICARE,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,UNITED HEALTHCARE,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,UNITED HEALTHCARE,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,VA,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,VA TRICARE,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,WELLMED,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,HUMANA,MGD,36.61,,,,,,,per diem,36.61,36.61,"Per diem rate, code is bundled with other services"
ISOTONER THERAPUTIC GLOVE     ,33144102,CDM,270,RC,,,,,,Inpatient,,,36.61,36.61,HUMANA CHOICE PLUS,MGD,36.61,,,,,,,case rate,36.61,36.61,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,AETNA,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,CIGNA,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,TRICARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,UNITED HEALTHCARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,UNITED HEALTHCARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,VA,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,VA TRICARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,WELLMED,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,HUMANA,MGD,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
"COLLAR, ATLAS ADULT REGULAR   ",33144199,CDM,270,RC,,,,,,Inpatient,,,104.31,104.31,HUMANA CHOICE PLUS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,AETNA,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,BCBS,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,CIGNA,COM,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,TRICARE,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,UNITED HEALTHCARE,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,UNITED HEALTHCARE,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,VA,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,VA TRICARE,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,WELLMED,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,HUMANA,MGD,107.17,,,,,,,per diem,107.17,107.17,"Per diem rate, code is bundled with other services"
HEEL/ELBOW PROTECTOR          ,33144200,CDM,270,RC,,,,,,Inpatient,,,107.17,107.17,HUMANA CHOICE PLUS,MGD,107.17,,,,,,,case rate,107.17,107.17,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,AETNA,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,BCBS,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,CIGNA,COM,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,TRICARE,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,UNITED HEALTHCARE,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,UNITED HEALTHCARE,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,VA,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,VA TRICARE,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,WELLMED,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,HUMANA,MGD,171.75,,,,,,,per diem,171.75,171.75,"Per diem rate, code is bundled with other services"
AIRCAST RIGHT LARGE           ,33144201,CDM,270,RC,,,,,,Inpatient,,,171.75,171.75,HUMANA CHOICE PLUS,MGD,171.75,,,,,,,case rate,171.75,171.75,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,AETNA,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,BCBS,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,CIGNA,COM,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,TRICARE,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,UNITED HEALTHCARE,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,UNITED HEALTHCARE,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,VA,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,VA TRICARE,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,WELLMED,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,HUMANA,MGD,13.47,,,,,,,per diem,13.47,13.47,"Per diem rate, code is bundled with other services"
"SLING, ARM, DEEP POCKET W/NECK",33144202,CDM,270,RC,,,,,,Inpatient,,,13.47,13.47,HUMANA CHOICE PLUS,MGD,13.47,,,,,,,case rate,13.47,13.47,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,AETNA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,CIGNA,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,WELLMED,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA,MGD,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33144219,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA CHOICE PLUS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,AETNA,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,CIGNA,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,TRICARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,UNITED HEALTHCARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,UNITED HEALTHCARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,VA,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,VA TRICARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,WELLMED,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,HUMANA,MGD,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880)  ,33144220,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,HUMANA CHOICE PLUS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,AETNA,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,BCBS,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,CIGNA,COM,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,TRICARE,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,UNITED HEALTHCARE,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,UNITED HEALTHCARE,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,VA,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,VA TRICARE,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,WELLMED,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,HUMANA,MGD,26.39,,,,,,,per diem,26.39,26.39,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL      ,33144221,CDM,279,RC,,,,,,Inpatient,,,26.39,26.39,HUMANA CHOICE PLUS,MGD,26.39,,,,,,,case rate,26.39,26.39,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,AETNA,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,BCBS,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,CIGNA,COM,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,TRICARE,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,UNITED HEALTHCARE,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,UNITED HEALTHCARE,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,VA,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,VA TRICARE,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,WELLMED,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,HUMANA,MGD,159.93,,,,,,,per diem,159.93,159.93,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED   ,33144222,CDM,279,RC,,,,,,Inpatient,,,159.93,159.93,HUMANA CHOICE PLUS,MGD,159.93,,,,,,,case rate,159.93,159.93,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,AETNA,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,BCBS,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,CIGNA,COM,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,TRICARE,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,UNITED HEALTHCARE,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,UNITED HEALTHCARE,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,VA,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,VA TRICARE,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,WELLMED,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,HUMANA,MGD,93.43,,,,,,,per diem,93.43,93.43,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER  ,33144223,CDM,279,RC,,,,,,Inpatient,,,93.43,93.43,HUMANA CHOICE PLUS,MGD,93.43,,,,,,,case rate,93.43,93.43,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,AETNA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,CIGNA,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,WELLMED,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA,MGD,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY  ,33144224,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA CHOICE PLUS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,AETNA,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,BCBS,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,CIGNA,COM,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,TRICARE,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,UNITED HEALTHCARE,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,UNITED HEALTHCARE,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,VA,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,VA TRICARE,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,WELLMED,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,HUMANA,MGD,187.4,,,,,,,per diem,187.4,187.4,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33144225,CDM,279,RC,,,,,,Inpatient,,,187.4,187.4,HUMANA CHOICE PLUS,MGD,187.4,,,,,,,case rate,187.4,187.4,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,AETNA,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,CIGNA,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,TRICARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,UNITED HEALTHCARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,UNITED HEALTHCARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,VA,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,VA TRICARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,WELLMED,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,HUMANA,MGD,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR        ,33144226,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,HUMANA CHOICE PLUS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,AETNA,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,BCBS,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,CIGNA,COM,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,TRICARE,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,UNITED HEALTHCARE,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,UNITED HEALTHCARE,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,VA,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,VA TRICARE,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,WELLMED,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,HUMANA,MGD,14.85,,,,,,,per diem,14.85,14.85,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33144227,CDM,279,RC,,,,,,Inpatient,,,14.85,14.85,HUMANA CHOICE PLUS,MGD,14.85,,,,,,,case rate,14.85,14.85,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,AETNA,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,BCBS,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,CIGNA,COM,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,TRICARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,UNITED HEALTHCARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,UNITED HEALTHCARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,VA,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,VA TRICARE,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,WELLMED,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,HUMANA,MGD,119.54,,,,,,,per diem,119.54,119.54,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33144228,CDM,279,RC,,,,,,Inpatient,,,119.54,119.54,HUMANA CHOICE PLUS,MGD,119.54,,,,,,,case rate,119.54,119.54,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,AETNA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,CIGNA,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,WELLMED,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA,MGD,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR   ,33144229,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA CHOICE PLUS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,AETNA,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,CIGNA,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,TRICARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,UNITED HEALTHCARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,UNITED HEALTHCARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,VA,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,VA TRICARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,WELLMED,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,HUMANA,MGD,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33144230,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,HUMANA CHOICE PLUS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,AETNA,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,BCBS,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,CIGNA,COM,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,TRICARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,UNITED HEALTHCARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,UNITED HEALTHCARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,VA,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,VA TRICARE,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,WELLMED,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,HUMANA,MGD,106.34,,,,,,,per diem,106.34,106.34,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW     ,33144231,CDM,279,RC,,,,,,Inpatient,,,106.34,106.34,HUMANA CHOICE PLUS,MGD,106.34,,,,,,,case rate,106.34,106.34,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,AETNA,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,BCBS,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,CIGNA,COM,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,TRICARE,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,UNITED HEALTHCARE,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,UNITED HEALTHCARE,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,VA,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,VA TRICARE,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,WELLMED,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,HUMANA,MGD,213.23,,,,,,,per diem,213.23,213.23,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB PLATFORM,33144232,CDM,279,RC,,,,,,Inpatient,,,213.23,213.23,HUMANA CHOICE PLUS,MGD,213.23,,,,,,,case rate,213.23,213.23,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,AETNA,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,BCBS,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,CIGNA,COM,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,TRICARE,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,UNITED HEALTHCARE,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,UNITED HEALTHCARE,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,VA,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,VA TRICARE,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,WELLMED,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,HUMANA,MGD,1754.61,,,,,,,per diem,1754.61,1754.61,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM    ,33144233,CDM,279,RC,,,,,,Inpatient,,,1754.61,1754.61,HUMANA CHOICE PLUS,MGD,1754.61,,,,,,,case rate,1754.61,1754.61,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,AETNA,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,BCBS,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,CIGNA,COM,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,TRICARE,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,UNITED HEALTHCARE,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,UNITED HEALTHCARE,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,VA,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,VA TRICARE,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,WELLMED,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,HUMANA,MGD,26.93,,,,,,,per diem,26.93,26.93,"Per diem rate, code is bundled with other services"
FULL FRAME TRAPEZE ASSEMBLY   ,33144234,CDM,279,RC,,,,,,Inpatient,,,26.93,26.93,HUMANA CHOICE PLUS,MGD,26.93,,,,,,,case rate,26.93,26.93,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,AETNA,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,CIGNA,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,TRICARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,UNITED HEALTHCARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,UNITED HEALTHCARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,VA,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,VA TRICARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,WELLMED,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,HUMANA,MGD,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33144235,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,HUMANA CHOICE PLUS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,AETNA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,CIGNA,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,WELLMED,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA,MGD,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33144236,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA CHOICE PLUS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,AETNA,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,BCBS,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,CIGNA,COM,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,TRICARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,UNITED HEALTHCARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,UNITED HEALTHCARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,VA,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,VA TRICARE,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,WELLMED,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,HUMANA,MGD,64.03,,,,,,,per diem,64.03,64.03,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb    ,33144237,CDM,279,RC,,,,,,Inpatient,,,64.03,64.03,HUMANA CHOICE PLUS,MGD,64.03,,,,,,,case rate,64.03,64.03,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,AETNA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,CIGNA,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,WELLMED,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA,MGD,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33144239,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA CHOICE PLUS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,AETNA,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,CIGNA,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,TRICARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,UNITED HEALTHCARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,UNITED HEALTHCARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,VA,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,VA TRICARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,WELLMED,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,HUMANA,MGD,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED  ,33144240,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,HUMANA CHOICE PLUS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,AETNA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,CIGNA,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,WELLMED,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA,MGD,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY     ,33144241,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA CHOICE PLUS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,AETNA,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,BCBS,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,CIGNA,COM,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,TRICARE,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,UNITED HEALTHCARE,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,UNITED HEALTHCARE,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,VA,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,VA TRICARE,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,WELLMED,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,HUMANA,MGD,21.16,,,,,,,per diem,21.16,21.16,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33144242,CDM,279,RC,,,,,,Inpatient,,,21.16,21.16,HUMANA CHOICE PLUS,MGD,21.16,,,,,,,case rate,21.16,21.16,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,AETNA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,CIGNA,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,WELLMED,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA,MGD,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS        ,33144243,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA CHOICE PLUS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,AETNA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,CIGNA,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,VA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,VA TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,WELLMED,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,HUMANA,MGD,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION   ",33144245,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,HUMANA CHOICE PLUS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,AETNA,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,BCBS,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,CIGNA,COM,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,TRICARE,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,UNITED HEALTHCARE,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,UNITED HEALTHCARE,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,VA,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,VA TRICARE,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,WELLMED,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,HUMANA,MGD,205.26,,,,,,,per diem,205.26,205.26,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED  ,33144246,CDM,279,RC,,,,,,Inpatient,,,205.26,205.26,HUMANA CHOICE PLUS,MGD,205.26,,,,,,,case rate,205.26,205.26,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,AETNA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,CIGNA,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,WELLMED,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA,MGD,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33144247,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA CHOICE PLUS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,AETNA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,CIGNA,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,WELLMED,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA,MGD,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY  ,33144248,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA CHOICE PLUS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,AETNA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,CIGNA,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,VA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,VA TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,WELLMED,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,HUMANA,MGD,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33144250,CDM,279,RC,,,,,,Inpatient,,,9.07,9.07,HUMANA CHOICE PLUS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,AETNA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,CIGNA,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,WELLMED,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA,MGD,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33144251,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA CHOICE PLUS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,AETNA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,CIGNA,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,WELLMED,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA,MGD,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVERLAY MATTRESS ,33144252,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA CHOICE PLUS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,AETNA,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,BCBS,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,CIGNA,COM,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,TRICARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,UNITED HEALTHCARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,UNITED HEALTHCARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,VA,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,VA TRICARE,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,WELLMED,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,HUMANA,MGD,42.87,,,,,,,per diem,42.87,42.87,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY    ,33144253,CDM,279,RC,,,,,,Inpatient,,,42.87,42.87,HUMANA CHOICE PLUS,MGD,42.87,,,,,,,case rate,42.87,42.87,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,AETNA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,CIGNA,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,WELLMED,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA,MGD,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33144254,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA CHOICE PLUS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,AETNA,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,BCBS,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,CIGNA,COM,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,TRICARE,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,UNITED HEALTHCARE,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,UNITED HEALTHCARE,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,VA,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,VA TRICARE,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,WELLMED,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,HUMANA,MGD,319.31,,,,,,,per diem,319.31,319.31,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33144255,CDM,279,RC,,,,,,Inpatient,,,319.31,319.31,HUMANA CHOICE PLUS,MGD,319.31,,,,,,,case rate,319.31,319.31,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,AETNA,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,BCBS,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,CIGNA,COM,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,TRICARE,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,UNITED HEALTHCARE,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,UNITED HEALTHCARE,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,VA,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,VA TRICARE,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,WELLMED,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,HUMANA,MGD,67.87,,,,,,,per diem,67.87,67.87,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33144256,CDM,279,RC,,,,,,Inpatient,,,67.87,67.87,HUMANA CHOICE PLUS,MGD,67.87,,,,,,,case rate,67.87,67.87,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,AETNA,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,BCBS,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,CIGNA,COM,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,TRICARE,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,UNITED HEALTHCARE,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,UNITED HEALTHCARE,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,VA,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,VA TRICARE,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,WELLMED,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,HUMANA,MGD,638.6,,,,,,,per diem,638.6,638.6,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE   ,33144257,CDM,279,RC,,,,,,Inpatient,,,638.6,638.6,HUMANA CHOICE PLUS,MGD,638.6,,,,,,,case rate,638.6,638.6,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,AETNA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,CIGNA,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,WELLMED,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA,MGD,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33144258,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA CHOICE PLUS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,AETNA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,CIGNA,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,WELLMED,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA,MGD,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33144259,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA CHOICE PLUS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,AETNA,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,CIGNA,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,TRICARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,UNITED HEALTHCARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,UNITED HEALTHCARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,VA,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,VA TRICARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,WELLMED,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,HUMANA,MGD,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144260,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,HUMANA CHOICE PLUS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,AETNA,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,CIGNA,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,TRICARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,UNITED HEALTHCARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,UNITED HEALTHCARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,VA,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,VA TRICARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,WELLMED,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,HUMANA,MGD,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144261,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,HUMANA CHOICE PLUS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,AETNA,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,CIGNA,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,TRICARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,UNITED HEALTHCARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,UNITED HEALTHCARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,VA,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,VA TRICARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,WELLMED,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,HUMANA,MGD,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144262,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,HUMANA CHOICE PLUS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,AETNA,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,CIGNA,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,TRICARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,UNITED HEALTHCARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,UNITED HEALTHCARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,VA,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,VA TRICARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,WELLMED,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,HUMANA,MGD,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144263,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,HUMANA CHOICE PLUS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,AETNA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,CIGNA,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,WELLMED,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA,MGD,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33144264,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA CHOICE PLUS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,AETNA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,CIGNA,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,WELLMED,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA,MGD,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33144265,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA CHOICE PLUS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,AETNA,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,BCBS,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,CIGNA,COM,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,TRICARE,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,UNITED HEALTHCARE,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,UNITED HEALTHCARE,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,VA,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,VA TRICARE,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,WELLMED,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,HUMANA,MGD,100.02,,,,,,,per diem,100.02,100.02,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33144266,CDM,279,RC,,,,,,Inpatient,,,100.02,100.02,HUMANA CHOICE PLUS,MGD,100.02,,,,,,,case rate,100.02,100.02,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,AETNA,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,BCBS,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,CIGNA,COM,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,TRICARE,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,UNITED HEALTHCARE,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,UNITED HEALTHCARE,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,VA,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,VA TRICARE,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,WELLMED,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,HUMANA,MGD,69.25,,,,,,,per diem,69.25,69.25,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33144267,CDM,279,RC,,,,,,Inpatient,,,69.25,69.25,HUMANA CHOICE PLUS,MGD,69.25,,,,,,,case rate,69.25,69.25,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,AETNA,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,BCBS,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,CIGNA,COM,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,TRICARE,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,UNITED HEALTHCARE,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,UNITED HEALTHCARE,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,VA,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,VA TRICARE,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,WELLMED,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,HUMANA,MGD,98.37,,,,,,,per diem,98.37,98.37,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33144268,CDM,279,RC,,,,,,Inpatient,,,98.37,98.37,HUMANA CHOICE PLUS,MGD,98.37,,,,,,,case rate,98.37,98.37,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,AETNA,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,BCBS,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,CIGNA,COM,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,TRICARE,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,UNITED HEALTHCARE,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,UNITED HEALTHCARE,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,VA,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,VA TRICARE,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,WELLMED,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,HUMANA,MGD,55.51,,,,,,,per diem,55.51,55.51,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33144269,CDM,279,RC,,,,,,Inpatient,,,55.51,55.51,HUMANA CHOICE PLUS,MGD,55.51,,,,,,,case rate,55.51,55.51,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,AETNA,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,BCBS,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,CIGNA,COM,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,TRICARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,UNITED HEALTHCARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,UNITED HEALTHCARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,VA,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,VA TRICARE,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,WELLMED,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,HUMANA,MGD,156.63,,,,,,,per diem,156.63,156.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33144270,CDM,279,RC,,,,,,Inpatient,,,156.63,156.63,HUMANA CHOICE PLUS,MGD,156.63,,,,,,,case rate,156.63,156.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,AETNA,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,BCBS,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,CIGNA,COM,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,TRICARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,UNITED HEALTHCARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,UNITED HEALTHCARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,VA,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,VA TRICARE,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,WELLMED,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,HUMANA,MGD,71.45,,,,,,,per diem,71.45,71.45,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33144271,CDM,279,RC,,,,,,Inpatient,,,71.45,71.45,HUMANA CHOICE PLUS,MGD,71.45,,,,,,,case rate,71.45,71.45,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,AETNA,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,BCBS,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,CIGNA,COM,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,TRICARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,UNITED HEALTHCARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,UNITED HEALTHCARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,VA,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,VA TRICARE,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,WELLMED,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,HUMANA,MGD,61.28,,,,,,,per diem,61.28,61.28,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33144272,CDM,279,RC,,,,,,Inpatient,,,61.28,61.28,HUMANA CHOICE PLUS,MGD,61.28,,,,,,,case rate,61.28,61.28,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,AETNA,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,BCBS,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,CIGNA,COM,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,TRICARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,UNITED HEALTHCARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,UNITED HEALTHCARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,VA,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,VA TRICARE,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,WELLMED,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,HUMANA,MGD,161.3,,,,,,,per diem,161.3,161.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33144273,CDM,279,RC,,,,,,Inpatient,,,161.3,161.3,HUMANA CHOICE PLUS,MGD,161.3,,,,,,,case rate,161.3,161.3,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,AETNA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,CIGNA,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,WELLMED,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA,MGD,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33144274,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA CHOICE PLUS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,AETNA,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,CIGNA,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,TRICARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,UNITED HEALTHCARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,UNITED HEALTHCARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,VA,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,VA TRICARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,WELLMED,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,HUMANA,MGD,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33144275,CDM,279,RC,,,,,,Inpatient,,,36,36,HUMANA CHOICE PLUS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,AETNA,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,BCBS,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,CIGNA,COM,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,TRICARE,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,UNITED HEALTHCARE,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,UNITED HEALTHCARE,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,VA,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,VA TRICARE,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,WELLMED,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,HUMANA,MGD,256.65,,,,,,,per diem,256.65,256.65,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144277,CDM,279,RC,,,,,,Inpatient,,,256.65,256.65,HUMANA CHOICE PLUS,MGD,256.65,,,,,,,case rate,256.65,256.65,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,AETNA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,BCBS,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,CIGNA,COM,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,UNITED HEALTHCARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,VA TRICARE,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,WELLMED,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA,MGD,53.04,,,,,,,per diem,53.04,53.04,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33144278,CDM,279,RC,,,,,,Inpatient,,,53.04,53.04,HUMANA CHOICE PLUS,MGD,53.04,,,,,,,case rate,53.04,53.04,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,AETNA,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,BCBS,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,CIGNA,COM,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,TRICARE,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,UNITED HEALTHCARE,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,UNITED HEALTHCARE,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,VA,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,VA TRICARE,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,WELLMED,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,HUMANA,MGD,207.47,,,,,,,per diem,207.47,207.47,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33144279,CDM,279,RC,,,,,,Inpatient,,,207.47,207.47,HUMANA CHOICE PLUS,MGD,207.47,,,,,,,case rate,207.47,207.47,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,AETNA,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,BCBS,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,CIGNA,COM,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,TRICARE,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,UNITED HEALTHCARE,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,UNITED HEALTHCARE,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,VA,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,VA TRICARE,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,WELLMED,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,HUMANA,MGD,164.05,,,,,,,per diem,164.05,164.05,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33144280,CDM,279,RC,,,,,,Inpatient,,,164.05,164.05,HUMANA CHOICE PLUS,MGD,164.05,,,,,,,case rate,164.05,164.05,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,AETNA,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,BCBS,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,CIGNA,COM,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,TRICARE,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,UNITED HEALTHCARE,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,UNITED HEALTHCARE,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,VA,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,VA TRICARE,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,WELLMED,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,HUMANA,MGD,89.59,,,,,,,per diem,89.59,89.59,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33144281,CDM,279,RC,,,,,,Inpatient,,,89.59,89.59,HUMANA CHOICE PLUS,MGD,89.59,,,,,,,case rate,89.59,89.59,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,AETNA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,CIGNA,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,VA TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,WELLMED,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA,MGD,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33144282,CDM,279,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA CHOICE PLUS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,AETNA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,CIGNA,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,VA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,VA TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,WELLMED,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA,MGD,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33144283,CDM,279,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA CHOICE PLUS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,AETNA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,BCBS,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,CIGNA,COM,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,UNITED HEALTHCARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,VA TRICARE,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,WELLMED,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA,MGD,172.57,,,,,,,per diem,172.57,172.57,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33144284,CDM,279,RC,,,,,,Inpatient,,,172.57,172.57,HUMANA CHOICE PLUS,MGD,172.57,,,,,,,case rate,172.57,172.57,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,AETNA,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,CIGNA,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,TRICARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,UNITED HEALTHCARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,UNITED HEALTHCARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,VA,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,VA TRICARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,WELLMED,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,HUMANA,MGD,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33144285,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,HUMANA CHOICE PLUS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,AETNA,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,BCBS,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,CIGNA,COM,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,TRICARE,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,UNITED HEALTHCARE,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,UNITED HEALTHCARE,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,VA,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,VA TRICARE,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,WELLMED,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,HUMANA,MGD,81.89,,,,,,,per diem,81.89,81.89,"Per diem rate, code is bundled with other services"
SMARTVEST AIRWAY (MEDPULSE)   ,33144287,CDM,279,RC,,,,,,Inpatient,,,81.89,81.89,HUMANA CHOICE PLUS,MGD,81.89,,,,,,,case rate,81.89,81.89,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,AETNA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,CIGNA,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,VA TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,WELLMED,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA,MGD,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
SCD- SEQUENTIAL COMPRESSION   ,33144288,CDM,279,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA CHOICE PLUS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,AETNA,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,BCBS,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,CIGNA,COM,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,TRICARE,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,UNITED HEALTHCARE,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,UNITED HEALTHCARE,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,VA,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,VA TRICARE,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,WELLMED,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,HUMANA,MGD,799.63,,,,,,,per diem,799.63,799.63,"Per diem rate, code is bundled with other services"
ECU MONTHLY RENTAL            ,33144289,CDM,279,RC,,,,,,Inpatient,,,799.63,799.63,HUMANA CHOICE PLUS,MGD,799.63,,,,,,,case rate,799.63,799.63,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,AETNA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,CIGNA,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,VA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,VA TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,WELLMED,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,HUMANA,MGD,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT   ,33144290,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,HUMANA CHOICE PLUS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,AETNA,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,BCBS,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,CIGNA,COM,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,TRICARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,UNITED HEALTHCARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,UNITED HEALTHCARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,VA,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,VA TRICARE,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,WELLMED,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,HUMANA,MGD,3.85,,,,,,,per diem,3.85,3.85,"Per diem rate, code is bundled with other services"
CPAP HUMIDIFIER W/HEATER DAILY,33144291,CDM,279,RC,,,,,,Inpatient,,,3.85,3.85,HUMANA CHOICE PLUS,MGD,3.85,,,,,,,case rate,3.85,3.85,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,AETNA,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,BCBS,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,CIGNA,COM,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,TRICARE,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,UNITED HEALTHCARE,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,UNITED HEALTHCARE,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,VA,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,VA TRICARE,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,WELLMED,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,HUMANA,MGD,186.31,,,,,,,per diem,186.31,186.31,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33144292,CDM,279,RC,,,,,,Inpatient,,,186.31,186.31,HUMANA CHOICE PLUS,MGD,186.31,,,,,,,case rate,186.31,186.31,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,AETNA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,CIGNA,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,WELLMED,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA,MGD,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33144293,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA CHOICE PLUS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,AETNA,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,BCBS,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,CIGNA,COM,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,TRICARE,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,UNITED HEALTHCARE,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,UNITED HEALTHCARE,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,VA,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,VA TRICARE,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,WELLMED,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,HUMANA,MGD,51.93,,,,,,,per diem,51.93,51.93,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33144294,CDM,279,RC,,,,,,Inpatient,,,51.93,51.93,HUMANA CHOICE PLUS,MGD,51.93,,,,,,,case rate,51.93,51.93,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,AETNA,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,BCBS,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,CIGNA,COM,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,TRICARE,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,UNITED HEALTHCARE,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,UNITED HEALTHCARE,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,VA,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,VA TRICARE,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,WELLMED,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,HUMANA,MGD,28.04,,,,,,,per diem,28.04,28.04,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33144295,CDM,279,RC,,,,,,Inpatient,,,28.04,28.04,HUMANA CHOICE PLUS,MGD,28.04,,,,,,,case rate,28.04,28.04,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,AETNA,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,BCBS,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,CIGNA,COM,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,TRICARE,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,UNITED HEALTHCARE,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,UNITED HEALTHCARE,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,VA,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,VA TRICARE,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,WELLMED,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,HUMANA,MGD,139.6,,,,,,,per diem,139.6,139.6,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC  ,33144296,CDM,279,RC,,,,,,Inpatient,,,139.6,139.6,HUMANA CHOICE PLUS,MGD,139.6,,,,,,,case rate,139.6,139.6,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,AETNA,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,CIGNA,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,TRICARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,UNITED HEALTHCARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,UNITED HEALTHCARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,VA,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,VA TRICARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,WELLMED,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,HUMANA,MGD,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33144297,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,HUMANA CHOICE PLUS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,AETNA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,BCBS,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,CIGNA,COM,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,UNITED HEALTHCARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,VA TRICARE,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,WELLMED,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA,MGD,39.57,,,,,,,per diem,39.57,39.57,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33144298,CDM,279,RC,,,,,,Inpatient,,,39.57,39.57,HUMANA CHOICE PLUS,MGD,39.57,,,,,,,case rate,39.57,39.57,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,AETNA,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,BCBS,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,CIGNA,COM,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,TRICARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,UNITED HEALTHCARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,UNITED HEALTHCARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,VA,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,VA TRICARE,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,WELLMED,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,HUMANA,MGD,36,,,,,,,per diem,36,36,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33144299,CDM,279,RC,,,,,,Inpatient,,,36,36,HUMANA CHOICE PLUS,MGD,36,,,,,,,case rate,36,36,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,AETNA,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,BCBS,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,CIGNA,COM,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,TRICARE,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,UNITED HEALTHCARE,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,UNITED HEALTHCARE,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,VA,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,VA TRICARE,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,WELLMED,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,HUMANA,MGD,167.62,,,,,,,per diem,167.62,167.62,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR   ,33144300,CDM,279,RC,,,,,,Inpatient,,,167.62,167.62,HUMANA CHOICE PLUS,MGD,167.62,,,,,,,case rate,167.62,167.62,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,AETNA,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,BCBS,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,CIGNA,COM,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,TRICARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,UNITED HEALTHCARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,UNITED HEALTHCARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,VA,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,VA TRICARE,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,WELLMED,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,HUMANA,MGD,199.5,,,,,,,per diem,199.5,199.5,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33144301,CDM,279,RC,,,,,,Inpatient,,,199.5,199.5,HUMANA CHOICE PLUS,MGD,199.5,,,,,,,case rate,199.5,199.5,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,AETNA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,BCBS,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,CIGNA,COM,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,UNITED HEALTHCARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,VA TRICARE,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,WELLMED,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA,MGD,48.09,,,,,,,per diem,48.09,48.09,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33144302,CDM,279,RC,,,,,,Inpatient,,,48.09,48.09,HUMANA CHOICE PLUS,MGD,48.09,,,,,,,case rate,48.09,48.09,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,AETNA,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,BCBS,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,CIGNA,COM,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,TRICARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,UNITED HEALTHCARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,UNITED HEALTHCARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,VA,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,VA TRICARE,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,WELLMED,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,HUMANA,MGD,23.64,,,,,,,per diem,23.64,23.64,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33144303,CDM,279,RC,,,,,,Inpatient,,,23.64,23.64,HUMANA CHOICE PLUS,MGD,23.64,,,,,,,case rate,23.64,23.64,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,AETNA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,BCBS,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,CIGNA,COM,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,UNITED HEALTHCARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,VA TRICARE,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,WELLMED,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA,MGD,5.23,,,,,,,per diem,5.23,5.23,"Per diem rate, code is bundled with other services"
MEDLEY PUMP MODULE LVP DAILY  ,33144305,CDM,279,RC,,,,,,Inpatient,,,5.23,5.23,HUMANA CHOICE PLUS,MGD,5.23,,,,,,,case rate,5.23,5.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,AETNA,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,BCBS,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,CIGNA,COM,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,TRICARE,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,UNITED HEALTHCARE,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,UNITED HEALTHCARE,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,VA,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,VA TRICARE,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,WELLMED,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,HUMANA,MGD,8.53,,,,,,,per diem,8.53,8.53,"Per diem rate, code is bundled with other services"
KANGAROO PUMP ENTERAL DAILY   ,33144307,CDM,279,RC,,,,,,Inpatient,,,8.53,8.53,HUMANA CHOICE PLUS,MGD,8.53,,,,,,,case rate,8.53,8.53,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,AETNA,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,BCBS,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,CIGNA,COM,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,TRICARE,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,UNITED HEALTHCARE,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,UNITED HEALTHCARE,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,VA,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,VA TRICARE,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,WELLMED,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,HUMANA,MGD,65.13,,,,,,,per diem,65.13,65.13,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 RECL/         ,33144309,CDM,279,RC,,,,,,Inpatient,,,65.13,65.13,HUMANA CHOICE PLUS,MGD,65.13,,,,,,,case rate,65.13,65.13,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,AETNA,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,BCBS,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,CIGNA,COM,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,TRICARE,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,UNITED HEALTHCARE,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,UNITED HEALTHCARE,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,VA,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,VA TRICARE,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,WELLMED,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,HUMANA,MGD,40.97,,,,,,,per diem,40.97,40.97,"Per diem rate, code is bundled with other services"
SHOWER COMMODE CHAIR 750LB    ,33144310,CDM,279,RC,,,,,,Inpatient,,,40.97,40.97,HUMANA CHOICE PLUS,MGD,40.97,,,,,,,case rate,40.97,40.97,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,AETNA,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,CIGNA,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,TRICARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,UNITED HEALTHCARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,UNITED HEALTHCARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,VA,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,VA TRICARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,WELLMED,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,HUMANA,MGD,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
BARIATRIC LIFT 600LB CAP      ,33144311,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,HUMANA CHOICE PLUS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,AETNA,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,BCBS,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,CIGNA,COM,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,TRICARE,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,UNITED HEALTHCARE,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,UNITED HEALTHCARE,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,VA,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,VA TRICARE,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,WELLMED,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,HUMANA,MGD,192.09,,,,,,,per diem,192.09,192.09,"Per diem rate, code is bundled with other services"
DOLPHIN BARIATRIC MATTRESS    ,33144312,CDM,279,RC,,,,,,Inpatient,,,192.09,192.09,HUMANA CHOICE PLUS,MGD,192.09,,,,,,,case rate,192.09,192.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,AETNA,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,CIGNA,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,TRICARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,UNITED HEALTHCARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,UNITED HEALTHCARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,VA,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,VA TRICARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,WELLMED,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,HUMANA,MGD,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
POSEY BED BUMPER PAD 49       ,33144314,CDM,279,RC,,,,,,Inpatient,,,23.09,23.09,HUMANA CHOICE PLUS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,AETNA,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,BCBS,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,CIGNA,COM,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,TRICARE,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,UNITED HEALTHCARE,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,UNITED HEALTHCARE,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,VA,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,VA TRICARE,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,WELLMED,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,HUMANA,MGD,256.92,,,,,,,per diem,256.92,256.92,"Per diem rate, code is bundled with other services"
VAC ULTA THERAPY UNIT DAILY   ,33144315,CDM,279,RC,,,,,,Inpatient,,,256.92,256.92,HUMANA CHOICE PLUS,MGD,256.92,,,,,,,case rate,256.92,256.92,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,AETNA,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,BCBS,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,CIGNA,COM,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,TRICARE,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,UNITED HEALTHCARE,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,UNITED HEALTHCARE,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,VA,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,VA TRICARE,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,WELLMED,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,HUMANA,MGD,21.44,,,,,,,per diem,21.44,21.44,"Per diem rate, code is bundled with other services"
SPECTRA CPM DAILY RENTAL UHC  ,33144316,CDM,279,RC,,,,,,Inpatient,,,21.44,21.44,HUMANA CHOICE PLUS,MGD,21.44,,,,,,,case rate,21.44,21.44,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,AETNA,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,BCBS,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,CIGNA,COM,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,TRICARE,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,UNITED HEALTHCARE,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,UNITED HEALTHCARE,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,VA,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,VA TRICARE,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,WELLMED,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,HUMANA,MGD,153.6,,,,,,,per diem,153.6,153.6,"Per diem rate, code is bundled with other services"
"POSEY 8070 SAFE BED FRAME,    ",33144317,CDM,279,RC,,,,,,Inpatient,,,153.6,153.6,HUMANA CHOICE PLUS,MGD,153.6,,,,,,,case rate,153.6,153.6,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,AETNA,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,BCBS,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,CIGNA,COM,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,TRICARE,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,UNITED HEALTHCARE,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,UNITED HEALTHCARE,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,VA,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,VA TRICARE,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,WELLMED,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,HUMANA,MGD,241.82,,,,,,,per diem,241.82,241.82,"Per diem rate, code is bundled with other services"
BARIATRIC BED 1000LB RENTAL   ,33144318,CDM,279,RC,,,,,,Inpatient,,,241.82,241.82,HUMANA CHOICE PLUS,MGD,241.82,,,,,,,case rate,241.82,241.82,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,AETNA,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,BCBS,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,CIGNA,COM,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,TRICARE,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,UNITED HEALTHCARE,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,UNITED HEALTHCARE,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,VA,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,VA TRICARE,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,WELLMED,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,HUMANA,MGD,95.9,,,,,,,per diem,95.9,95.9,"Per diem rate, code is bundled with other services"
"SECURE II BED 35X84, 500LB,   ",33144319,CDM,279,RC,,,,,,Inpatient,,,95.9,95.9,HUMANA CHOICE PLUS,MGD,95.9,,,,,,,case rate,95.9,95.9,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,AETNA,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,BCBS,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,CIGNA,COM,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,TRICARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,UNITED HEALTHCARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,UNITED HEALTHCARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,VA,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,VA TRICARE,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,WELLMED,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,HUMANA,MGD,76.67,,,,,,,per diem,76.67,76.67,"Per diem rate, code is bundled with other services"
STAGE IV 3000 AP/LAL MATTRESS ,33144322,CDM,279,RC,,,,,,Inpatient,,,76.67,76.67,HUMANA CHOICE PLUS,MGD,76.67,,,,,,,case rate,76.67,76.67,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,AETNA,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,BCBS,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,CIGNA,COM,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,TRICARE,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,UNITED HEALTHCARE,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,UNITED HEALTHCARE,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,VA,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,VA TRICARE,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,WELLMED,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,HUMANA,MGD,134.38,,,,,,,per diem,134.38,134.38,"Per diem rate, code is bundled with other services"
TRIFLEX 2 BED PLATFOMR 1000LB ,33144323,CDM,279,RC,,,,,,Inpatient,,,134.38,134.38,HUMANA CHOICE PLUS,MGD,134.38,,,,,,,case rate,134.38,134.38,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,AETNA,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,BCBS,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,CIGNA,COM,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,TRICARE,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,UNITED HEALTHCARE,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,UNITED HEALTHCARE,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,VA,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,VA TRICARE,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,WELLMED,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,HUMANA,MGD,19.24,,,,,,,per diem,19.24,19.24,"Per diem rate, code is bundled with other services"
REM MATTRESS-STRYKER BED FRAME,33144324,CDM,279,RC,,,,,,Inpatient,,,19.24,19.24,HUMANA CHOICE PLUS,MGD,19.24,,,,,,,case rate,19.24,19.24,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,AETNA,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,BCBS,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,CIGNA,COM,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,TRICARE,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,UNITED HEALTHCARE,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,UNITED HEALTHCARE,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,VA,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,VA TRICARE,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,WELLMED,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,HUMANA,MGD,37.6,,,,,,,per diem,37.6,37.6,"Per diem rate, code is bundled with other services"
CERVICAL COLLAR OPEN TRACHEA  ,33144363,CDM,270,RC,,,,,,Inpatient,,,37.6,37.6,HUMANA CHOICE PLUS,MGD,37.6,,,,,,,case rate,37.6,37.6,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,AETNA,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,CIGNA,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,TRICARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,UNITED HEALTHCARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,UNITED HEALTHCARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,VA,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,VA TRICARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,WELLMED,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,HUMANA,MGD,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
ALARIS PUMP RENTAL            ,33144364,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,HUMANA CHOICE PLUS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,AETNA,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,BCBS,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,CIGNA,COM,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,TRICARE,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,UNITED HEALTHCARE,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,UNITED HEALTHCARE,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,VA,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,VA TRICARE,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,WELLMED,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,HUMANA,MGD,43.64,,,,,,,per diem,43.64,43.64,"Per diem rate, code is bundled with other services"
DOLPHIN MATTRESS              ,33144365,CDM,279,RC,,,,,,Inpatient,,,43.64,43.64,HUMANA CHOICE PLUS,MGD,43.64,,,,,,,case rate,43.64,43.64,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,AETNA,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,BCBS,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,CIGNA,COM,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,TRICARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,UNITED HEALTHCARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,UNITED HEALTHCARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,VA,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,VA TRICARE,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,WELLMED,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,HUMANA,MGD,7.23,,,,,,,per diem,7.23,7.23,"Per diem rate, code is bundled with other services"
KANGAROO PUMP RENTAL          ,33144366,CDM,279,RC,,,,,,Inpatient,,,7.23,7.23,HUMANA CHOICE PLUS,MGD,7.23,,,,,,,case rate,7.23,7.23,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,AETNA,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,BCBS,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,CIGNA,COM,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,TRICARE,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,UNITED HEALTHCARE,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,UNITED HEALTHCARE,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,VA,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,VA TRICARE,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,WELLMED,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,HUMANA,MGD,127.7,,,,,,,per diem,127.7,127.7,"Per diem rate, code is bundled with other services"
SHRINKER                      ,33144367,CDM,270,RC,L8440,HCPCS,,,,Inpatient,,,127.7,127.7,HUMANA CHOICE PLUS,MGD,127.7,,,,,,,case rate,127.7,127.7,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
JEVITY 1.2 BOTTLES            ,33146255,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"ABD 9""                        ",33146444,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,AETNA,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,BCBS,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,CIGNA,COM,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,TRICARE,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,UNITED HEALTHCARE,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,UNITED HEALTHCARE,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,VA,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,VA TRICARE,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,WELLMED,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,HUMANA,MGD,9.77,,,,,,,per diem,9.77,9.77,"Per diem rate, code is bundled with other services"
SLINGS ARM                    ,33146450,CDM,270,RC,,,,,,Inpatient,,,9.77,9.77,HUMANA CHOICE PLUS,MGD,9.77,,,,,,,case rate,9.77,9.77,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,AETNA,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,BCBS,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,CIGNA,COM,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,TRICARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UNITED HEALTHCARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,UNITED HEALTHCARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,VA,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,VA TRICARE,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,WELLMED,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,HUMANA,MGD,18.42,,,,,,,per diem,18.42,18.42,"Per diem rate, code is bundled with other services"
POST OP SHOES                 ,33146451,CDM,270,RC,,,,,,Inpatient,,,18.42,18.42,HUMANA CHOICE PLUS,MGD,18.42,,,,,,,case rate,18.42,18.42,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33146639,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,AETNA,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,BCBS,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,CIGNA,COM,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,TRICARE,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,UNITED HEALTHCARE,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,UNITED HEALTHCARE,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,VA,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,VA TRICARE,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,WELLMED,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,HUMANA,MGD,3502.8,,,,,,,per diem,3502.8,3502.8,"Per diem rate, code is bundled with other services"
BARI WHEELCHAIR W/ELECT       ,33146650,CDM,279,RC,,,,,,Inpatient,,,3502.8,3502.8,HUMANA CHOICE PLUS,MGD,3502.8,,,,,,,case rate,3502.8,3502.8,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,AETNA,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,BCBS,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,CIGNA,COM,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,TRICARE,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,UNITED HEALTHCARE,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,UNITED HEALTHCARE,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,VA,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,VA TRICARE,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,WELLMED,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,HUMANA,MGD,60.9,,,,,,,per diem,60.9,60.9,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33146676,CDM,279,RC,,,,,,Inpatient,,,60.9,60.9,HUMANA CHOICE PLUS,MGD,60.9,,,,,,,case rate,60.9,60.9,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,AETNA,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,CIGNA,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,TRICARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,UNITED HEALTHCARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,UNITED HEALTHCARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,VA,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,VA TRICARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,WELLMED,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,HUMANA,MGD,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
BI-PAP RENTAL (FREEDOM)       ,33146678,CDM,279,RC,,,,,,Inpatient,,,50.78,50.78,HUMANA CHOICE PLUS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,AETNA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,CIGNA,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,WELLMED,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA,MGD,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33146705,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA CHOICE PLUS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
BARIATRIC RECLINING CHAIR     ,33146715,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,AETNA,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,BCBS,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,CIGNA,COM,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,TRICARE,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,UNITED HEALTHCARE,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,UNITED HEALTHCARE,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,VA,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,VA TRICARE,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,WELLMED,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,HUMANA,MGD,1001.7,,,,,,,per diem,1001.7,1001.7,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SPECIAL ORDER     ",33146717,CDM,279,RC,,,,,,Inpatient,,,1001.7,1001.7,HUMANA CHOICE PLUS,MGD,1001.7,,,,,,,case rate,1001.7,1001.7,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
CPM HAND DAILY RENTAL         ,33146721,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,AETNA,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,BCBS,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,CIGNA,COM,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,TRICARE,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,UNITED HEALTHCARE,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,UNITED HEALTHCARE,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,VA,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,VA TRICARE,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,WELLMED,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,HUMANA,MGD,16.88,,,,,,,per diem,16.88,16.88,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY DAILY RENTAL   ,33146724,CDM,279,RC,,,,,,Inpatient,,,16.88,16.88,HUMANA CHOICE PLUS,MGD,16.88,,,,,,,case rate,16.88,16.88,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BARI RECLINER RENT            ,33146732,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,AETNA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,CIGNA,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,WELLMED,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA,MGD,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
BARIATRIC LW BED FIXED WI     ,33146733,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA CHOICE PLUS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,AETNA,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,BCBS,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,CIGNA,COM,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,TRICARE,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,UNITED HEALTHCARE,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,UNITED HEALTHCARE,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,VA,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,VA TRICARE,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,WELLMED,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,HUMANA,MGD,48.56,,,,,,,per diem,48.56,48.56,"Per diem rate, code is bundled with other services"
BARIATRIC W/C 24/36 WIDTH     ,33146734,CDM,279,RC,,,,,,Inpatient,,,48.56,48.56,HUMANA CHOICE PLUS,MGD,48.56,,,,,,,case rate,48.56,48.56,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,AETNA,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,BCBS,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,CIGNA,COM,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,TRICARE,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,UNITED HEALTHCARE,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,UNITED HEALTHCARE,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,VA,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,VA TRICARE,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,WELLMED,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,HUMANA,MGD,565.16,,,,,,,per diem,565.16,565.16,"Per diem rate, code is bundled with other services"
CPAP AUTO M SERIES            ,33146741,CDM,279,RC,,,,,,Inpatient,,,565.16,565.16,HUMANA CHOICE PLUS,MGD,565.16,,,,,,,case rate,565.16,565.16,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CPAP AUTO RESRONIC RENTAL     ,33146742,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,AETNA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,BCBS,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,CIGNA,COM,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,UNITED HEALTHCARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,VA TRICARE,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,WELLMED,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA,MGD,174.04,,,,,,,per diem,174.04,174.04,"Per diem rate, code is bundled with other services"
FREEDOM VAC RENTAL            ,33146747,CDM,279,RC,,,,,,Inpatient,,,174.04,174.04,HUMANA CHOICE PLUS,MGD,174.04,,,,,,,case rate,174.04,174.04,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
KNEE CPM RENTAL               ,33146782,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
LAL MATTRESS RENTAL           ,33146783,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
LAL MATTRESS SYSTEM RENT      ,33146784,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,AETNA,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,BCBS,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,CIGNA,COM,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,TRICARE,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,UNITED HEALTHCARE,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,UNITED HEALTHCARE,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,VA,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,VA TRICARE,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,WELLMED,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,HUMANA,MGD,8.97,,,,,,,per diem,8.97,8.97,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY 1 SECT       ,33146786,CDM,279,RC,,,,,,Inpatient,,,8.97,8.97,HUMANA CHOICE PLUS,MGD,8.97,,,,,,,case rate,8.97,8.97,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
MATTRESS OVERLAY W/CVR        ,33146787,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,AETNA,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,BCBS,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,CIGNA,COM,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,TRICARE,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,UNITED HEALTHCARE,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,UNITED HEALTHCARE,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,VA,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,VA TRICARE,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,WELLMED,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,HUMANA,MGD,190.89,,,,,,,per diem,190.89,190.89,"Per diem rate, code is bundled with other services"
REST HAND ORHTO LG RIGHT      ,33146789,CDM,270,RC,,,,,,Inpatient,,,190.89,190.89,HUMANA CHOICE PLUS,MGD,190.89,,,,,,,case rate,190.89,190.89,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO CUSHION RECLINER RNT     ,33146791,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
ROHO W/C CUSHION RENTAL       ,33146792,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,AETNA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,CIGNA,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,WELLMED,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA,MGD,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 16IN DRIVE LW      ,33146796,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA CHOICE PLUS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,AETNA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,CIGNA,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,WELLMED,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA,MGD,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE LW      ,33146797,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA CHOICE PLUS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN DRIVE STND    ,33146798,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
WHEELCHAIR 18IN RECLINE       ,33146799,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,AETNA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,CIGNA,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,WELLMED,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA,MGD,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 20IN DRIVE LW      ,33146800,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA CHOICE PLUS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,AETNA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,BCBS,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,CIGNA,COM,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,UNITED HEALTHCARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,VA TRICARE,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,WELLMED,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA,MGD,96.86,,,,,,,per diem,96.86,96.86,"Per diem rate, code is bundled with other services"
WHEELCHAIR 24IN WIDE          ,33146801,CDM,279,RC,,,,,,Inpatient,,,96.86,96.86,HUMANA CHOICE PLUS,MGD,96.86,,,,,,,case rate,96.86,96.86,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,AETNA,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,BCBS,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,CIGNA,COM,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,TRICARE,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,UNITED HEALTHCARE,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,UNITED HEALTHCARE,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,VA,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,VA TRICARE,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,WELLMED,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,HUMANA,MGD,145.43,,,,,,,per diem,145.43,145.43,"Per diem rate, code is bundled with other services"
WHLCHR REC 20X16 SIL RENT     ,33146802,CDM,279,RC,,,,,,Inpatient,,,145.43,145.43,HUMANA CHOICE PLUS,MGD,145.43,,,,,,,case rate,145.43,145.43,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,AETNA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,CIGNA,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,VA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,VA TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,WELLMED,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,HUMANA,MGD,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
WHLCHR TRACER 20IN DE RENT    ,33146803,CDM,279,RC,,,,,,Inpatient,,,129.15,129.15,HUMANA CHOICE PLUS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,AETNA,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,BCBS,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,CIGNA,COM,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,TRICARE,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,UNITED HEALTHCARE,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,UNITED HEALTHCARE,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,VA,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,VA TRICARE,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,WELLMED,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,HUMANA,MGD,1130.06,,,,,,,per diem,1130.06,1130.06,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN            ,33146804,CDM,279,RC,,,,,,Inpatient,,,1130.06,1130.06,HUMANA CHOICE PLUS,MGD,1130.06,,,,,,,case rate,1130.06,1130.06,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,AETNA,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,BCBS,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,CIGNA,COM,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,TRICARE,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,UNITED HEALTHCARE,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,UNITED HEALTHCARE,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,VA,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,VA TRICARE,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,WELLMED,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,HUMANA,MGD,46.46,,,,,,,per diem,46.46,46.46,"Per diem rate, code is bundled with other services"
ORTHO ARM SLING W/STRAP       ,33146805,CDM,270,RC,,,,,,Inpatient,,,46.46,46.46,HUMANA CHOICE PLUS,MGD,46.46,,,,,,,case rate,46.46,46.46,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,AETNA,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,BCBS,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,CIGNA,COM,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,TRICARE,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,UNITED HEALTHCARE,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,UNITED HEALTHCARE,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,VA,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,VA TRICARE,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,WELLMED,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,HUMANA,MGD,99.49,,,,,,,per diem,99.49,99.49,"Per diem rate, code is bundled with other services"
ORTHO WALKING CAST SHOE       ,33146819,CDM,270,RC,,,,,,Inpatient,,,99.49,99.49,HUMANA CHOICE PLUS,MGD,99.49,,,,,,,case rate,99.49,99.49,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,AETNA,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,BCBS,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,CIGNA,COM,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,TRICARE,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,UNITED HEALTHCARE,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,UNITED HEALTHCARE,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,VA,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,VA TRICARE,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,WELLMED,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,HUMANA,MGD,2.89,,,,,,,per diem,2.89,2.89,"Per diem rate, code is bundled with other services"
"ORTHO, PLASTER ROLL 2IN       ",33146820,CDM,272,RC,,,,,,Inpatient,,,2.89,2.89,HUMANA CHOICE PLUS,MGD,2.89,,,,,,,case rate,2.89,2.89,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,AETNA,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,BCBS,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,CIGNA,COM,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,TRICARE,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,UNITED HEALTHCARE,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,UNITED HEALTHCARE,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,VA,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,VA TRICARE,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,WELLMED,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,HUMANA,MGD,178.76,,,,,,,per diem,178.76,178.76,"Per diem rate, code is bundled with other services"
SPLINT POSTERIOR FOOT MED     ,33146864,CDM,272,RC,,,,,,Inpatient,,,178.76,178.76,HUMANA CHOICE PLUS,MGD,178.76,,,,,,,case rate,178.76,178.76,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,AETNA,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,BCBS,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,CIGNA,COM,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,TRICARE,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,UNITED HEALTHCARE,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,UNITED HEALTHCARE,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,VA,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,VA TRICARE,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,WELLMED,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,HUMANA,MGD,29.72,,,,,,,per diem,29.72,29.72,"Per diem rate, code is bundled with other services"
PHILADELPHIA COLLAR           ,33147383,CDM,274,RC,,,,,,Inpatient,,,29.72,29.72,HUMANA CHOICE PLUS,MGD,29.72,,,,,,,case rate,29.72,29.72,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,AETNA,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,BCBS,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,CIGNA,COM,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,TRICARE,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,UNITED HEALTHCARE,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,UNITED HEALTHCARE,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,VA,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,VA TRICARE,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,WELLMED,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,HUMANA,MGD,94.45,,,,,,,per diem,94.45,94.45,"Per diem rate, code is bundled with other services"
PREFAB WHFO W/O JOINTS        ,33147384,CDM,274,RC,,,,,,Inpatient,,,94.45,94.45,HUMANA CHOICE PLUS,MGD,94.45,,,,,,,case rate,94.45,94.45,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
FALL PADS (PAIR) DAILY RENTAL ,33147464,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
WHEELCHAIR DAILY RENTAL       ,33147475,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,AETNA,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,CIGNA,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,TRICARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,UNITED HEALTHCARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,UNITED HEALTHCARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,VA,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,VA TRICARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,WELLMED,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,HUMANA,MGD,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
TILT IN SPACE 24IN MEDXCHANGE ,33147529,CDM,279,RC,,,,,,Inpatient,,,1102.5,1102.5,HUMANA CHOICE PLUS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
HAND CPM LANTZ MEDICAL        ,33147530,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO Mattress Overlay Section ,33147534,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,AETNA,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,BCBS,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,CIGNA,COM,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,TRICARE,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,UNITED HEALTHCARE,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,UNITED HEALTHCARE,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,VA,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,VA TRICARE,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,WELLMED,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,HUMANA,MGD,34.65,,,,,,,per diem,34.65,34.65,"Per diem rate, code is bundled with other services"
NOA Low Bed                   ,33147535,CDM,279,RC,,,,,,Inpatient,,,34.65,34.65,HUMANA CHOICE PLUS,MGD,34.65,,,,,,,case rate,34.65,34.65,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Bariatric Low Bed - 42 IN     ,33147536,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,AETNA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,CIGNA,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,VA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,VA TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,WELLMED,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA,MGD,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Low Bed with scales ,33147537,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA CHOICE PLUS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Posey Bed Canopy Enclosure    ,33147538,CDM,279,RC,,,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,AETNA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,CIGNA,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,VA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,VA TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,WELLMED,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA,MGD,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Bariatric Bed with Scales     ,33147539,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA CHOICE PLUS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
Bariatric Foam Mattress       ,33147540,CDM,279,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Bariatric Free Standing Trapez,33147541,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
Bariatric Room Package        ,33147542,CDM,279,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
SARA Lift (Stand Up Lift)     ,33147543,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
Lazy Boy Recliner             ,33147544,CDM,279,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,AETNA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,BCBS,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,CIGNA,COM,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,UNITED HEALTHCARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,VA,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,VA TRICARE,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,WELLMED,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA,MGD,189,,,,,,,per diem,189,189,"Per diem rate, code is bundled with other services"
Safe-T Ambassador Bed         ,33147545,CDM,279,RC,,,,,,Inpatient,,,189,189,HUMANA CHOICE PLUS,MGD,189,,,,,,,case rate,189,189,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Pro          ,33147546,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Resironics Auto CPAP          ,33147547,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro 2       ,33147548,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Bipap ST          ,33147549,CDM,279,RC,,,,,,Inpatient,,,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
Respironics Pro-Auto          ,33147550,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
Respironics Auto SV           ,33147551,CDM,279,RC,,,,,,Inpatient,,,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,AETNA,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,CIGNA,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,TRICARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,UNITED HEALTHCARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,UNITED HEALTHCARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,VA,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,VA TRICARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,WELLMED,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,HUMANA,MGD,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
Respironics Trilogy Vent      ,33147552,CDM,279,RC,,,,,,Inpatient,,,89.25,89.25,HUMANA CHOICE PLUS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,AETNA,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,CIGNA,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,TRICARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,UNITED HEALTHCARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,UNITED HEALTHCARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,VA,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,VA TRICARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,WELLMED,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,HUMANA,MGD,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147553,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,HUMANA CHOICE PLUS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,AETNA,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,BCBS,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,CIGNA,COM,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,TRICARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,UNITED HEALTHCARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,UNITED HEALTHCARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,VA,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,VA TRICARE,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,WELLMED,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,HUMANA,MGD,4.73,,,,,,,per diem,4.73,4.73,"Per diem rate, code is bundled with other services"
Respironics CPAP Remstar      ,33147554,CDM,279,RC,,,,,,Inpatient,,,4.73,4.73,HUMANA CHOICE PLUS,MGD,4.73,,,,,,,case rate,4.73,4.73,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147555,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Respironics CPAP Auto M Series,33147556,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,AETNA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,CIGNA,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,WELLMED,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA,MGD,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Pro System  ,33147557,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA CHOICE PLUS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,AETNA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,CIGNA,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,WELLMED,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA,MGD,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
Respironics Bipap Auto        ,33147558,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA CHOICE PLUS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
Cpap Icon Nova w/ Heater      ,33147561,CDM,279,RC,,,,,,Inpatient,,,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,AETNA,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,BCBS,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,CIGNA,COM,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,TRICARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,UNITED HEALTHCARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,UNITED HEALTHCARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,VA,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,VA TRICARE,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,WELLMED,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,HUMANA,MGD,787.5,,,,,,,per diem,787.5,787.5,"Per diem rate, code is bundled with other services"
Quickie Iris Wheelchair       ,33147564,CDM,279,RC,,,,,,Inpatient,,,787.5,787.5,HUMANA CHOICE PLUS,MGD,787.5,,,,,,,case rate,787.5,787.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 LW Wheelchair      ,33147565,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 LW Wheelchair      ,33147566,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 LW Wheelchair      ,33147567,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in16 Standard Wheelchair,33147568,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in18 Standard Wheelchair,33147569,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in20 Standard Wheelchair,33147570,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Drive in22 Sentra Wheelchair  ,33147571,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
Articulating Leg Rest         ,33147572,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Drive in22 Reclining Wheelchai,33147573,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
Drive Anti Tippers            ,33147574,CDM,279,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,AETNA,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,BCBS,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,CIGNA,COM,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,TRICARE,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,UNITED HEALTHCARE,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,UNITED HEALTHCARE,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,VA,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,VA TRICARE,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,WELLMED,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,HUMANA,MGD,240.98,,,,,,,per diem,240.98,240.98,"Per diem rate, code is bundled with other services"
Stand Up Lift (SARA Lift)     ,33147575,CDM,279,RC,,,,,,Inpatient,,,240.98,240.98,HUMANA CHOICE PLUS,MGD,240.98,,,,,,,case rate,240.98,240.98,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,AETNA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,CIGNA,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,VA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,VA TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,WELLMED,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA,MGD,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
Wheelchair LW 16X             ,33147576,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA CHOICE PLUS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
Wheelchair SX                 ,33147577,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147578,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 20in DE     ,33147580,CDM,279,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair             ,33147581,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair LT WT              ,33147582,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Tracer Wheelchair 24 inch     ,33147583,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
Wheelchair 20in Recliner      ,33147584,CDM,279,RC,,,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
Wheelchair 20X16              ,33147585,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
Wheelchair 24 Inch Wide       ,33147586,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES - LANTZ MEDICAL        ,33147613,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
GLOVES LARGE RIGHT - LANTZ MED,33147614,CDM,270,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
WHEELCHAIR RECLINING 18X16    ,33147616,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,AETNA,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,BCBS,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,CIGNA,COM,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,TRICARE,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,UNITED HEALTHCARE,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,UNITED HEALTHCARE,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,VA,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,VA TRICARE,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,WELLMED,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,HUMANA,MGD,21.01,,,,,,,per diem,21.01,21.01,"Per diem rate, code is bundled with other services"
BIPAP AUTO SV ADV             ,33147619,CDM,279,RC,,,,,,Inpatient,,,21.01,21.01,HUMANA CHOICE PLUS,MGD,21.01,,,,,,,case rate,21.01,21.01,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ROHO MATTRESS OVERLAY 4 SECT  ,33147623,CDM,279,RC,,,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LIFE VEST-ZOLL                ,33147626,CDM,279,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,AETNA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,CIGNA,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,VA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,VA TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,WELLMED,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,HUMANA,MGD,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
LIGHTWT WHEELCHAIR-MED SPEC   ,33147627,CDM,279,RC,,,,,,Inpatient,,,173.25,173.25,HUMANA CHOICE PLUS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,AETNA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,CIGNA,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,VA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,VA TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,WELLMED,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA,MGD,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
VIPER WHEELCHAIR              ,33147629,CDM,279,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA CHOICE PLUS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
ONE ARM DRIVE                 ,33147634,CDM,279,RC,,,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,AETNA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,CIGNA,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,VA TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,WELLMED,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA,MGD,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
AIRCURUVE 10 V AUTO BIPAP KIT ,33147636,CDM,279,RC,,,,,,Inpatient,,,10.24,10.24,HUMANA CHOICE PLUS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,AETNA,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,BCBS,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,CIGNA,COM,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,TRICARE,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,UNITED HEALTHCARE,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,UNITED HEALTHCARE,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,VA,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,VA TRICARE,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,WELLMED,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,HUMANA,MGD,3150,,,,,,,per diem,3150,3150,"Per diem rate, code is bundled with other services"
TRILOGY VENT RENTAL           ,33147646,CDM,279,RC,,,,,,Inpatient,,,3150,3150,HUMANA CHOICE PLUS,MGD,3150,,,,,,,case rate,3150,3150,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL L,33148001,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP SMALL R,33148002,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148003,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP MEDIUM ,33148004,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE L,33148005,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,AETNA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,BCBS,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,CIGNA,COM,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,UNITED HEALTHCARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,VA TRICARE,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,WELLMED,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA,MGD,68.7,,,,,,,per diem,68.7,68.7,"Per diem rate, code is bundled with other services"
SPLINT AIRCAST STIRRUP LARGE R,33148006,CDM,270,RC,,,,,,Inpatient,,,68.7,68.7,HUMANA CHOICE PLUS,MGD,68.7,,,,,,,case rate,68.7,68.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,AETNA,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,BCBS,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,CIGNA,COM,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,TRICARE,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,UNITED HEALTHCARE,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,UNITED HEALTHCARE,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,VA,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,VA TRICARE,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,WELLMED,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,HUMANA,MGD,79.7,,,,,,,per diem,79.7,79.7,"Per diem rate, code is bundled with other services"
BOOT CAST SLIMLINE PED SM     ,33148019,CDM,270,RC,,,,,,Inpatient,,,79.7,79.7,HUMANA CHOICE PLUS,MGD,79.7,,,,,,,case rate,79.7,79.7,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,AETNA,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,BCBS,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,CIGNA,COM,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,TRICARE,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,UNITED HEALTHCARE,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,UNITED HEALTHCARE,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,VA,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,VA TRICARE,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,WELLMED,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,HUMANA,MGD,147.84,,,,,,,per diem,147.84,147.84,"Per diem rate, code is bundled with other services"
BOOT CRADLE                   ,33148020,CDM,270,RC,,,,,,Inpatient,,,147.84,147.84,HUMANA CHOICE PLUS,MGD,147.84,,,,,,,case rate,147.84,147.84,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,AETNA,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,BCBS,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,CIGNA,COM,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,TRICARE,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,UNITED HEALTHCARE,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,UNITED HEALTHCARE,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,VA,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,VA TRICARE,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,WELLMED,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,HUMANA,MGD,359.21,,,,,,,per diem,359.21,359.21,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR LNG 13IN,33148021,CDM,270,RC,,,,,,Inpatient,,,359.21,359.21,HUMANA CHOICE PLUS,MGD,359.21,,,,,,,case rate,359.21,359.21,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,AETNA,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,BCBS,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,CIGNA,COM,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,TRICARE,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,UNITED HEALTHCARE,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,UNITED HEALTHCARE,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,VA,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,VA TRICARE,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,WELLMED,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,HUMANA,MGD,140.68,,,,,,,per diem,140.68,140.68,"Per diem rate, code is bundled with other services"
BOOT CRADLE PRUVENTOR SHT 9IN ,33148022,CDM,270,RC,,,,,,Inpatient,,,140.68,140.68,HUMANA CHOICE PLUS,MGD,140.68,,,,,,,case rate,140.68,140.68,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
BOOT PRAFO LINER BARIATRIC    ,33148023,CDM,270,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,AETNA,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,BCBS,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,CIGNA,COM,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,TRICARE,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,UNITED HEALTHCARE,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,UNITED HEALTHCARE,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,VA,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,VA TRICARE,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,WELLMED,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,HUMANA,MGD,66.99,,,,,,,per diem,66.99,66.99,"Per diem rate, code is bundled with other services"
BOOT TRACTION UNIV            ,33148024,CDM,270,RC,,,,,,Inpatient,,,66.99,66.99,HUMANA CHOICE PLUS,MGD,66.99,,,,,,,case rate,66.99,66.99,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,AETNA,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,BCBS,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,CIGNA,COM,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,TRICARE,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,UNITED HEALTHCARE,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,UNITED HEALTHCARE,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,VA,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,VA TRICARE,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,WELLMED,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,HUMANA,MGD,688.38,,,,,,,per diem,688.38,688.38,"Per diem rate, code is bundled with other services"
BOOT VASC ROOKE MED           ,33148025,CDM,270,RC,,,,,,Inpatient,,,688.38,688.38,HUMANA CHOICE PLUS,MGD,688.38,,,,,,,case rate,688.38,688.38,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,AETNA,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,BCBS,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,CIGNA,COM,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,TRICARE,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,UNITED HEALTHCARE,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,UNITED HEALTHCARE,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,VA,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,VA TRICARE,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,WELLMED,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,HUMANA,MGD,721.88,,,,,,,per diem,721.88,721.88,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION      ,33148026,CDM,270,RC,,,,,,Inpatient,,,721.88,721.88,HUMANA CHOICE PLUS,MGD,721.88,,,,,,,case rate,721.88,721.88,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,AETNA,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,BCBS,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,CIGNA,COM,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,TRICARE,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,UNITED HEALTHCARE,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,UNITED HEALTHCARE,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,VA,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,VA TRICARE,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,WELLMED,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,HUMANA,MGD,757.68,,,,,,,per diem,757.68,757.68,"Per diem rate, code is bundled with other services"
BRACE ACE HYPEREXTENTION LNG  ,33148027,CDM,270,RC,,,,,,Inpatient,,,757.68,757.68,HUMANA CHOICE PLUS,MGD,757.68,,,,,,,case rate,757.68,757.68,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,AETNA,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,BCBS,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,CIGNA,COM,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,TRICARE,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,UNITED HEALTHCARE,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,UNITED HEALTHCARE,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,VA,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,VA TRICARE,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,WELLMED,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,HUMANA,MGD,990.99,,,,,,,per diem,990.99,990.99,"Per diem rate, code is bundled with other services"
BRACE CHAIR BACK LG           ,33148028,CDM,270,RC,,,,,,Inpatient,,,990.99,990.99,HUMANA CHOICE PLUS,MGD,990.99,,,,,,,case rate,990.99,990.99,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,AETNA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,CIGNA,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,VA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,VA TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,WELLMED,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA,MGD,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG MENS LG         ,33148029,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA CHOICE PLUS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,AETNA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,CIGNA,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,VA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,VA TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,WELLMED,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA,MGD,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
SHOE MED SURG WOMENS MED      ,33148030,CDM,270,RC,,,,,,Inpatient,,,28.88,28.88,HUMANA CHOICE PLUS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO LG      ,33148031,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO MED     ,33148032,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SHOE ORTHOWEDGE DARCO SM      ,33148033,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,AETNA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,CIGNA,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,WELLMED,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA,MGD,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33148034,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA CHOICE PLUS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,AETNA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,CIGNA,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,WELLMED,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA,MGD,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM MED                 ,33148035,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA CHOICE PLUS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,AETNA,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,CIGNA,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,TRICARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,UNITED HEALTHCARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,UNITED HEALTHCARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,VA,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,VA TRICARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,WELLMED,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,HUMANA,MGD,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU LG  ,33148036,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,HUMANA CHOICE PLUS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,AETNA,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,BCBS,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,CIGNA,COM,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,TRICARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,UNITED HEALTHCARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,UNITED HEALTHCARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,VA,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,VA TRICARE,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,WELLMED,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,HUMANA,MGD,19.64,,,,,,,per diem,19.64,19.64,"Per diem rate, code is bundled with other services"
SLING ARM W/PAD STRAP BLU MED ,33148037,CDM,270,RC,,,,,,Inpatient,,,19.64,19.64,HUMANA CHOICE PLUS,MGD,19.64,,,,,,,case rate,19.64,19.64,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,AETNA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,BCBS,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,CIGNA,COM,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,UNITED HEALTHCARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,VA,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,VA TRICARE,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,WELLMED,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA,MGD,291.06,,,,,,,per diem,291.06,291.06,"Per diem rate, code is bundled with other services"
SUPPORT BARI FULL BDY LAT ROTA,33148043,CDM,270,RC,,,,,,Inpatient,,,291.06,291.06,HUMANA CHOICE PLUS,MGD,291.06,,,,,,,case rate,291.06,291.06,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,AETNA,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,CIGNA,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,TRICARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,UNITED HEALTHCARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,UNITED HEALTHCARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,VA,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,VA TRICARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,WELLMED,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,HUMANA,MGD,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL ADJUS,33148047,CDM,272,RC,,,,,,Inpatient,,,55.98,55.98,HUMANA CHOICE PLUS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,AETNA,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,BCBS,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,CIGNA,COM,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,TRICARE,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,UNITED HEALTHCARE,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,UNITED HEALTHCARE,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,VA,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,VA TRICARE,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,WELLMED,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,HUMANA,MGD,63.32,,,,,,,per diem,63.32,63.32,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE 3 PANEL CANVA,33148048,CDM,272,RC,,,,,,Inpatient,,,63.32,63.32,HUMANA CHOICE PLUS,MGD,63.32,,,,,,,case rate,63.32,63.32,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,AETNA,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,BCBS,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,CIGNA,COM,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,TRICARE,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,UNITED HEALTHCARE,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,UNITED HEALTHCARE,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,VA,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,VA TRICARE,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,WELLMED,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,HUMANA,MGD,16.17,,,,,,,per diem,16.17,16.17,"Per diem rate, code is bundled with other services"
SET EPUMP KNGRO ANTI FREE FLOW,33148085,CDM,279,RC,,,,,,Inpatient,,,16.17,16.17,HUMANA CHOICE PLUS,MGD,16.17,,,,,,,case rate,16.17,16.17,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,AETNA,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,BCBS,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,CIGNA,COM,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,TRICARE,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,UNITED HEALTHCARE,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,UNITED HEALTHCARE,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,VA,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,VA TRICARE,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,WELLMED,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,HUMANA,MGD,299.97,,,,,,,per diem,299.97,299.97,"Per diem rate, code is bundled with other services"
Waffle Bariartic Overlay Mattr,33148137,CDM,279,RC,,,,,,Inpatient,,,299.97,299.97,HUMANA CHOICE PLUS,MGD,299.97,,,,,,,case rate,299.97,299.97,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,AETNA,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,BCBS,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,CIGNA,COM,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,TRICARE,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,UNITED HEALTHCARE,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,UNITED HEALTHCARE,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,VA,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,VA TRICARE,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,WELLMED,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,HUMANA,MGD,89.81,,,,,,,per diem,89.81,89.81,"Per diem rate, code is bundled with other services"
Waffle Overlay Mattress 1025EC,33148138,CDM,279,RC,,,,,,Inpatient,,,89.81,89.81,HUMANA CHOICE PLUS,MGD,89.81,,,,,,,case rate,89.81,89.81,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,AETNA,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,BCBS,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,CIGNA,COM,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,TRICARE,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,UNITED HEALTHCARE,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,UNITED HEALTHCARE,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,VA,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,VA TRICARE,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,WELLMED,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,HUMANA,MGD,39.97,,,,,,,per diem,39.97,39.97,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL SM,33148168,CDM,270,RC,,,,,,Inpatient,,,39.97,39.97,HUMANA CHOICE PLUS,MGD,39.97,,,,,,,case rate,39.97,39.97,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,AETNA,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,BCBS,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,CIGNA,COM,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,TRICARE,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,UNITED HEALTHCARE,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,UNITED HEALTHCARE,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,VA,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,VA TRICARE,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,WELLMED,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,HUMANA,MGD,40.29,,,,,,,per diem,40.29,40.29,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL ME,33148169,CDM,270,RC,,,,,,Inpatient,,,40.29,40.29,HUMANA CHOICE PLUS,MGD,40.29,,,,,,,case rate,40.29,40.29,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,AETNA,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,CIGNA,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,TRICARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,UNITED HEALTHCARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,UNITED HEALTHCARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,VA,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,VA TRICARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,WELLMED,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,HUMANA,MGD,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL LR,33148170,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,HUMANA CHOICE PLUS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,AETNA,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,BCBS,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,CIGNA,COM,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,TRICARE,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,UNITED HEALTHCARE,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,UNITED HEALTHCARE,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,VA,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,VA TRICARE,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,WELLMED,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,HUMANA,MGD,41.99,,,,,,,per diem,41.99,41.99,"Per diem rate, code is bundled with other services"
BELT 9-PANEL 12IN ABDOMINAL XL,33148171,CDM,270,RC,,,,,,Inpatient,,,41.99,41.99,HUMANA CHOICE PLUS,MGD,41.99,,,,,,,case rate,41.99,41.99,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,AETNA,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,BCBS,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,CIGNA,COM,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,TRICARE,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,UNITED HEALTHCARE,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,UNITED HEALTHCARE,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,VA,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,VA TRICARE,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,WELLMED,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,HUMANA,MGD,142,,,,,,,per diem,142,142,"Per diem rate, code is bundled with other services"
VISTA COLLAR SET- ADULT # 7983,33148177,CDM,270,RC,,,,,,Inpatient,,,142,142,HUMANA CHOICE PLUS,MGD,142,,,,,,,case rate,142,142,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,AETNA,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,CIGNA,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,TRICARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UNITED HEALTHCARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,UNITED HEALTHCARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,VA TRICARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,WELLMED,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,HUMANA,MGD,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
DRSG CALCIUM ALGINATE 4x4.75 #,33148233,CDM,270,RC,,,,,,Inpatient,,,22.62,22.62,HUMANA CHOICE PLUS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,AETNA,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,BCBS,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,CIGNA,COM,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,TRICARE,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,UNITED HEALTHCARE,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,UNITED HEALTHCARE,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,VA,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,VA TRICARE,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,WELLMED,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,HUMANA,MGD,363.83,,,,,,,per diem,363.83,363.83,"Per diem rate, code is bundled with other services"
OVERLAY MATTRESS SOFCARE W/PUM,33148275,CDM,279,RC,,,,,,Inpatient,,,363.83,363.83,HUMANA CHOICE PLUS,MGD,363.83,,,,,,,case rate,363.83,363.83,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,AETNA,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,BCBS,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,CIGNA,COM,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,TRICARE,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,UNITED HEALTHCARE,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,UNITED HEALTHCARE,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,VA,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,VA TRICARE,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,WELLMED,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,HUMANA,MGD,103.79,,,,,,,per diem,103.79,103.79,"Per diem rate, code is bundled with other services"
TLSO REPLACEMENT PAD # 993642 ,33148281,CDM,270,RC,,,,,,Inpatient,,,103.79,103.79,HUMANA CHOICE PLUS,MGD,103.79,,,,,,,case rate,103.79,103.79,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,AETNA,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,CIGNA,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,TRICARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,UNITED HEALTHCARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,UNITED HEALTHCARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,VA,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,VA TRICARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,WELLMED,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,HUMANA,MGD,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW/HEEL FOAM SM  ,33148289,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,HUMANA CHOICE PLUS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,AETNA,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,BCBS,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,CIGNA,COM,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,TRICARE,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,UNITED HEALTHCARE,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,UNITED HEALTHCARE,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,VA,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,VA TRICARE,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,WELLMED,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,HUMANA,MGD,35.81,,,,,,,per diem,35.81,35.81,"Per diem rate, code is bundled with other services"
PROTECTOR EYE I-GUARD         ,33148290,CDM,272,RC,,,,,,Inpatient,,,35.81,35.81,HUMANA CHOICE PLUS,MGD,35.81,,,,,,,case rate,35.81,35.81,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,AETNA,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,BCBS,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,CIGNA,COM,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,TRICARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,UNITED HEALTHCARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,UNITED HEALTHCARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,VA,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,VA TRICARE,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,WELLMED,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,HUMANA,MGD,90.09,,,,,,,per diem,90.09,90.09,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL ELBOW MED      ,33148291,CDM,270,RC,,,,,,Inpatient,,,90.09,90.09,HUMANA CHOICE PLUS,MGD,90.09,,,,,,,case rate,90.09,90.09,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,AETNA,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,BCBS,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,CIGNA,COM,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,TRICARE,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,UNITED HEALTHCARE,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,UNITED HEALTHCARE,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,VA,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,VA TRICARE,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,WELLMED,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,HUMANA,MGD,33.5,,,,,,,per diem,33.5,33.5,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL SHEEPSKIN MED  ,33148292,CDM,270,RC,,,,,,Inpatient,,,33.5,33.5,HUMANA CHOICE PLUS,MGD,33.5,,,,,,,case rate,33.5,33.5,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,AETNA,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,CIGNA,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,TRICARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,UNITED HEALTHCARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,UNITED HEALTHCARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,VA,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,VA TRICARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,WELLMED,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,HUMANA,MGD,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW STD      ,33148293,CDM,270,RC,,,,,,Inpatient,,,53.13,53.13,HUMANA CHOICE PLUS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,AETNA,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,BCBS,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,CIGNA,COM,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,TRICARE,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,UNITED HEALTHCARE,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,UNITED HEALTHCARE,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,VA,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,VA TRICARE,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,WELLMED,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,HUMANA,MGD,17.42,,,,,,,per diem,17.42,17.42,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL/ELBOW LG # 6224,33148298,CDM,270,RC,,,,,,Inpatient,,,17.42,17.42,HUMANA CHOICE PLUS,MGD,17.42,,,,,,,case rate,17.42,17.42,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,AETNA,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,BCBS,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,CIGNA,COM,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,TRICARE,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,UNITED HEALTHCARE,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,UNITED HEALTHCARE,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,VA,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,VA TRICARE,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,WELLMED,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,HUMANA,MGD,41.06,,,,,,,per diem,41.06,41.06,"Per diem rate, code is bundled with other services"
BELT 9 PANEL ABDOM XXL 79-8932,33148358,CDM,270,RC,,,,,,Inpatient,,,41.06,41.06,HUMANA CHOICE PLUS,MGD,41.06,,,,,,,case rate,41.06,41.06,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,AETNA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,CIGNA,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,VA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,VA TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,WELLMED,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,HUMANA,MGD,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COLLAR TRACH ADULT 204B       ,33148364,CDM,272,RC,,,,,,Inpatient,,,6.04,6.04,HUMANA CHOICE PLUS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,AETNA,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,BCBS,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,CIGNA,COM,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,TRICARE,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,UNITED HEALTHCARE,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,UNITED HEALTHCARE,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,VA,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,VA TRICARE,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,WELLMED,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,HUMANA,MGD,834.75,,,,,,,per diem,834.75,834.75,"Per diem rate, code is bundled with other services"
LSO BACK BRACE #993540        ,33148615,CDM,274,RC,,,,,,Inpatient,,,834.75,834.75,HUMANA CHOICE PLUS,MGD,834.75,,,,,,,case rate,834.75,834.75,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,AETNA,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,BCBS,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,CIGNA,COM,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,TRICARE,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,UNITED HEALTHCARE,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,UNITED HEALTHCARE,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,VA,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,VA TRICARE,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,WELLMED,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,HUMANA,MGD,1055.25,,,,,,,per diem,1055.25,1055.25,"Per diem rate, code is bundled with other services"
TLSO BACK BRACE #993640       ,33148616,CDM,274,RC,,,,,,Inpatient,,,1055.25,1055.25,HUMANA CHOICE PLUS,MGD,1055.25,,,,,,,case rate,1055.25,1055.25,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,AETNA,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,BCBS,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,CIGNA,COM,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,TRICARE,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,UNITED HEALTHCARE,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,UNITED HEALTHCARE,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,VA,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,VA TRICARE,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,WELLMED,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,HUMANA,MGD,524.09,,,,,,,per diem,524.09,524.09,"Per diem rate, code is bundled with other services"
MACHINE ICEMAN COLD THERAPY   ,33148631,CDM,279,RC,,,,,,Inpatient,,,524.09,524.09,HUMANA CHOICE PLUS,MGD,524.09,,,,,,,case rate,524.09,524.09,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,AETNA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,CIGNA,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,WELLMED,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA,MGD,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP OPEN PAT MED ,33148670,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA CHOICE PLUS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,AETNA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,CIGNA,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,WELLMED,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA,MGD,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT LG       ,33148671,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA CHOICE PLUS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,AETNA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,BCBS,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,CIGNA,COM,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,UNITED HEALTHCARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,VA TRICARE,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,WELLMED,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA,MGD,20.76,,,,,,,per diem,20.76,20.76,"Per diem rate, code is bundled with other services"
SLEEVE KNEE SUPP PAT XL       ,33148672,CDM,270,RC,,,,,,Inpatient,,,20.76,20.76,HUMANA CHOICE PLUS,MGD,20.76,,,,,,,case rate,20.76,20.76,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,AETNA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,CIGNA,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,WELLMED,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA,MGD,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SM 11-16IN    ,33148679,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA CHOICE PLUS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,AETNA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,CIGNA,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,WELLMED,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA,MGD,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MED 13-18IN   ,33148680,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA CHOICE PLUS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,AETNA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,BCBS,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,CIGNA,COM,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,UNITED HEALTHCARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,VA TRICARE,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,WELLMED,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA,MGD,9.67,,,,,,,per diem,9.67,9.67,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL LG 15-20IN    ,33148681,CDM,270,RC,,,,,,Inpatient,,,9.67,9.67,HUMANA CHOICE PLUS,MGD,9.67,,,,,,,case rate,9.67,9.67,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,AETNA,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,CIGNA,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,TRICARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,UNITED HEALTHCARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,UNITED HEALTHCARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,VA,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,VA TRICARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,WELLMED,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,HUMANA,MGD,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BINDER 9in 3-PANEL ELASTIC    ,33150013,CDM,270,RC,,,,,,Inpatient,,,46.2,46.2,HUMANA CHOICE PLUS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL LG             ,33150014,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,AETNA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,BCBS,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,CIGNA,COM,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,UNITED HEALTHCARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,VA TRICARE,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,WELLMED,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA,MGD,61.95,,,,,,,per diem,61.95,61.95,"Per diem rate, code is bundled with other services"
BINDER 4 PANEL SM             ,33150015,CDM,270,RC,,,,,,Inpatient,,,61.95,61.95,HUMANA CHOICE PLUS,MGD,61.95,,,,,,,case rate,61.95,61.95,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
ABDOMINAL BINDER 10in         ,33150017,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ARM ELEVATOR                  ,33150033,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,AETNA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,CIGNA,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,VA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,VA TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,WELLMED,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA,MGD,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
BOOT BUCK                     ,33150057,CDM,270,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA CHOICE PLUS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,AETNA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,CIGNA,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,VA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,VA TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,WELLMED,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,HUMANA,MGD,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX LARGE            ,33150076,CDM,270,RC,,,,,,Inpatient,,,42,42,HUMANA CHOICE PLUS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,AETNA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,CIGNA,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,VA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,VA TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,WELLMED,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,HUMANA,MGD,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
CAST SHOE EX SMALL            ,33150077,CDM,270,RC,,,,,,Inpatient,,,42,42,HUMANA CHOICE PLUS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,AETNA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,CIGNA,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,VA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,VA TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,WELLMED,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,HUMANA,MGD,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
CAST SHOE SMALL               ,33150078,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,HUMANA CHOICE PLUS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 3inin    ,33150079,CDM,270,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 4inin    ,33150080,CDM,270,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CAST TAPE FIBERGLASS 5inin    ,33150081,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,AETNA,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,CIGNA,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,TRICARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,UNITED HEALTHCARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,UNITED HEALTHCARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,VA,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,VA TRICARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,WELLMED,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,HUMANA,MGD,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
"COLLAR, STIFF NECK (ALL)      ",33150097,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,HUMANA CHOICE PLUS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,AETNA,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,BCBS,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,CIGNA,COM,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,TRICARE,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,UNITED HEALTHCARE,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,UNITED HEALTHCARE,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,VA,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,VA TRICARE,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,WELLMED,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,HUMANA,MGD,71.4,,,,,,,per diem,71.4,71.4,"Per diem rate, code is bundled with other services"
CRUTCHES PAIR                 ,33150113,CDM,270,RC,,,,,,Inpatient,,,71.4,71.4,HUMANA CHOICE PLUS,MGD,71.4,,,,,,,case rate,71.4,71.4,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,AETNA,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,BCBS,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,CIGNA,COM,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,TRICARE,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,UNITED HEALTHCARE,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,UNITED HEALTHCARE,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,VA,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,VA TRICARE,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,WELLMED,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,HUMANA,MGD,162.75,,,,,,,per diem,162.75,162.75,"Per diem rate, code is bundled with other services"
ELECTRIC-COOL MACHINE         ,33150153,CDM,279,RC,,,,,,Inpatient,,,162.75,162.75,HUMANA CHOICE PLUS,MGD,162.75,,,,,,,case rate,162.75,162.75,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,AETNA,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,BCBS,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,CIGNA,COM,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,TRICARE,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,UNITED HEALTHCARE,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,UNITED HEALTHCARE,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,VA,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,VA TRICARE,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,WELLMED,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,HUMANA,MGD,5.78,,,,,,,per diem,5.78,5.78,"Per diem rate, code is bundled with other services"
FOOTWEAR PATIENT DOUBLE       ,33150166,CDM,270,RC,,,,,,Inpatient,,,5.78,5.78,HUMANA CHOICE PLUS,MGD,5.78,,,,,,,case rate,5.78,5.78,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,AETNA,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,BCBS,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,CIGNA,COM,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,TRICARE,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,UNITED HEALTHCARE,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,UNITED HEALTHCARE,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,VA,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,VA TRICARE,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,WELLMED,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,HUMANA,MGD,224.7,,,,,,,per diem,224.7,224.7,"Per diem rate, code is bundled with other services"
HALO L1                       ,33150179,CDM,270,RC,,,,,,Inpatient,,,224.7,224.7,HUMANA CHOICE PLUS,MGD,224.7,,,,,,,case rate,224.7,224.7,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,AETNA,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,BCBS,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,CIGNA,COM,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,TRICARE,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,UNITED HEALTHCARE,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,UNITED HEALTHCARE,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,VA,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,VA TRICARE,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,WELLMED,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,HUMANA,MGD,417.9,,,,,,,per diem,417.9,417.9,"Per diem rate, code is bundled with other services"
HALO L2                       ,33150180,CDM,270,RC,,,,,,Inpatient,,,417.9,417.9,HUMANA CHOICE PLUS,MGD,417.9,,,,,,,case rate,417.9,417.9,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,AETNA,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,BCBS,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,CIGNA,COM,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,TRICARE,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,UNITED HEALTHCARE,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,UNITED HEALTHCARE,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,VA,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,VA TRICARE,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,WELLMED,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,HUMANA,MGD,642.6,,,,,,,per diem,642.6,642.6,"Per diem rate, code is bundled with other services"
HALO L3                       ,33150181,CDM,270,RC,,,,,,Inpatient,,,642.6,642.6,HUMANA CHOICE PLUS,MGD,642.6,,,,,,,case rate,642.6,642.6,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,AETNA,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,BCBS,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,CIGNA,COM,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,TRICARE,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,UNITED HEALTHCARE,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,UNITED HEALTHCARE,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,VA,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,VA TRICARE,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,WELLMED,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,HUMANA,MGD,689.85,,,,,,,per diem,689.85,689.85,"Per diem rate, code is bundled with other services"
HALO L4                       ,33150182,CDM,270,RC,,,,,,Inpatient,,,689.85,689.85,HUMANA CHOICE PLUS,MGD,689.85,,,,,,,case rate,689.85,689.85,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,AETNA,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,BCBS,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,CIGNA,COM,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,TRICARE,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,UNITED HEALTHCARE,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,UNITED HEALTHCARE,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,VA,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,VA TRICARE,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,WELLMED,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,HUMANA,MGD,921.9,,,,,,,per diem,921.9,921.9,"Per diem rate, code is bundled with other services"
HALO L5                       ,33150183,CDM,270,RC,,,,,,Inpatient,,,921.9,921.9,HUMANA CHOICE PLUS,MGD,921.9,,,,,,,case rate,921.9,921.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,AETNA,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,BCBS,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,CIGNA,COM,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,TRICARE,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,UNITED HEALTHCARE,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,UNITED HEALTHCARE,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,VA,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,VA TRICARE,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,WELLMED,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,HUMANA,MGD,1152.9,,,,,,,per diem,1152.9,1152.9,"Per diem rate, code is bundled with other services"
HALO L6                       ,33150184,CDM,270,RC,,,,,,Inpatient,,,1152.9,1152.9,HUMANA CHOICE PLUS,MGD,1152.9,,,,,,,case rate,1152.9,1152.9,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,AETNA,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,BCBS,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,CIGNA,COM,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,TRICARE,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,UNITED HEALTHCARE,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,UNITED HEALTHCARE,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,VA,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,VA TRICARE,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,WELLMED,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,HUMANA,MGD,1913.1,,,,,,,per diem,1913.1,1913.1,"Per diem rate, code is bundled with other services"
HALO L7                       ,33150185,CDM,270,RC,,,,,,Inpatient,,,1913.1,1913.1,HUMANA CHOICE PLUS,MGD,1913.1,,,,,,,case rate,1913.1,1913.1,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,AETNA,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,BCBS,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,CIGNA,COM,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,TRICARE,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,UNITED HEALTHCARE,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,UNITED HEALTHCARE,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,VA,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,VA TRICARE,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,WELLMED,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,HUMANA,MGD,2871.75,,,,,,,per diem,2871.75,2871.75,"Per diem rate, code is bundled with other services"
HALO L8                       ,33150186,CDM,270,RC,,,,,,Inpatient,,,2871.75,2871.75,HUMANA CHOICE PLUS,MGD,2871.75,,,,,,,case rate,2871.75,2871.75,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,AETNA,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,BCBS,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,CIGNA,COM,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,TRICARE,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,UNITED HEALTHCARE,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,UNITED HEALTHCARE,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,VA,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,VA TRICARE,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,WELLMED,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,HUMANA,MGD,3832.5,,,,,,,per diem,3832.5,3832.5,"Per diem rate, code is bundled with other services"
HALO L9                       ,33150187,CDM,270,RC,,,,,,Inpatient,,,3832.5,3832.5,HUMANA CHOICE PLUS,MGD,3832.5,,,,,,,case rate,3832.5,3832.5,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,AETNA,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,BCBS,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,CIGNA,COM,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,TRICARE,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,UNITED HEALTHCARE,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,UNITED HEALTHCARE,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,VA,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,VA TRICARE,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,WELLMED,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,HUMANA,MGD,3746.4,,,,,,,per diem,3746.4,3746.4,"Per diem rate, code is bundled with other services"
HARDWARE VEST HALO            ,33150188,CDM,270,RC,,,,,,Inpatient,,,3746.4,3746.4,HUMANA CHOICE PLUS,MGD,3746.4,,,,,,,case rate,3746.4,3746.4,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,AETNA,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,BCBS,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,CIGNA,COM,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,TRICARE,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,UNITED HEALTHCARE,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,UNITED HEALTHCARE,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,VA,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,VA TRICARE,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,WELLMED,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,HUMANA,MGD,423.15,,,,,,,per diem,423.15,423.15,"Per diem rate, code is bundled with other services"
HEEL PRESSURE DVC - SAGE      ,33150192,CDM,270,RC,,,,,,Inpatient,,,423.15,423.15,HUMANA CHOICE PLUS,MGD,423.15,,,,,,,case rate,423.15,423.15,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,AETNA,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,BCBS,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,CIGNA,COM,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,TRICARE,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UNITED HEALTHCARE,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,UNITED HEALTHCARE,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,VA,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,VA TRICARE,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,WELLMED,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,HUMANA,MGD,101.85,,,,,,,per diem,101.85,101.85,"Per diem rate, code is bundled with other services"
LOW LEVEL AIR THERAPY BED     ,33150194,CDM,279,RC,,,,,,Inpatient,,,101.85,101.85,HUMANA CHOICE PLUS,MGD,101.85,,,,,,,case rate,101.85,101.85,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,AETNA,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,BCBS,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,CIGNA,COM,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,TRICARE,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,UNITED HEALTHCARE,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,UNITED HEALTHCARE,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,VA,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,VA TRICARE,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,WELLMED,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,HUMANA,MGD,309.75,,,,,,,per diem,309.75,309.75,"Per diem rate, code is bundled with other services"
MEDIUM LEVEL AIR THERAPY BED  ,33150195,CDM,279,RC,,,,,,Inpatient,,,309.75,309.75,HUMANA CHOICE PLUS,MGD,309.75,,,,,,,case rate,309.75,309.75,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,AETNA,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,BCBS,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,CIGNA,COM,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,TRICARE,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,UNITED HEALTHCARE,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,UNITED HEALTHCARE,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,VA,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,VA TRICARE,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,WELLMED,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,HUMANA,MGD,370.65,,,,,,,per diem,370.65,370.65,"Per diem rate, code is bundled with other services"
KCI ABDOMEN VAC RENTAL        ,33150210,CDM,279,RC,,,,,,Inpatient,,,370.65,370.65,HUMANA CHOICE PLUS,MGD,370.65,,,,,,,case rate,370.65,370.65,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,AETNA,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,BCBS,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,CIGNA,COM,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,TRICARE,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,UNITED HEALTHCARE,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,UNITED HEALTHCARE,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,VA,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,VA TRICARE,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,WELLMED,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,HUMANA,MGD,510.3,,,,,,,per diem,510.3,510.3,"Per diem rate, code is bundled with other services"
KCI VAC SYSTEM                ,33150211,CDM,279,RC,,,,,,Inpatient,,,510.3,510.3,HUMANA CHOICE PLUS,MGD,510.3,,,,,,,case rate,510.3,510.3,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
MATTRESS WAFFLE               ,33150224,CDM,279,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,AETNA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,CIGNA,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,VA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,VA TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,WELLMED,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,HUMANA,MGD,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
MED/SURG SHOE                 ,33150225,CDM,270,RC,,,,,,Inpatient,,,20.48,20.48,HUMANA CHOICE PLUS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,AETNA,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,BCBS,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,CIGNA,COM,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,TRICARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,UNITED HEALTHCARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,UNITED HEALTHCARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,VA,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,VA TRICARE,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,WELLMED,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,HUMANA,MGD,156.98,,,,,,,per diem,156.98,156.98,"Per diem rate, code is bundled with other services"
MUELLER WRAPAROUND KNEE BRACE ,33150238,CDM,270,RC,,,,,,Inpatient,,,156.98,156.98,HUMANA CHOICE PLUS,MGD,156.98,,,,,,,case rate,156.98,156.98,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,AETNA,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,BCBS,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,CIGNA,COM,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,TRICARE,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,UNITED HEALTHCARE,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,UNITED HEALTHCARE,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,VA,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,VA TRICARE,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,WELLMED,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,HUMANA,MGD,178.5,,,,,,,per diem,178.5,178.5,"Per diem rate, code is bundled with other services"
MULTI-PODUS BOOT              ,33150240,CDM,270,RC,,,,,,Inpatient,,,178.5,178.5,HUMANA CHOICE PLUS,MGD,178.5,,,,,,,case rate,178.5,178.5,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,AETNA,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,CIGNA,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,TRICARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,UNITED HEALTHCARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,UNITED HEALTHCARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,VA,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,VA TRICARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,WELLMED,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,HUMANA,MGD,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
OVERHEAD TRAPEZE              ,33150300,CDM,279,RC,,,,,,Inpatient,,,118.39,118.39,HUMANA CHOICE PLUS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,AETNA,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,BCBS,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,CIGNA,COM,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,TRICARE,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,UNITED HEALTHCARE,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,UNITED HEALTHCARE,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,VA,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,VA TRICARE,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,WELLMED,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,HUMANA,MGD,149.1,,,,,,,per diem,149.1,149.1,"Per diem rate, code is bundled with other services"
PILLOW GRAV LINEAR            ,33150329,CDM,270,RC,,,,,,Inpatient,,,149.1,149.1,HUMANA CHOICE PLUS,MGD,149.1,,,,,,,case rate,149.1,149.1,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,AETNA,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,BCBS,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,CIGNA,COM,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,TRICARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,UNITED HEALTHCARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,UNITED HEALTHCARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,VA,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,VA TRICARE,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,WELLMED,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,HUMANA,MGD,68.25,,,,,,,per diem,68.25,68.25,"Per diem rate, code is bundled with other services"
PILLOW PRONE 5in OSI          ,33150330,CDM,270,RC,,,,,,Inpatient,,,68.25,68.25,HUMANA CHOICE PLUS,MGD,68.25,,,,,,,case rate,68.25,68.25,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,AETNA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,CIGNA,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,VA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,VA TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,WELLMED,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,HUMANA,MGD,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
PROTECTOR ELBOW STANDARD      ,33150340,CDM,270,RC,,,,,,Inpatient,,,6.83,6.83,HUMANA CHOICE PLUS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,AETNA,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,BCBS,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,CIGNA,COM,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,TRICARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,UNITED HEALTHCARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,UNITED HEALTHCARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,VA,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,VA TRICARE,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,WELLMED,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,HUMANA,MGD,1041.08,,,,,,,per diem,1041.08,1041.08,"Per diem rate, code is bundled with other services"
RAIL PADDED SIDE for SEIZURE  ,33150342,CDM,279,RC,,,,,,Inpatient,,,1041.08,1041.08,HUMANA CHOICE PLUS,MGD,1041.08,,,,,,,case rate,1041.08,1041.08,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
"SHOE, POST OP (ALL)           ",33150356,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,AETNA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,CIGNA,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,VA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,VA TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,WELLMED,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,HUMANA,MGD,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
SLING KNEE                    ,33150363,CDM,270,RC,,,,,,Inpatient,,,45.15,45.15,HUMANA CHOICE PLUS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
SPLINT ROLL 2in-4in           ,33150371,CDM,270,RC,,,,,,Inpatient,,,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SPLINT ROLL 5in x 30in        ,33150372,CDM,270,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
ALPHA EXCELL OVLY MATT - RENTA,33150487,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
ALTERNATE LOW-AIR LOSS MATTRES,33150488,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,AETNA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,CIGNA,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,VA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,VA TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,WELLMED,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,HUMANA,MGD,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
ALTERNATING PRESSURE MATTRESS ,33150489,CDM,279,RC,,,,,,Inpatient,,,17.33,17.33,HUMANA CHOICE PLUS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,AETNA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,CIGNA,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,WELLMED,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA,MGD,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
AUTO EXCELL MATTRESS DAILY REN,33150490,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA CHOICE PLUS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
BARI WCHAIR W/ELECT REC RENT  ,33150491,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,AETNA,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,BCBS,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,CIGNA,COM,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,TRICARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,UNITED HEALTHCARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,UNITED HEALTHCARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,VA,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,VA TRICARE,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,WELLMED,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,HUMANA,MGD,174.83,,,,,,,per diem,174.83,174.83,"Per diem rate, code is bundled with other services"
BARIATRIC BED - REHAB - RENTAL,33150492,CDM,279,RC,,,,,,Inpatient,,,174.83,174.83,HUMANA CHOICE PLUS,MGD,174.83,,,,,,,case rate,174.83,174.83,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,AETNA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,CIGNA,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,WELLMED,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA,MGD,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
BARIATRIC BED (CONTOURA 880) R,33150493,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA CHOICE PLUS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,AETNA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,CIGNA,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,VA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,VA TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,WELLMED,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA,MGD,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
BARIATRIC BED TRIFLEX BLOWER A,33150494,CDM,279,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA CHOICE PLUS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,AETNA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,CIGNA,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,WELLMED,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA,MGD,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
BARIATRIC BED-REHAB PLTFRM W/M,33150495,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA CHOICE PLUS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,AETNA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,CIGNA,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,VA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,VA TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,WELLMED,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,HUMANA,MGD,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE RENTAL (700l,33150496,CDM,279,RC,,,,,,Inpatient,,,21.53,21.53,HUMANA CHOICE PLUS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,AETNA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,CIGNA,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,WELLMED,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA,MGD,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC COMMODE/SHOWER CHAIR,33150497,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA CHOICE PLUS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,AETNA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,CIGNA,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,WELLMED,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA,MGD,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BARIATRIC WALKER DAILY RENTAL ,33150498,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA CHOICE PLUS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,AETNA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,BCBS,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,CIGNA,COM,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,UNITED HEALTHCARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,VA TRICARE,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,WELLMED,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA,MGD,52.5,,,,,,,per diem,52.5,52.5,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR 750lb CAP,33150499,CDM,279,RC,,,,,,Inpatient,,,52.5,52.5,HUMANA CHOICE PLUS,MGD,52.5,,,,,,,case rate,52.5,52.5,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BARIATRIC WHEELCHAIR RENTAL   ,33150500,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,AETNA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,BCBS,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,CIGNA,COM,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,UNITED HEALTHCARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,VA TRICARE,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,WELLMED,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA,MGD,4.2,,,,,,,per diem,4.2,4.2,"Per diem rate, code is bundled with other services"
BED FLOOR MAT DAILY RENTAL    ,33150502,CDM,279,RC,,,,,,Inpatient,,,4.2,4.2,HUMANA CHOICE PLUS,MGD,4.2,,,,,,,case rate,4.2,4.2,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
BI-PAP DAILY RENTAL (FREEDOM) ,33150503,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
BREEZE AIR MATTRESS DAILY RENT,33150504,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,AETNA,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,BCBS,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,CIGNA,COM,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,TRICARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,UNITED HEALTHCARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,UNITED HEALTHCARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,VA,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,VA TRICARE,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,WELLMED,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,HUMANA,MGD,46.2,,,,,,,per diem,46.2,46.2,"Per diem rate, code is bundled with other services"
BUMPER GUARD-RENT             ,33150505,CDM,279,RC,,,,,,Inpatient,,,46.2,46.2,HUMANA CHOICE PLUS,MGD,46.2,,,,,,,case rate,46.2,46.2,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
BURKE TRIFLEX BARIATRIC BED RE,33150506,CDM,279,RC,,,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
CAMTEK RECLINING WHEELCHAIR RE,33150507,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,AETNA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,CIGNA,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,WELLMED,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA,MGD,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
CONTOURA 1080- BARIATRIC BED D,33150508,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA CHOICE PLUS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
CONTOURA 980 - BARIATRIC BED D,33150509,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
CPAP UNIT DAILY RENTAL CONT PO,33150511,CDM,279,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,AETNA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,CIGNA,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,WELLMED,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA,MGD,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
CPM KNEE DAILY RENTAL         ,33150512,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA CHOICE PLUS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,AETNA,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,BCBS,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,CIGNA,COM,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,TRICARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,UNITED HEALTHCARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,UNITED HEALTHCARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,VA,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,VA TRICARE,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,WELLMED,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,HUMANA,MGD,55.65,,,,,,,per diem,55.65,55.65,"Per diem rate, code is bundled with other services"
CPM MACHINE DAILY RENTAL      ,33150513,CDM,279,RC,,,,,,Inpatient,,,55.65,55.65,HUMANA CHOICE PLUS,MGD,55.65,,,,,,,case rate,55.65,55.65,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
CRADLE FOOT ND-RENT           ,33150515,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
EQUIP HEAT LAMP               ,33150517,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-EMERSON PUMP    ,33150518,CDM,279,RC,,,,,,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,AETNA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,CIGNA,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,VA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,VA TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,WELLMED,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA,MGD,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
EQUIP PERDIEM-KNEE EXERCISER  ,33150519,CDM,279,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA CHOICE PLUS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,AETNA,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,BCBS,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,CIGNA,COM,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,TRICARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,UNITED HEALTHCARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,UNITED HEALTHCARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,VA,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,VA TRICARE,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,WELLMED,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,HUMANA,MGD,210.53,,,,,,,per diem,210.53,210.53,"Per diem rate, code is bundled with other services"
EQUIP T-WALKER                ,33150520,CDM,279,RC,,,,,,Inpatient,,,210.53,210.53,HUMANA CHOICE PLUS,MGD,210.53,,,,,,,case rate,210.53,210.53,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
EQUIP WALKER                  ,33150521,CDM,279,RC,,,,,,Inpatient,,,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE PADS    ,33150522,CDM,279,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,AETNA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,CIGNA,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,VA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,VA TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,WELLMED,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,HUMANA,MGD,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
EQUIP.HOT/ICE MACHINE-PERDIEM ,33150523,CDM,279,RC,,,,,,Inpatient,,,45.68,45.68,HUMANA CHOICE PLUS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
EQUIP-AQUA K PAD              ,33150524,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,AETNA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,CIGNA,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,WELLMED,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA,MGD,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150525,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA CHOICE PLUS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,AETNA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,BCBS,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,CIGNA,COM,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,UNITED HEALTHCARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,VA TRICARE,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,WELLMED,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA,MGD,128.63,,,,,,,per diem,128.63,128.63,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP PADS  ,33150526,CDM,279,RC,,,,,,Inpatient,,,128.63,128.63,HUMANA CHOICE PLUS,MGD,128.63,,,,,,,case rate,128.63,128.63,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150527,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
EQUIP-FOOT IMPULSE PUMP-DAILY ,33150528,CDM,279,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150529,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
EQUIP-GOMCO                   ,33150530,CDM,279,RC,,,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150531,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
EQUIP-TED COMPRESSION DEVICE  ,33150532,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,AETNA,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,BCBS,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,CIGNA,COM,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,TRICARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,UNITED HEALTHCARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,UNITED HEALTHCARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,VA,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,VA TRICARE,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,WELLMED,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,HUMANA,MGD,523.95,,,,,,,per diem,523.95,523.95,"Per diem rate, code is bundled with other services"
ERGO BARIATRIC ENVIRO WHOLE RO,33150533,CDM,279,RC,,,,,,Inpatient,,,523.95,523.95,HUMANA CHOICE PLUS,MGD,523.95,,,,,,,case rate,523.95,523.95,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,AETNA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,CIGNA,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,VA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,VA TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,WELLMED,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,HUMANA,MGD,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
FREEDOM MEDICAL -CPM K-4 DAILY,33150534,CDM,279,RC,,,,,,Inpatient,,,12.08,12.08,HUMANA CHOICE PLUS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
FULL FRM TRAPEZE ASSEM RENT   ,33150535,CDM,279,RC,,,,,,Inpatient,,,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,AETNA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,CIGNA,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,VA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,VA TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,WELLMED,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA,MGD,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
HEAT MODULE H2O-RENT          ,33150536,CDM,279,RC,,,,,,Inpatient,,,77.7,77.7,HUMANA CHOICE PLUS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
HEMI WHEELCHAIR W/ANTI-TIPPER ,33150537,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
HUNTLEIGH MINUET 2 BED DAILY R,33150538,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,AETNA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,BCBS,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,CIGNA,COM,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,UNITED HEALTHCARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,VA,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,VA TRICARE,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,WELLMED,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA,MGD,168.53,,,,,,,per diem,168.53,168.53,"Per diem rate, code is bundled with other services"
KCI KINAIR MEDSURG PULSE BED D,33150540,CDM,279,RC,,,,,,Inpatient,,,168.53,168.53,HUMANA CHOICE PLUS,MGD,168.53,,,,,,,case rate,168.53,168.53,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
KCI WOUND VAC ATS RENTAL      ,33150541,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,AETNA,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,BCBS,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,CIGNA,COM,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,TRICARE,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,UNITED HEALTHCARE,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,UNITED HEALTHCARE,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,VA,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,VA TRICARE,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,WELLMED,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,HUMANA,MGD,153.83,,,,,,,per diem,153.83,153.83,"Per diem rate, code is bundled with other services"
KCI WOUND VAC DAILY RENTAL    ,33150542,CDM,279,RC,,,,,,Inpatient,,,153.83,153.83,HUMANA CHOICE PLUS,MGD,153.83,,,,,,,case rate,153.83,153.83,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,AETNA,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,BCBS,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,CIGNA,COM,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,TRICARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,UNITED HEALTHCARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,UNITED HEALTHCARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,VA,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,VA TRICARE,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,WELLMED,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,HUMANA,MGD,77.18,,,,,,,per diem,77.18,77.18,"Per diem rate, code is bundled with other services"
KCI WOUND VAC FREEDOM RENTAL  ,33150543,CDM,279,RC,,,,,,Inpatient,,,77.18,77.18,HUMANA CHOICE PLUS,MGD,77.18,,,,,,,case rate,77.18,77.18,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
LOW BOY BED DAILY RENTAL      ,33150544,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
MIGHTY AIR MATTRESS - LOW AIRL,33150545,CDM,279,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
PORTA WARM MATTRESS           ,33150549,CDM,279,RC,,,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
PUFF PAKS WHEELCHAIR          ,33150550,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
RC HI/LOW BED W/TRAPEXE       ,33150551,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC HI-LO BED DAILY RENTAL     ,33150552,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,AETNA,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,BCBS,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,CIGNA,COM,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,TRICARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,UNITED HEALTHCARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,UNITED HEALTHCARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,VA,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,VA TRICARE,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,WELLMED,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,HUMANA,MGD,152.78,,,,,,,per diem,152.78,152.78,"Per diem rate, code is bundled with other services"
RC TALL BED DAILY RENTAL      ,33150553,CDM,279,RC,,,,,,Inpatient,,,152.78,152.78,HUMANA CHOICE PLUS,MGD,152.78,,,,,,,case rate,152.78,152.78,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,AETNA,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,BCBS,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,CIGNA,COM,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,TRICARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,UNITED HEALTHCARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,UNITED HEALTHCARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,VA,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,VA TRICARE,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,WELLMED,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,HUMANA,MGD,114.45,,,,,,,per diem,114.45,114.45,"Per diem rate, code is bundled with other services"
RC ULTRA HI-LO BED BARIATRIC D,33150554,CDM,279,RC,,,,,,Inpatient,,,114.45,114.45,HUMANA CHOICE PLUS,MGD,114.45,,,,,,,case rate,114.45,114.45,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RC WHEELCHAIR BARIATRIC DAILY ,33150555,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,AETNA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,BCBS,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,CIGNA,COM,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,UNITED HEALTHCARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,VA,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,VA TRICARE,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,WELLMED,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA,MGD,137.55,,,,,,,per diem,137.55,137.55,"Per diem rate, code is bundled with other services"
RC750 W/SCALES & RECOVERAIR 30,33150556,CDM,279,RC,,,,,,Inpatient,,,137.55,137.55,HUMANA CHOICE PLUS,MGD,137.55,,,,,,,case rate,137.55,137.55,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,AETNA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,CIGNA,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,VA TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,WELLMED,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA,MGD,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
RECOVER AIR 100 AIR MATTRESS  ,33150557,CDM,279,RC,,,,,,Inpatient,,,19.43,19.43,HUMANA CHOICE PLUS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,AETNA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,BCBS,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,CIGNA,COM,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,UNITED HEALTHCARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,VA TRICARE,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,WELLMED,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA,MGD,35.18,,,,,,,per diem,35.18,35.18,"Per diem rate, code is bundled with other services"
RECOVER CARE RS LOWAIR MATTRES,33150558,CDM,279,RC,,,,,,Inpatient,,,35.18,35.18,HUMANA CHOICE PLUS,MGD,35.18,,,,,,,case rate,35.18,35.18,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RECOVER CARE STIM JR OVERLAY M,33150559,CDM,279,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,AETNA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,CIGNA,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,VA TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,WELLMED,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA,MGD,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
RECOVER CARE TRU-TURN MATTRESS,33150560,CDM,279,RC,,,,,,Inpatient,,,98.18,98.18,HUMANA CHOICE PLUS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RECOVERAIR 2000 MATTRESS DAILY,33150561,CDM,279,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RECOVERAIR 250 MATTRESS DAILY ,33150562,CDM,279,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,AETNA,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,BCBS,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,CIGNA,COM,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,TRICARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,UNITED HEALTHCARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,UNITED HEALTHCARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,VA,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,VA TRICARE,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,WELLMED,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,HUMANA,MGD,42.53,,,,,,,per diem,42.53,42.53,"Per diem rate, code is bundled with other services"
RECOVERAIR 3000 MATTRESS DAILY,33150563,CDM,279,RC,,,,,,Inpatient,,,42.53,42.53,HUMANA CHOICE PLUS,MGD,42.53,,,,,,,case rate,42.53,42.53,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,AETNA,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,BCBS,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,CIGNA,COM,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,TRICARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,UNITED HEALTHCARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,UNITED HEALTHCARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,VA,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,VA TRICARE,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,WELLMED,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,HUMANA,MGD,134.4,,,,,,,per diem,134.4,134.4,"Per diem rate, code is bundled with other services"
SAFE-T-CARE LTC RENTAL        ,33150565,CDM,279,RC,,,,,,Inpatient,,,134.4,134.4,HUMANA CHOICE PLUS,MGD,134.4,,,,,,,case rate,134.4,134.4,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,AETNA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,CIGNA,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,VA TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,WELLMED,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA,MGD,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
"SAFETY BED, DAILY RENTAL      ",33150566,CDM,279,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA CHOICE PLUS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,AETNA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,BCBS,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,CIGNA,COM,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,UNITED HEALTHCARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,VA TRICARE,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,WELLMED,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA,MGD,261.98,,,,,,,per diem,261.98,261.98,"Per diem rate, code is bundled with other services"
SHUTTLE CHAIR DAILY RENTAL    ,33150567,CDM,279,RC,,,,,,Inpatient,,,261.98,261.98,HUMANA CHOICE PLUS,MGD,261.98,,,,,,,case rate,261.98,261.98,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
SIZE WISE PULSATE AIR MATTRESS,33150568,CDM,279,RC,,,,,,Inpatient,,,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,AETNA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,CIGNA,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,VA TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,WELLMED,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA,MGD,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SPECIALTY MATTRESS            ,33150569,CDM,279,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA CHOICE PLUS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,AETNA,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,BCBS,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,CIGNA,COM,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,TRICARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,UNITED HEALTHCARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,UNITED HEALTHCARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,VA,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,VA TRICARE,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,WELLMED,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,HUMANA,MGD,3.15,,,,,,,per diem,3.15,3.15,"Per diem rate, code is bundled with other services"
T-PUMP DAILY RENTAL           ,33150570,CDM,279,RC,,,,,,Inpatient,,,3.15,3.15,HUMANA CHOICE PLUS,MGD,3.15,,,,,,,case rate,3.15,3.15,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
VERSATILE-1 PUMP DAILY RENTAL ,33150571,CDM,279,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,AETNA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,BCBS,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,CIGNA,COM,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,UNITED HEALTHCARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,VA TRICARE,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,WELLMED,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA,MGD,43.58,,,,,,,per diem,43.58,43.58,"Per diem rate, code is bundled with other services"
WALKER MATRIX CAM-A/S         ,33150572,CDM,279,RC,,,,,,Inpatient,,,43.58,43.58,HUMANA CHOICE PLUS,MGD,43.58,,,,,,,case rate,43.58,43.58,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"WHEELCHAIR, SELF PROPULSION DA",33150573,CDM,279,RC,,,,,,Inpatient,,,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,AETNA,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,BCBS,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,CIGNA,COM,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,TRICARE,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,UNITED HEALTHCARE,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,UNITED HEALTHCARE,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,VA,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,VA TRICARE,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,WELLMED,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,HUMANA,MGD,139.13,,,,,,,per diem,139.13,139.13,"Per diem rate, code is bundled with other services"
MATTRESS DOLPHIN REPL - RENTAL,33150575,CDM,279,RC,,,,,,Inpatient,,,139.13,139.13,HUMANA CHOICE PLUS,MGD,139.13,,,,,,,case rate,139.13,139.13,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
DOLPHIN CHAIR PAD RENTAL      ,33150577,CDM,279,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,AETNA,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,BCBS,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,CIGNA,COM,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,TRICARE,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,UNITED HEALTHCARE,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,UNITED HEALTHCARE,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,VA,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,VA TRICARE,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,WELLMED,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,HUMANA,MGD,121.54,,,,,,,per diem,121.54,121.54,"Per diem rate, code is bundled with other services"
V60 VENTILATOR WITH STAND DAIL,33150578,CDM,279,RC,,,,,,Inpatient,,,121.54,121.54,HUMANA CHOICE PLUS,MGD,121.54,,,,,,,case rate,121.54,121.54,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
REGENCY XL 2000 WHEELCHAIR    ,33150579,CDM,279,RC,,,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LIFE VEST (ZOLL)              ,33150594,CDM,279,RC,,,,,,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,AETNA,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,BCBS,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,CIGNA,COM,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,TRICARE,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,UNITED HEALTHCARE,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,UNITED HEALTHCARE,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,VA,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,VA TRICARE,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,WELLMED,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,HUMANA,MGD,34.91,,,,,,,per diem,34.91,34.91,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 3 IN      ,33150595,CDM,279,RC,,,,,,Inpatient,,,34.91,34.91,HUMANA CHOICE PLUS,MGD,34.91,,,,,,,case rate,34.91,34.91,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,AETNA,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,BCBS,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,CIGNA,COM,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,TRICARE,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,UNITED HEALTHCARE,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,UNITED HEALTHCARE,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,VA,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,VA TRICARE,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,WELLMED,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,HUMANA,MGD,69.56,,,,,,,per diem,69.56,69.56,"Per diem rate, code is bundled with other services"
SKIN GUARD MATTRESS 8 IN      ,33150596,CDM,279,RC,,,,,,Inpatient,,,69.56,69.56,HUMANA CHOICE PLUS,MGD,69.56,,,,,,,case rate,69.56,69.56,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,AETNA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,BCBS,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,CIGNA,COM,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,UNITED HEALTHCARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,VA TRICARE,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,WELLMED,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA,MGD,163.8,,,,,,,per diem,163.8,163.8,"Per diem rate, code is bundled with other services"
SLEEVE ARM EXOSOFT XL TALL    ,33152345,CDM,270,RC,,,,,,Inpatient,,,163.8,163.8,HUMANA CHOICE PLUS,MGD,163.8,,,,,,,case rate,163.8,163.8,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL RT ,33152354,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS RT ,33152355,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MED RT,33152356,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG RT ,33152357,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XS LT ,33152358,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA SM LT ,33152359,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA MD LT ,33152360,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA LG LT ,33152361,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,AETNA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,BCBS,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,CIGNA,COM,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,UNITED HEALTHCARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,VA TRICARE,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,WELLMED,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA,MGD,30.45,,,,,,,per diem,30.45,30.45,"Per diem rate, code is bundled with other services"
BRACE WRIST THUMB SPICA XL LT ,33152362,CDM,270,RC,,,,,,Inpatient,,,30.45,30.45,HUMANA CHOICE PLUS,MGD,30.45,,,,,,,case rate,30.45,30.45,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS SM   ,33152364,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS MED  ,33152365,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,AETNA,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,CIGNA,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,TRICARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,UNITED HEALTHCARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,UNITED HEALTHCARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,VA,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,VA TRICARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,WELLMED,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,HUMANA,MGD,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
SHOE MED-SURG DARCO MENS LG   ,33152366,CDM,270,RC,,,,,,Inpatient,,,27.3,27.3,HUMANA CHOICE PLUS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,AETNA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,CIGNA,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,WELLMED,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA,MGD,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM SM  ,33152375,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA CHOICE PLUS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,AETNA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,CIGNA,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,WELLMED,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA,MGD,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM MED ,33152376,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA CHOICE PLUS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,AETNA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,CIGNA,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,VA TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,WELLMED,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA,MGD,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
IMMOBILIZER KNEE AQUAFORM LG  ,33152377,CDM,270,RC,,,,,,Inpatient,,,159.6,159.6,HUMANA CHOICE PLUS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,AETNA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,CIGNA,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,WELLMED,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA,MGD,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN SM      ,33152378,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA CHOICE PLUS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,AETNA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,CIGNA,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,WELLMED,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA,MGD,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN MED     ,33152379,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA CHOICE PLUS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,AETNA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,CIGNA,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,WELLMED,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA,MGD,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN LG      ,33152380,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA CHOICE PLUS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,AETNA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,BCBS,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,CIGNA,COM,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,UNITED HEALTHCARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,VA TRICARE,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,WELLMED,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA,MGD,499.8,,,,,,,per diem,499.8,499.8,"Per diem rate, code is bundled with other services"
HELMET HARD SHELL TAN X-LG    ,33152381,CDM,270,RC,,,,,,Inpatient,,,499.8,499.8,HUMANA CHOICE PLUS,MGD,499.8,,,,,,,case rate,499.8,499.8,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,AETNA,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,BCBS,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,CIGNA,COM,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,TRICARE,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,UNITED HEALTHCARE,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,UNITED HEALTHCARE,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,VA,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,VA TRICARE,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,WELLMED,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,HUMANA,MGD,195.3,,,,,,,per diem,195.3,195.3,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL MIAMI JR      ,33152382,CDM,270,RC,,,,,,Inpatient,,,195.3,195.3,HUMANA CHOICE PLUS,MGD,195.3,,,,,,,case rate,195.3,195.3,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,AETNA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,CIGNA,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,VA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,VA TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,WELLMED,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,HUMANA,MGD,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
SLING ARM ADULT UNIVERSAL     ,33152383,CDM,270,RC,,,,,,Inpatient,,,16.8,16.8,HUMANA CHOICE PLUS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,AETNA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,CIGNA,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,WELLMED,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA,MGD,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG LT,33152386,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA CHOICE PLUS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,AETNA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,CIGNA,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,WELLMED,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA,MGD,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD LT ,33152387,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA CHOICE PLUS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,AETNA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,CIGNA,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,WELLMED,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA,MGD,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED MED/LG RT,33152388,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA CHOICE PLUS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,AETNA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,BCBS,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,CIGNA,COM,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,UNITED HEALTHCARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,VA TRICARE,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,WELLMED,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA,MGD,358.05,,,,,,,per diem,358.05,358.05,"Per diem rate, code is bundled with other services"
SPLINT FOREARM BASED SM/MD RT ,33152389,CDM,270,RC,,,,,,Inpatient,,,358.05,358.05,HUMANA CHOICE PLUS,MGD,358.05,,,,,,,case rate,358.05,358.05,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,AETNA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,CIGNA,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,VA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,VA TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,WELLMED,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,HUMANA,MGD,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
BRACE KNEE HINGED ADJUSTABLE M,33152390,CDM,270,RC,,,,,,Inpatient,,,105,105,HUMANA CHOICE PLUS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,AETNA,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,BCBS,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,CIGNA,COM,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,TRICARE,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,UNITED HEALTHCARE,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,UNITED HEALTHCARE,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,VA,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,VA TRICARE,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,WELLMED,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,HUMANA,MGD,25.82,,,,,,,per diem,25.82,25.82,"Per diem rate, code is bundled with other services"
PILLOW HEEL PRESUR RELIEF UNIV,33152395,CDM,270,RC,,,,,,Inpatient,,,25.82,25.82,HUMANA CHOICE PLUS,MGD,25.82,,,,,,,case rate,25.82,25.82,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
BOOT DUAL AFO MED             ,33152400,CDM,270,RC,,,,,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,AETNA,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,BCBS,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,CIGNA,COM,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,TRICARE,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,UNITED HEALTHCARE,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,UNITED HEALTHCARE,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,VA,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,VA TRICARE,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,WELLMED,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,HUMANA,MGD,268.8,,,,,,,per diem,268.8,268.8,"Per diem rate, code is bundled with other services"
HARNESS CHEST BUTTERFLY FML LG,33152401,CDM,270,RC,,,,,,Inpatient,,,268.8,268.8,HUMANA CHOICE PLUS,MGD,268.8,,,,,,,case rate,268.8,268.8,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,AETNA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,CIGNA,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,VA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,VA TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,WELLMED,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,HUMANA,MGD,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
SPLINT THUMB BILATERAL        ,33152402,CDM,270,RC,,,,,,Inpatient,,,51.45,51.45,HUMANA CHOICE PLUS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,AETNA,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,CIGNA,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,TRICARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,UNITED HEALTHCARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,UNITED HEALTHCARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,VA,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,VA TRICARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,WELLMED,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,HUMANA,MGD,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
BRACE LUMBAR MUELLER REMOV PAD,33152403,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,HUMANA CHOICE PLUS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,AETNA,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,BCBS,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,CIGNA,COM,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,TRICARE,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,UNITED HEALTHCARE,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,UNITED HEALTHCARE,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,VA,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,VA TRICARE,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,WELLMED,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,HUMANA,MGD,275.1,,,,,,,per diem,275.1,275.1,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL HEADMASTER JUN,33152421,CDM,270,RC,,,,,,Inpatient,,,275.1,275.1,HUMANA CHOICE PLUS,MGD,275.1,,,,,,,case rate,275.1,275.1,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM LT,33152422,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD LT,33152423,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM LG LT,33152424,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM SM RT,33152425,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
BRACE HUMRUS FX AQUAFORM MD RT,33152426,CDM,270,RC,,,,,,Inpatient,,,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,AETNA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,CIGNA,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,VA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,VA TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,WELLMED,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,HUMANA,MGD,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
SET FEEDING ENTERAL PUMP W/   ,33154081,CDM,279,RC,,,,,,Inpatient,,,13.2,13.2,HUMANA CHOICE PLUS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,AETNA,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,BCBS,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,CIGNA,COM,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,TRICARE,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,UNITED HEALTHCARE,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,UNITED HEALTHCARE,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,VA,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,VA TRICARE,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,WELLMED,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,HUMANA,MGD,4.91,,,,,,,per diem,4.91,4.91,"Per diem rate, code is bundled with other services"
SET FEEDING KANGAROO GRAVITY  ,33154082,CDM,279,RC,,,,,,Inpatient,,,4.91,4.91,HUMANA CHOICE PLUS,MGD,4.91,,,,,,,case rate,4.91,4.91,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,AETNA,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,BCBS,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,CIGNA,COM,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,TRICARE,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,UNITED HEALTHCARE,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,UNITED HEALTHCARE,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,VA,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,VA TRICARE,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,WELLMED,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,HUMANA,MGD,3.69,,,,,,,per diem,3.69,3.69,"Per diem rate, code is bundled with other services"
POSITIONER HEAD FOAM SURGICAL ,33154138,CDM,270,RC,,,,,,Inpatient,,,3.69,3.69,HUMANA CHOICE PLUS,MGD,3.69,,,,,,,case rate,3.69,3.69,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,AETNA,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,BCBS,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,CIGNA,COM,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,TRICARE,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,UNITED HEALTHCARE,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,UNITED HEALTHCARE,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,VA,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,VA TRICARE,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,WELLMED,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,HUMANA,MGD,11.87,,,,,,,per diem,11.87,11.87,"Per diem rate, code is bundled with other services"
PROTECTOR HEEL AND ELBOW      ,33154139,CDM,270,RC,,,,,,Inpatient,,,11.87,11.87,HUMANA CHOICE PLUS,MGD,11.87,,,,,,,case rate,11.87,11.87,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,AETNA,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,BCBS,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,CIGNA,COM,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,TRICARE,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,UNITED HEALTHCARE,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,UNITED HEALTHCARE,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,VA,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,VA TRICARE,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,WELLMED,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,HUMANA,MGD,92.9,,,,,,,per diem,92.9,92.9,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33154217,CDM,279,RC,,,,,,Inpatient,,,92.9,92.9,HUMANA CHOICE PLUS,MGD,92.9,,,,,,,case rate,92.9,92.9,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,AETNA,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,BCBS,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,CIGNA,COM,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,TRICARE,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,UNITED HEALTHCARE,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,UNITED HEALTHCARE,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,VA,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,VA TRICARE,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,WELLMED,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,HUMANA,MGD,26.43,,,,,,,per diem,26.43,26.43,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM DARK TONE     ,33154271,CDM,270,RC,,,,,,Inpatient,,,26.43,26.43,HUMANA CHOICE PLUS,MGD,26.43,,,,,,,case rate,26.43,26.43,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,AETNA,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,BCBS,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,CIGNA,COM,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,TRICARE,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,UNITED HEALTHCARE,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,UNITED HEALTHCARE,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,VA,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,VA TRICARE,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,WELLMED,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,HUMANA,MGD,24.32,,,,,,,per diem,24.32,24.32,"Per diem rate, code is bundled with other services"
SLEEVE SKIN ARM MEDIUM LIGHT  ,33154272,CDM,270,RC,,,,,,Inpatient,,,24.32,24.32,HUMANA CHOICE PLUS,MGD,24.32,,,,,,,case rate,24.32,24.32,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,AETNA,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,BCBS,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,CIGNA,COM,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,TRICARE,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,UNITED HEALTHCARE,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,UNITED HEALTHCARE,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,VA,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,VA TRICARE,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,WELLMED,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,HUMANA,MGD,18.66,,,,,,,per diem,18.66,18.66,"Per diem rate, code is bundled with other services"
WEDGE POSITIONING 22X12X9IN   ,33154289,CDM,270,RC,,,,,,Inpatient,,,18.66,18.66,HUMANA CHOICE PLUS,MGD,18.66,,,,,,,case rate,18.66,18.66,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
Lift Belt for Roomer and Singe,33154373,CDM,279,RC,,,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Pediatric  w/R ,33154379,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Reg  w/Replace ,33154380,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Super short  w ,33154381,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar XS  w/Replacem ,33154382,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,AETNA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,CIGNA,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,VA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,VA TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,WELLMED,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,HUMANA,MGD,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
18IN Univ Knee Immobilizer Ext,33154383,CDM,270,RC,,,,,,Inpatient,,,103.95,103.95,HUMANA CHOICE PLUS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,AETNA,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,BCBS,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,CIGNA,COM,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,TRICARE,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,UNITED HEALTHCARE,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,UNITED HEALTHCARE,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,VA,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,VA TRICARE,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,WELLMED,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,HUMANA,MGD,63.57,,,,,,,per diem,63.57,63.57,"Per diem rate, code is bundled with other services"
ABD Binders 2XL               ,33154384,CDM,270,RC,,,,,,Inpatient,,,63.57,63.57,HUMANA CHOICE PLUS,MGD,63.57,,,,,,,case rate,63.57,63.57,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right L,33154385,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right M,33154386,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
Adjuster Lift or Level Right S,33154387,CDM,270,RC,,,,,,Inpatient,,,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,AETNA,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,BCBS,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,CIGNA,COM,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,TRICARE,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,UNITED HEALTHCARE,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,UNITED HEALTHCARE,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,VA,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,VA TRICARE,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,WELLMED,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,HUMANA,MGD,283.34,,,,,,,per diem,283.34,283.34,"Per diem rate, code is bundled with other services"
Aspen QuikDraw Pro White-Med. ,33154389,CDM,270,RC,,,,,,Inpatient,,,283.34,283.34,HUMANA CHOICE PLUS,MGD,283.34,,,,,,,case rate,283.34,283.34,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,AETNA,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,BCBS,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,CIGNA,COM,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,TRICARE,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,UNITED HEALTHCARE,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,UNITED HEALTHCARE,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,VA,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,VA TRICARE,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,WELLMED,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,HUMANA,MGD,67.98,,,,,,,per diem,67.98,67.98,"Per diem rate, code is bundled with other services"
DARCO Off-loading Shoe        ,33154393,CDM,270,RC,,,,,,Inpatient,,,67.98,67.98,HUMANA CHOICE PLUS,MGD,67.98,,,,,,,case rate,67.98,67.98,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,AETNA,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,CIGNA,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,TRICARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,UNITED HEALTHCARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,UNITED HEALTHCARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,VA,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,VA TRICARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,WELLMED,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,HUMANA,MGD,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe L       ,33154394,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,HUMANA CHOICE PLUS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,AETNA,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,BCBS,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,CIGNA,COM,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,TRICARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,UNITED HEALTHCARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,UNITED HEALTHCARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,VA,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,VA TRICARE,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,WELLMED,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,HUMANA,MGD,56.54,,,,,,,per diem,56.54,56.54,"Per diem rate, code is bundled with other services"
Darco Orthowedge Shoe XL      ,33154395,CDM,270,RC,,,,,,Inpatient,,,56.54,56.54,HUMANA CHOICE PLUS,MGD,56.54,,,,,,,case rate,56.54,56.54,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,AETNA,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,BCBS,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,CIGNA,COM,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,TRICARE,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,UNITED HEALTHCARE,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,UNITED HEALTHCARE,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,VA,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,VA TRICARE,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,WELLMED,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,HUMANA,MGD,28.19,,,,,,,per diem,28.19,28.19,"Per diem rate, code is bundled with other services"
Darco Small/Med Rocker Cast Bo,33154396,CDM,270,RC,,,,,,Inpatient,,,28.19,28.19,HUMANA CHOICE PLUS,MGD,28.19,,,,,,,case rate,28.19,28.19,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,AETNA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,CIGNA,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,WELLMED,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA,MGD,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock Large Arm Sling     ,33154399,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA CHOICE PLUS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,AETNA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,CIGNA,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,WELLMED,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA,MGD,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock SMALL Arm Sling     ,33154400,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA CHOICE PLUS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,AETNA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,CIGNA,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,VA TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,WELLMED,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA,MGD,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
For Stock X- Large Arm Sling  ,33154401,CDM,270,RC,,,,,,Inpatient,,,18.74,18.74,HUMANA CHOICE PLUS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,AETNA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,CIGNA,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,WELLMED,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA,MGD,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Large Walker Boot w/Air       ,33154404,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA CHOICE PLUS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,AETNA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,CIGNA,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,WELLMED,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA,MGD,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Medium Walker Boot w/Air      ,33154405,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA CHOICE PLUS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Miami J collar Large  w/Replac,33154406,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,AETNA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,CIGNA,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,VA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,VA TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,WELLMED,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA,MGD,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
Miami LSO Belt                ,33154407,CDM,270,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA CHOICE PLUS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,AETNA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,CIGNA,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,WELLMED,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA,MGD,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154410,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA CHOICE PLUS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,AETNA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,CIGNA,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,WELLMED,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA,MGD,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154411,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA CHOICE PLUS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,AETNA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,BCBS,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,CIGNA,COM,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,UNITED HEALTHCARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,VA TRICARE,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,WELLMED,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA,MGD,81.9,,,,,,,per diem,81.9,81.9,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154412,CDM,270,RC,,,,,,Inpatient,,,81.9,81.9,HUMANA CHOICE PLUS,MGD,81.9,,,,,,,case rate,81.9,81.9,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,AETNA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,CIGNA,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,VA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,VA TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,WELLMED,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,HUMANA,MGD,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
Ossur Neoprene Wrap Hinged Kne,33154413,CDM,270,RC,,,,,,Inpatient,,,85.05,85.05,HUMANA CHOICE PLUS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Large      ,33154415,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Medium     ,33154416,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's Small      ,33154417,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Men's X-Large    ,33154418,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Large    ,33154419,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Post Op Shoe Women's Meduim   ,33154420,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154421,CDM,270,RC,,,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
Replacement Pads for Miami J c,33154422,CDM,270,RC,,,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Left,33154423,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Large Righ,33154424,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Lef,33154425,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Medium Rig,33154426,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Left,33154427,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,AETNA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,BCBS,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,CIGNA,COM,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,UNITED HEALTHCARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,VA TRICARE,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,WELLMED,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA,MGD,188.84,,,,,,,per diem,188.84,188.84,"Per diem rate, code is bundled with other services"
Resting Hand Splint Small Righ,33154428,CDM,270,RC,,,,,,Inpatient,,,188.84,188.84,HUMANA CHOICE PLUS,MGD,188.84,,,,,,,case rate,188.84,188.84,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,AETNA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,BCBS,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,CIGNA,COM,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,UNITED HEALTHCARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,VA TRICARE,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,WELLMED,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA,MGD,157.34,,,,,,,per diem,157.34,157.34,"Per diem rate, code is bundled with other services"
Small Walker Boot w/Air       ,33154429,CDM,270,RC,,,,,,Inpatient,,,157.34,157.34,HUMANA CHOICE PLUS,MGD,157.34,,,,,,,case rate,157.34,157.34,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,AETNA,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,BCBS,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,CIGNA,COM,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,TRICARE,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,UNITED HEALTHCARE,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,UNITED HEALTHCARE,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,VA,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,VA TRICARE,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,WELLMED,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,HUMANA,MGD,21.89,,,,,,,per diem,21.89,21.89,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2IN      ,33154430,CDM,270,RC,,,,,,Inpatient,,,21.89,21.89,HUMANA CHOICE PLUS,MGD,21.89,,,,,,,case rate,21.89,21.89,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,AETNA,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,BCBS,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,CIGNA,COM,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,TRICARE,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,UNITED HEALTHCARE,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,UNITED HEALTHCARE,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,VA,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,VA TRICARE,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,WELLMED,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,HUMANA,MGD,21.58,,,,,,,per diem,21.58,21.58,"Per diem rate, code is bundled with other services"
Soft Cervical Collar 2.5IN    ,33154432,CDM,270,RC,,,,,,Inpatient,,,21.58,21.58,HUMANA CHOICE PLUS,MGD,21.58,,,,,,,case rate,21.58,21.58,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,AETNA,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,BCBS,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,CIGNA,COM,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,TRICARE,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,UNITED HEALTHCARE,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,UNITED HEALTHCARE,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,VA,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,VA TRICARE,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,WELLMED,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,HUMANA,MGD,59.54,,,,,,,per diem,59.54,59.54,"Per diem rate, code is bundled with other services"
Titan 10.5 Universal Wrist & F,33154435,CDM,270,RC,,,,,,Inpatient,,,59.54,59.54,HUMANA CHOICE PLUS,MGD,59.54,,,,,,,case rate,59.54,59.54,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,AETNA,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,BCBS,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,CIGNA,COM,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,TRICARE,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,UNITED HEALTHCARE,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,UNITED HEALTHCARE,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,VA,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,VA TRICARE,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,WELLMED,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,HUMANA,MGD,43.94,,,,,,,per diem,43.94,43.94,"Per diem rate, code is bundled with other services"
Titan 8IN Universal Wrist Supp,33154436,CDM,270,RC,,,,,,Inpatient,,,43.94,43.94,HUMANA CHOICE PLUS,MGD,43.94,,,,,,,case rate,43.94,43.94,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154437,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154438,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154439,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,AETNA,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,BCBS,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,CIGNA,COM,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,TRICARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,UNITED HEALTHCARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,UNITED HEALTHCARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,VA,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,VA TRICARE,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,WELLMED,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,HUMANA,MGD,41.04,,,,,,,per diem,41.04,41.04,"Per diem rate, code is bundled with other services"
ABD Binders Large             ,33154440,CDM,270,RC,,,,,,Inpatient,,,41.04,41.04,HUMANA CHOICE PLUS,MGD,41.04,,,,,,,case rate,41.04,41.04,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,AETNA,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,CIGNA,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,TRICARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,UNITED HEALTHCARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,UNITED HEALTHCARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,VA,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,VA TRICARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,WELLMED,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,HUMANA,MGD,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
ABD Binders Small             ,33154441,CDM,270,RC,,,,,,Inpatient,,,21.99,21.99,HUMANA CHOICE PLUS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154442,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,AETNA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,BCBS,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,CIGNA,COM,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,UNITED HEALTHCARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,VA TRICARE,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,WELLMED,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA,MGD,25.04,,,,,,,per diem,25.04,25.04,"Per diem rate, code is bundled with other services"
Velpeau Shoulder Immobilizer S,33154443,CDM,270,RC,,,,,,Inpatient,,,25.04,25.04,HUMANA CHOICE PLUS,MGD,25.04,,,,,,,case rate,25.04,25.04,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,AETNA,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,BCBS,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,CIGNA,COM,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,TRICARE,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,UNITED HEALTHCARE,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,UNITED HEALTHCARE,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,VA,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,VA TRICARE,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,WELLMED,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,HUMANA,MGD,50.81,,,,,,,per diem,50.81,50.81,"Per diem rate, code is bundled with other services"
ABD Binders Extra Large       ,33154444,CDM,270,RC,,,,,,Inpatient,,,50.81,50.81,HUMANA CHOICE PLUS,MGD,50.81,,,,,,,case rate,50.81,50.81,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,AETNA,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,BCBS,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,CIGNA,COM,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,TRICARE,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,UNITED HEALTHCARE,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,UNITED HEALTHCARE,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,VA,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,VA TRICARE,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,WELLMED,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,HUMANA,MGD,147.26,,,,,,,per diem,147.26,147.26,"Per diem rate, code is bundled with other services"
Waffle Boot                   ,33154445,CDM,270,RC,,,,,,Inpatient,,,147.26,147.26,HUMANA CHOICE PLUS,MGD,147.26,,,,,,,case rate,147.26,147.26,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,AETNA,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,CIGNA,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,TRICARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,UNITED HEALTHCARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,UNITED HEALTHCARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,VA,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,VA TRICARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,WELLMED,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,HUMANA,MGD,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Regular,33154451,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,HUMANA CHOICE PLUS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,AETNA,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,BCBS,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,CIGNA,COM,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,TRICARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,UNITED HEALTHCARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,UNITED HEALTHCARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,VA,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,VA TRICARE,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,WELLMED,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,HUMANA,MGD,220.34,,,,,,,per diem,220.34,220.34,"Per diem rate, code is bundled with other services"
LEEDER BOOT Ambulatory Large  ,33154452,CDM,270,RC,,,,,,Inpatient,,,220.34,220.34,HUMANA CHOICE PLUS,MGD,220.34,,,,,,,case rate,220.34,220.34,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,AETNA,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,BCBS,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,CIGNA,COM,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,TRICARE,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,UNITED HEALTHCARE,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,UNITED HEALTHCARE,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,VA,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,VA TRICARE,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,WELLMED,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,HUMANA,MGD,71.47,,,,,,,per diem,71.47,71.47,"Per diem rate, code is bundled with other services"
Knee Immobilizer 16IN         ,33154459,CDM,270,RC,,,,,,Inpatient,,,71.47,71.47,HUMANA CHOICE PLUS,MGD,71.47,,,,,,,case rate,71.47,71.47,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,AETNA,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,BCBS,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,CIGNA,COM,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,TRICARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,UNITED HEALTHCARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,UNITED HEALTHCARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,VA,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,VA TRICARE,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,WELLMED,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,HUMANA,MGD,116.55,,,,,,,per diem,116.55,116.55,"Per diem rate, code is bundled with other services"
20IN Univ Knee Immobilizer Ext,33154460,CDM,270,RC,,,,,,Inpatient,,,116.55,116.55,HUMANA CHOICE PLUS,MGD,116.55,,,,,,,case rate,116.55,116.55,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,AETNA,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,CIGNA,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,TRICARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,UNITED HEALTHCARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,UNITED HEALTHCARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,VA,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,VA TRICARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,WELLMED,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,HUMANA,MGD,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
Philadelphia Collar           ,33154462,CDM,270,RC,,,,,,Inpatient,,,47.09,47.09,HUMANA CHOICE PLUS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,AETNA,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,BCBS,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,CIGNA,COM,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,TRICARE,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,UNITED HEALTHCARE,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,UNITED HEALTHCARE,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,VA,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,VA TRICARE,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,WELLMED,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,HUMANA,MGD,343.35,,,,,,,per diem,343.35,343.35,"Per diem rate, code is bundled with other services"
Aspen Quick Draw Lumbar Brace ,33154463,CDM,270,RC,,,,,,Inpatient,,,343.35,343.35,HUMANA CHOICE PLUS,MGD,343.35,,,,,,,case rate,343.35,343.35,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,AETNA,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,BCBS,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,CIGNA,COM,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,TRICARE,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,UNITED HEALTHCARE,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,UNITED HEALTHCARE,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,VA,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,VA TRICARE,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,WELLMED,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,HUMANA,MGD,48.3,,,,,,,per diem,48.3,48.3,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 36   ,33155001,CDM,270,RC,,,,,,Inpatient,,,48.3,48.3,HUMANA CHOICE PLUS,MGD,48.3,,,,,,,case rate,48.3,48.3,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K3 42   ,33155002,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATT K3 OVLY 36  ,33155003,CDM,270,RC,,,,,,Inpatient,,,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 36   ,33155004,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,AETNA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,BCBS,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,CIGNA,COM,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,UNITED HEALTHCARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,VA,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,VA TRICARE,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,WELLMED,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA,MGD,87.15,,,,,,,per diem,87.15,87.15,"Per diem rate, code is bundled with other services"
RENTAL - AIR MATTRESS K4 42   ,33155005,CDM,270,RC,,,,,,Inpatient,,,87.15,87.15,HUMANA CHOICE PLUS,MGD,87.15,,,,,,,case rate,87.15,87.15,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,AETNA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,CIGNA,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,VA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,VA TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,WELLMED,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA,MGD,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/ SCALE    ,33155006,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA CHOICE PLUS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,AETNA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,CIGNA,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,WELLMED,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA,MGD,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARI BED W/O SCALE   ,33155007,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA CHOICE PLUS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,AETNA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,CIGNA,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,VA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,VA TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,WELLMED,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,HUMANA,MGD,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI COMMODE 1000LBS ,33155008,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,HUMANA CHOICE PLUS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,AETNA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,CIGNA,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,VA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,VA TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,WELLMED,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,HUMANA,MGD,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
RENTAL - BARI WALKER 1000LBS  ,33155009,CDM,270,RC,,,,,,Inpatient,,,38.85,38.85,HUMANA CHOICE PLUS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
RENTAL - BARI WHEELCHAIR      ,33155010,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,AETNA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,CIGNA,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,WELLMED,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA,MGD,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - BARIATRIC RECLINER   ,33155011,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA CHOICE PLUS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,AETNA,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,BCBS,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,CIGNA,COM,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,TRICARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,UNITED HEALTHCARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,UNITED HEALTHCARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,VA,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,VA TRICARE,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,WELLMED,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,HUMANA,MGD,67.2,,,,,,,per diem,67.2,67.2,"Per diem rate, code is bundled with other services"
RENTAL - CPAP                 ,33155012,CDM,270,RC,,,,,,Inpatient,,,67.2,67.2,HUMANA CHOICE PLUS,MGD,67.2,,,,,,,case rate,67.2,67.2,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - BRODA CHAIR          ,33155013,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,AETNA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,CIGNA,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,VA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,VA TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,WELLMED,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA,MGD,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
RENTAL - HAND CPM             ,33155014,CDM,270,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA CHOICE PLUS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,AETNA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,CIGNA,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,WELLMED,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA,MGD,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - HOYER 600LBS         ,33155015,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA CHOICE PLUS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
RENTAL - IV PUMP BAXTER 6201  ,33155016,CDM,270,RC,,,,,,Inpatient,,,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
RENTAL - LOW BED              ,33155017,CDM,270,RC,,,,,,Inpatient,,,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
RENTAL - ROHO CUSHION         ,33155018,CDM,270,RC,,,,,,Inpatient,,,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,AETNA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,BCBS,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,CIGNA,COM,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,UNITED HEALTHCARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,VA,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,VA TRICARE,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,WELLMED,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA,MGD,32.55,,,,,,,per diem,32.55,32.55,"Per diem rate, code is bundled with other services"
RENTAL - SCD PUMP 700 SERIES  ,33155019,CDM,270,RC,,,,,,Inpatient,,,32.55,32.55,HUMANA CHOICE PLUS,MGD,32.55,,,,,,,case rate,32.55,32.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
RENTAL - SHOWER CHAIR 750LBS  ,33155020,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,AETNA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,BCBS,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,CIGNA,COM,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,UNITED HEALTHCARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,VA TRICARE,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,WELLMED,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA,MGD,44.1,,,,,,,per diem,44.1,44.1,"Per diem rate, code is bundled with other services"
RENTAL - SIT TO STAND         ,33155021,CDM,270,RC,,,,,,Inpatient,,,44.1,44.1,HUMANA CHOICE PLUS,MGD,44.1,,,,,,,case rate,44.1,44.1,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
RENTAL - SPO2 NELLCOR N-600   ,33155022,CDM,270,RC,,,,,,Inpatient,,,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,AETNA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,BCBS,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,CIGNA,COM,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,UNITED HEALTHCARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,VA TRICARE,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,WELLMED,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA,MGD,121.8,,,,,,,per diem,121.8,121.8,"Per diem rate, code is bundled with other services"
RENTAL - TILT TABLE           ,33155023,CDM,270,RC,,,,,,Inpatient,,,121.8,121.8,HUMANA CHOICE PLUS,MGD,121.8,,,,,,,case rate,121.8,121.8,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,AETNA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,CIGNA,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,VA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,VA TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,WELLMED,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,HUMANA,MGD,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
RENTAL - TRAPEZE FREE STANDING,33155024,CDM,270,RC,,,,,,Inpatient,,,24.15,24.15,HUMANA CHOICE PLUS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,AETNA,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,BCBS,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,CIGNA,COM,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,TRICARE,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,UNITED HEALTHCARE,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,UNITED HEALTHCARE,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,VA,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,VA TRICARE,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,WELLMED,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,HUMANA,MGD,276.15,,,,,,,per diem,276.15,276.15,"Per diem rate, code is bundled with other services"
RENTAL - WOULD VAC FREEDOM    ,33155025,CDM,270,RC,,,,,,Inpatient,,,276.15,276.15,HUMANA CHOICE PLUS,MGD,276.15,,,,,,,case rate,276.15,276.15,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,AETNA,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,BCBS,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,CIGNA,COM,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,TRICARE,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,UNITED HEALTHCARE,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,UNITED HEALTHCARE,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,VA,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,VA TRICARE,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,WELLMED,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,HUMANA,MGD,16.81,,,,,,,per diem,16.81,16.81,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,33163207,CDM,279,RC,,,,,,Inpatient,,,16.81,16.81,HUMANA CHOICE PLUS,MGD,16.81,,,,,,,case rate,16.81,16.81,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,AETNA,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,BCBS,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,CIGNA,COM,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,TRICARE,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,UNITED HEALTHCARE,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,UNITED HEALTHCARE,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,VA,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,VA TRICARE,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,WELLMED,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,HUMANA,MGD,170.16,,,,,,,per diem,170.16,170.16,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR STRAP XL    ,33170447,CDM,270,RC,,,,,,Inpatient,,,170.16,170.16,HUMANA CHOICE PLUS,MGD,170.16,,,,,,,case rate,170.16,170.16,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
BOOT PODUS W/TSFR PAD/STRAP XL,33170451,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,AETNA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,CIGNA,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,VA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,VA TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,WELLMED,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,HUMANA,MGD,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
BINDER ABD 9 30-45            ,33175774,CDM,270,RC,,,,,,Inpatient,,,13.1,13.1,HUMANA CHOICE PLUS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,AETNA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,CIGNA,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,VA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,VA TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,WELLMED,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,HUMANA,MGD,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10 UNIVERSAL ,33175776,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,HUMANA CHOICE PLUS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,AETNA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,CIGNA,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,VA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,VA TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,WELLMED,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,HUMANA,MGD,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 12 UNIVERSAL ,33175777,CDM,270,RC,,,,,,Inpatient,,,19.95,19.95,HUMANA CHOICE PLUS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
MULTIBOOT REGULAR             ,33176640,CDM,270,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FDG CNTNR PATROL PUMP EZ  ,33176839,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,AETNA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,BCBS,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,CIGNA,COM,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,UNITED HEALTHCARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,VA TRICARE,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,WELLMED,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA,MGD,18.48,,,,,,,per diem,18.48,18.48,"Per diem rate, code is bundled with other services"
SLING ARM LG                  ,33176911,CDM,270,RC,,,,,,Inpatient,,,18.48,18.48,HUMANA CHOICE PLUS,MGD,18.48,,,,,,,case rate,18.48,18.48,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,AETNA,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,BCBS,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,CIGNA,COM,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,TRICARE,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,UNITED HEALTHCARE,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,UNITED HEALTHCARE,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,VA,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,VA TRICARE,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,WELLMED,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,HUMANA,MGD,121.28,,,,,,,per diem,121.28,121.28,"Per diem rate, code is bundled with other services"
"BOOT, ANKLE CONTRACT          ",33190002,CDM,270,RC,,,,,,Inpatient,,,121.28,121.28,HUMANA CHOICE PLUS,MGD,121.28,,,,,,,case rate,121.28,121.28,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"BRIEF, XXL                    ",33190003,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,AETNA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,CIGNA,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,VA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,VA TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,WELLMED,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,HUMANA,MGD,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"CLEANSER, WOUND               ",33190005,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,HUMANA CHOICE PLUS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,AETNA,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,BCBS,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,CIGNA,COM,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,TRICARE,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,UNITED HEALTHCARE,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,UNITED HEALTHCARE,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,VA,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,VA TRICARE,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,WELLMED,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,HUMANA,MGD,10.3,,,,,,,per diem,10.3,10.3,"Per diem rate, code is bundled with other services"
"DRESSING, BORDER 4X1          ",33190006,CDM,270,RC,,,,,,Inpatient,,,10.3,10.3,HUMANA CHOICE PLUS,MGD,10.3,,,,,,,case rate,10.3,10.3,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,AETNA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,CIGNA,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,VA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,VA TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,WELLMED,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,HUMANA,MGD,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM S          ",33190009,CDM,270,RC,,,,,,Inpatient,,,9.95,9.95,HUMANA CHOICE PLUS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,AETNA,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,BCBS,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,CIGNA,COM,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,TRICARE,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,UNITED HEALTHCARE,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,UNITED HEALTHCARE,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,VA,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,VA TRICARE,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,WELLMED,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,HUMANA,MGD,13.01,,,,,,,per diem,13.01,13.01,"Per diem rate, code is bundled with other services"
"DRESSING, OPTIFOAM T          ",33190010,CDM,270,RC,,,,,,Inpatient,,,13.01,13.01,HUMANA CHOICE PLUS,MGD,13.01,,,,,,,case rate,13.01,13.01,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"GOWN, ISOLATION YELL          ",33190011,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,AETNA,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,CIGNA,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,TRICARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,UNITED HEALTHCARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,UNITED HEALTHCARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,VA,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,VA TRICARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,WELLMED,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,HUMANA,MGD,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
"KIT, SELF CATH 14FR           ",33190012,CDM,270,RC,,,,,,Inpatient,,,25.99,25.99,HUMANA CHOICE PLUS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"LOTION, PHYTOPLEX HY          ",33190019,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190022,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190023,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
"NUTR, ENSURE ENLIVE           ",33190024,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,AETNA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,BCBS,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,CIGNA,COM,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,UNITED HEALTHCARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,VA,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,VA TRICARE,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,WELLMED,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA,MGD,194.25,,,,,,,per diem,194.25,194.25,"Per diem rate, code is bundled with other services"
"RENTAL, BARI BED W/           ",33190027,CDM,279,RC,,,,,,Inpatient,,,194.25,194.25,HUMANA CHOICE PLUS,MGD,194.25,,,,,,,case rate,194.25,194.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
"RENTAL, BIPAP VISION          ",33190028,CDM,279,RC,,,,,,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,AETNA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,CIGNA,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,VA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,VA TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,WELLMED,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,HUMANA,MGD,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
"SET, C-FLO DUOVENT            ",33190029,CDM,270,RC,,,,,,Inpatient,,,35.31,35.31,HUMANA CHOICE PLUS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 4X4          ,33190037,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DRSNG STRATASORB 6X6          ,33190038,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
ALARM NURSE CALL              ,33190040,CDM,270,RC,,,,,,Inpatient,,,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP M 28-40               ,33190043,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP L 40-56               ,33190044,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PULL UP XL 56-68              ,33190045,CDM,270,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,AETNA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,CIGNA,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,VA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,VA TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,WELLMED,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,HUMANA,MGD,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
WIPE ALOE TOUCH               ,33190046,CDM,270,RC,,,,,,Inpatient,,,18.52,18.52,HUMANA CHOICE PLUS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,AETNA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,CIGNA,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,VA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,VA TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,WELLMED,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,HUMANA,MGD,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
"PAD, MAXI PACK                ",33190047,CDM,270,RC,,,,,,Inpatient,,,22.71,22.71,HUMANA CHOICE PLUS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,AETNA,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,BCBS,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,CIGNA,COM,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,TRICARE,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,UNITED HEALTHCARE,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,UNITED HEALTHCARE,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,VA,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,VA TRICARE,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,WELLMED,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,HUMANA,MGD,13.17,,,,,,,per diem,13.17,13.17,"Per diem rate, code is bundled with other services"
DRESSING ALLEVYN 4X4          ,33190048,CDM,270,RC,,,,,,Inpatient,,,13.17,13.17,HUMANA CHOICE PLUS,MGD,13.17,,,,,,,case rate,13.17,13.17,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
"SYSTEM, CLEARLINK             ",33190049,CDM,270,RC,,,,,,Inpatient,,,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,AETNA,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,BCBS,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,CIGNA,COM,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,TRICARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,UNITED HEALTHCARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,UNITED HEALTHCARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,VA,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,VA TRICARE,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,WELLMED,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,HUMANA,MGD,10.43,,,,,,,per diem,10.43,10.43,"Per diem rate, code is bundled with other services"
DRESSING OPTIFOM ADH          ,33190052,CDM,270,RC,,,,,,Inpatient,,,10.43,10.43,HUMANA CHOICE PLUS,MGD,10.43,,,,,,,case rate,10.43,10.43,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,AETNA,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,CIGNA,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,TRICARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,UNITED HEALTHCARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,UNITED HEALTHCARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,VA,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,VA TRICARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,WELLMED,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,HUMANA,MGD,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP L                   ,33190053,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,HUMANA CHOICE PLUS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,AETNA,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,BCBS,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,CIGNA,COM,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,TRICARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,UNITED HEALTHCARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,UNITED HEALTHCARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,VA,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,VA TRICARE,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,WELLMED,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,HUMANA,MGD,566.91,,,,,,,per diem,566.91,566.91,"Per diem rate, code is bundled with other services"
SLING DSP MED                 ,33190054,CDM,270,RC,,,,,,Inpatient,,,566.91,566.91,HUMANA CHOICE PLUS,MGD,566.91,,,,,,,case rate,566.91,566.91,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,AETNA,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,BCBS,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,CIGNA,COM,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,TRICARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,UNITED HEALTHCARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,UNITED HEALTHCARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,VA,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,VA TRICARE,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,WELLMED,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,HUMANA,MGD,203.7,,,,,,,per diem,203.7,203.7,"Per diem rate, code is bundled with other services"
BOOT SOFPRO AMB AFO FLC LG    ,33194422,CDM,270,RC,,,,,,Inpatient,,,203.7,203.7,HUMANA CHOICE PLUS,MGD,203.7,,,,,,,case rate,203.7,203.7,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,AETNA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,BCBS,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,CIGNA,COM,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,UNITED HEALTHCARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,VA,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,VA TRICARE,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,WELLMED,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,HUMANA,MGD,357.21,,,,,,,per diem,357.21,357.21,"Per diem rate, code is bundled with other services"
ELBOW WRIST HAND ORTHO STATIC ,33195576,CDM,274,RC,L3763,CPT,,,,Inpatient,,,357.21,357.21,HUMANA CHOICE PLUS,MGD,357.21,,,,,,,case rate,357.21,357.21,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,AETNA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,CIGNA,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,VA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,VA TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,WELLMED,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,HUMANA,MGD,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
ELBOW ORTHO (EO) STAT CUST FAB,33195578,CDM,274,RC,L3702,CPT,,,,Inpatient,,,220.5,220.5,HUMANA CHOICE PLUS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FINGER ORTHO PIP DIP JOINT    ,33195586,CDM,274,RC,L3925,CPT,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,AETNA,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,CIGNA,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,TRICARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,UNITED HEALTHCARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,UNITED HEALTHCARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,VA,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,VA TRICARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,WELLMED,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,HUMANA,MGD,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) DYNAMIC ,33195600,CDM,274,RC,L3921,CPT,,,,Inpatient,,,255.78,255.78,HUMANA CHOICE PLUS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,AETNA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,CIGNA,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,VA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,VA TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,WELLMED,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,HUMANA,MGD,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HFO) STATIC  ,33195601,CDM,274,RC,L3913,CPT,,,,Inpatient,,,220.5,220.5,HUMANA CHOICE PLUS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,AETNA,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,BCBS,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,CIGNA,COM,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,TRICARE,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,UNITED HEALTHCARE,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,UNITED HEALTHCARE,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,VA,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,VA TRICARE,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,WELLMED,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,HUMANA,MGD,118.65,,,,,,,per diem,118.65,118.65,"Per diem rate, code is bundled with other services"
HAND FING ORTHO (HVO) FLX GLV ,33195602,CDM,274,RC,L3912,CPT,,,,Inpatient,,,118.65,118.65,HUMANA CHOICE PLUS,MGD,118.65,,,,,,,case rate,118.65,118.65,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,AETNA,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,BCBS,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,CIGNA,COM,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,TRICARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,UNITED HEALTHCARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,UNITED HEALTHCARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,VA,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,VA TRICARE,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,WELLMED,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,HUMANA,MGD,255.78,,,,,,,per diem,255.78,255.78,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO (WHO) STATIC ,33195642,CDM,274,RC,L3906,CPT,,,,Inpatient,,,255.78,255.78,HUMANA CHOICE PLUS,MGD,255.78,,,,,,,case rate,255.78,255.78,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,AETNA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,BCBS,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,CIGNA,COM,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,UNITED HEALTHCARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,VA,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,VA TRICARE,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,WELLMED,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,HUMANA,MGD,136.71,,,,,,,per diem,136.71,136.71,"Per diem rate, code is bundled with other services"
WRIST HAND ORTHO W EXT COCKUP ,33195643,CDM,274,RC,L3908,CPT,,,,Inpatient,,,136.71,136.71,HUMANA CHOICE PLUS,MGD,136.71,,,,,,,case rate,136.71,136.71,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,AETNA,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,BCBS,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,CIGNA,COM,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,TRICARE,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,UNITED HEALTHCARE,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,UNITED HEALTHCARE,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,VA,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,VA TRICARE,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,WELLMED,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,HUMANA,MGD,347.55,,,,,,,per diem,347.55,347.55,"Per diem rate, code is bundled with other services"
W/H/F ORTHO (WHFO) STATIC     ,33195661,CDM,274,RC,L3808,CPT,,,,Inpatient,,,347.55,347.55,HUMANA CHOICE PLUS,MGD,347.55,,,,,,,case rate,347.55,347.55,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,AETNA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,BCBS,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,CIGNA,COM,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,UNITED HEALTHCARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,VA,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,VA TRICARE,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,WELLMED,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,HUMANA,MGD,119.07,,,,,,,per diem,119.07,119.07,"Per diem rate, code is bundled with other services"
FO W/O JOINTS CUSTOM          ,33195665,CDM,274,RC,L3933,HCPCS,,,,Inpatient,,,119.07,119.07,HUMANA CHOICE PLUS,MGD,119.07,,,,,,,case rate,119.07,119.07,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
SET FEED SPIKE PROXIMAL E-PUMP,33198631,CDM,279,RC,,,,,,Inpatient,,,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,AETNA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,CIGNA,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,WELLMED,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA,MGD,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33198789,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA CHOICE PLUS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
COLLAR CERV FIRM MED 3X17IN   ,33199603,CDM,270,RC,,,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,AETNA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,CIGNA,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,VA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,VA TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,WELLMED,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,HUMANA,MGD,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
COLLAR CERV SOFT SML 2.75X15IN,33199604,CDM,270,RC,,,,,,Inpatient,,,14.7,14.7,HUMANA CHOICE PLUS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,AETNA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,CIGNA,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,VA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,VA TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,WELLMED,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,HUMANA,MGD,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
BINDER ABDOMINAL 10  UNIVERSAL,33200046,CDM,270,RC,,,,,,Inpatient,,,14.96,14.96,HUMANA CHOICE PLUS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,AETNA,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,BCBS,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,CIGNA,COM,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,TRICARE,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,UNITED HEALTHCARE,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,UNITED HEALTHCARE,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,VA,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,VA TRICARE,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,WELLMED,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,HUMANA,MGD,437.98,,,,,,,per diem,437.98,437.98,"Per diem rate, code is bundled with other services"
BOOT PRAFO AFO KODEL ADULT    ,33200048,CDM,270,RC,,,,,,Inpatient,,,437.98,437.98,HUMANA CHOICE PLUS,MGD,437.98,,,,,,,case rate,437.98,437.98,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,AETNA,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,BCBS,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,CIGNA,COM,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,TRICARE,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,UNITED HEALTHCARE,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,UNITED HEALTHCARE,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,VA,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,VA TRICARE,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,WELLMED,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,HUMANA,MGD,30.93,,,,,,,per diem,30.93,30.93,"Per diem rate, code is bundled with other services"
CATHETER IV 22GA 1IN 1 PORT CL,33200074,CDM,270,RC,,,,,,Inpatient,,,30.93,30.93,HUMANA CHOICE PLUS,MGD,30.93,,,,,,,case rate,30.93,30.93,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,AETNA,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,BCBS,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,CIGNA,COM,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,TRICARE,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,UNITED HEALTHCARE,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,UNITED HEALTHCARE,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,VA,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,VA TRICARE,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,WELLMED,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,HUMANA,MGD,168.3,,,,,,,per diem,168.3,168.3,"Per diem rate, code is bundled with other services"
PROTECTOR BOOT HEEL PRESSURE R,33200225,CDM,270,RC,,,,,,Inpatient,,,168.3,168.3,HUMANA CHOICE PLUS,MGD,168.3,,,,,,,case rate,168.3,168.3,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
SET EPUMP 1000ML PUMP         ,33200239,CDM,279,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,AETNA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,CIGNA,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,WELLMED,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA,MGD,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML   ,33200240,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA CHOICE PLUS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,AETNA,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,BCBS,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,CIGNA,COM,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,TRICARE,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,UNITED HEALTHCARE,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,UNITED HEALTHCARE,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,VA,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,VA TRICARE,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,WELLMED,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,HUMANA,MGD,39,,,,,,,per diem,39,39,"Per diem rate, code is bundled with other services"
BINDER  ABDOMINAL 3 PANEL 9IN ,33200417,CDM,270,RC,,,,,,Inpatient,,,39,39,HUMANA CHOICE PLUS,MGD,39,,,,,,,case rate,39,39,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,AETNA,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,CIGNA,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,TRICARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,UNITED HEALTHCARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,UNITED HEALTHCARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,VA,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,VA TRICARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,WELLMED,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,HUMANA,MGD,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
BINDER 3 PANEL 45-62          ,33200418,CDM,270,RC,,,,,,Inpatient,,,15.21,15.21,HUMANA CHOICE PLUS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,AETNA,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,CIGNA,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,TRICARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,UNITED HEALTHCARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,UNITED HEALTHCARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,VA,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,VA TRICARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,WELLMED,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,HUMANA,MGD,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
BINDER 3PANEL 9IN XXL 62-84IN ,33200419,CDM,270,RC,,,,,,Inpatient,,,22.81,22.81,HUMANA CHOICE PLUS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,AETNA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,CIGNA,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,VA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,VA TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,WELLMED,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,HUMANA,MGD,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
CAST PURPLE 4YDX2IN DELTA-CAST,33200448,CDM,270,RC,,,,,,Inpatient,,,9.71,9.71,HUMANA CHOICE PLUS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,AETNA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,CIGNA,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,WELLMED,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA,MGD,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV MED CNTOR 20INX4IN,33200483,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA CHOICE PLUS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,AETNA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,CIGNA,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,WELLMED,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA,MGD,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERV SM 18.5INX3IN FRM ,33200484,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA CHOICE PLUS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,AETNA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,CIGNA,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,VA TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,WELLMED,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA,MGD,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
COLLAR CERVICAL SMALL LONG 22I,33200485,CDM,270,RC,,,,,,Inpatient,,,8.44,8.44,HUMANA CHOICE PLUS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,AETNA,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,BCBS,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,CIGNA,COM,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,TRICARE,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,UNITED HEALTHCARE,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,UNITED HEALTHCARE,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,VA,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,VA TRICARE,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,WELLMED,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,HUMANA,MGD,159.3,,,,,,,per diem,159.3,159.3,"Per diem rate, code is bundled with other services"
COLLAR VISTA                  ,33200486,CDM,270,RC,,,,,,Inpatient,,,159.3,159.3,HUMANA CHOICE PLUS,MGD,159.3,,,,,,,case rate,159.3,159.3,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,AETNA,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,CIGNA,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,TRICARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,UNITED HEALTHCARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,UNITED HEALTHCARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,VA,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,VA TRICARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,WELLMED,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,HUMANA,MGD,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
IMMOBILIZER ORTHOPEDIC UNIVERS,33200591,CDM,270,RC,,,,,,Inpatient,,,35.44,35.44,HUMANA CHOICE PLUS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,AETNA,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,BCBS,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,CIGNA,COM,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,TRICARE,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,UNITED HEALTHCARE,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,UNITED HEALTHCARE,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,VA,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,VA TRICARE,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,WELLMED,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,HUMANA,MGD,55.73,,,,,,,per diem,55.73,55.73,"Per diem rate, code is bundled with other services"
PAD CONVOLUTED BED OVERLAY    ,33200664,CDM,279,RC,,,,,,Inpatient,,,55.73,55.73,HUMANA CHOICE PLUS,MGD,55.73,,,,,,,case rate,55.73,55.73,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,AETNA,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,BCBS,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,CIGNA,COM,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,TRICARE,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,UNITED HEALTHCARE,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,UNITED HEALTHCARE,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,VA,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,VA TRICARE,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,WELLMED,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,HUMANA,MGD,12,,,,,,,per diem,12,12,"Per diem rate, code is bundled with other services"
PILLOW PT WHT 26X20IN MEDSOFT ,33200683,CDM,270,RC,,,,,,Inpatient,,,12,12,HUMANA CHOICE PLUS,MGD,12,,,,,,,case rate,12,12,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200703,CDM,270,RC,,,,,,Inpatient,,,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,AETNA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,BCBS,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,CIGNA,COM,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,UNITED HEALTHCARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,VA,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,VA TRICARE,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,WELLMED,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA,MGD,31.88,,,,,,,per diem,31.88,31.88,"Per diem rate, code is bundled with other services"
PROTECTOR MED 16.5IN 11IN SPND,33200704,CDM,270,RC,,,,,,Inpatient,,,31.88,31.88,HUMANA CHOICE PLUS,MGD,31.88,,,,,,,case rate,31.88,31.88,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,AETNA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,BCBS,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,CIGNA,COM,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,UNITED HEALTHCARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,VA TRICARE,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,WELLMED,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA,MGD,11.83,,,,,,,per diem,11.83,11.83,"Per diem rate, code is bundled with other services"
SET EPUMP FEED FLUSH 1000ML *S,33200744,CDM,279,RC,,,,,,Inpatient,,,11.83,11.83,HUMANA CHOICE PLUS,MGD,11.83,,,,,,,case rate,11.83,11.83,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SPLINT ORTHOPEDIC LARGE 22IN 1,33200783,CDM,270,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,AETNA,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,BCBS,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,CIGNA,COM,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,TRICARE,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,UNITED HEALTHCARE,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,UNITED HEALTHCARE,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,VA,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,VA TRICARE,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,WELLMED,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,HUMANA,MGD,103.57,,,,,,,per diem,103.57,103.57,"Per diem rate, code is bundled with other services"
WEDGE HEEL PROTECTOR TRUVUE LI,33200886,CDM,270,RC,,,,,,Inpatient,,,103.57,103.57,HUMANA CHOICE PLUS,MGD,103.57,,,,,,,case rate,103.57,103.57,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,AETNA,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,BCBS,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,CIGNA,COM,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,TRICARE,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,UNITED HEALTHCARE,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,UNITED HEALTHCARE,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,VA,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,VA TRICARE,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,WELLMED,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,HUMANA,MGD,354.18,,,,,,,per diem,354.18,354.18,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,33516002,CDM,510,RC,97607,CPT,,,,Inpatient,,,354.18,354.18,HUMANA CHOICE PLUS,MGD,354.18,,,,,,,case rate,354.18,354.18,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,AETNA,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,BCBS,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,CIGNA,COM,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,TRICARE,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,UNITED HEALTHCARE,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,UNITED HEALTHCARE,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,VA,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,VA TRICARE,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,WELLMED,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,HUMANA,MGD,258.08,,,,,,,per diem,258.08,258.08,"Per diem rate, code is bundled with other services"
Dplx Scan Veins Extrem        ,33516003,CDM,510,RC,,,,,,Inpatient,,,258.08,258.08,HUMANA CHOICE PLUS,MGD,258.08,,,,,,,case rate,258.08,258.08,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,AETNA,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,BCBS,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,CIGNA,COM,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,TRICARE,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,UNITED HEALTHCARE,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,UNITED HEALTHCARE,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,VA,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,VA TRICARE,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,WELLMED,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,HUMANA,MGD,965.58,,,,,,,per diem,965.58,965.58,"Per diem rate, code is bundled with other services"
DEBRIDE SUBQ TIS FIRST 20CM   ,33516021,CDM,761,RC,11042,CPT,,,,Inpatient,,,965.58,965.58,HUMANA CHOICE PLUS,MGD,965.58,,,,,,,case rate,965.58,965.58,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,AETNA,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,BCBS,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,CIGNA,COM,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,TRICARE,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,UNITED HEALTHCARE,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,UNITED HEALTHCARE,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,VA,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,VA TRICARE,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,WELLMED,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,HUMANA,MGD,166.98,,,,,,,per diem,166.98,166.98,"Per diem rate, code is bundled with other services"
NON-SELECTIVE DEBRIDEMENT     ,34000030,CDM,420,RC,97602,CPT,,,GP,Inpatient,,,166.98,166.98,HUMANA CHOICE PLUS,MGD,166.98,,,,,,,case rate,166.98,166.98,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,AETNA,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,BCBS,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,CIGNA,COM,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,TRICARE,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,UNITED HEALTHCARE,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,UNITED HEALTHCARE,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,VA,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,VA TRICARE,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,WELLMED,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,HUMANA,MGD,153.5,,,,,,,per diem,153.5,153.5,"Per diem rate, code is bundled with other services"
STRAPPING UNNA BOOT           ,34000031,CDM,420,RC,29580,CPT,,,GP,Inpatient,,,153.5,153.5,HUMANA CHOICE PLUS,MGD,153.5,,,,,,,case rate,153.5,153.5,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,AETNA,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,BCBS,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,CIGNA,COM,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,TRICARE,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,UNITED HEALTHCARE,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,UNITED HEALTHCARE,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,VA,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,VA TRICARE,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,WELLMED,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,HUMANA,MGD,358.28,,,,,,,per diem,358.28,358.28,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY EVAL         ,34000041,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,358.28,358.28,HUMANA CHOICE PLUS,MGD,358.28,,,,,,,case rate,358.28,358.28,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EVALUATION LOW COMPLEXITY  ,34000042,CDM,424,RC,97161,CPT,,,,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,AETNA,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,BCBS,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,CIGNA,COM,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,TRICARE,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,UNITED HEALTHCARE,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,UNITED HEALTHCARE,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,VA,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,VA TRICARE,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,WELLMED,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,HUMANA,MGD,205.21,,,,,,,per diem,205.21,205.21,"Per diem rate, code is bundled with other services"
PT EVALUATION MOD COMPLEXITY  ,34000043,CDM,424,RC,97162,CPT,,,,Inpatient,,,205.21,205.21,HUMANA CHOICE PLUS,MGD,205.21,,,,,,,case rate,205.21,205.21,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,AETNA,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,BCBS,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,CIGNA,COM,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,TRICARE,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,UNITED HEALTHCARE,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,UNITED HEALTHCARE,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,VA,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,VA TRICARE,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,WELLMED,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,HUMANA,MGD,361.74,,,,,,,per diem,361.74,361.74,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 45 MIN,34000044,CDM,424,RC,97163,CPT,,,,Inpatient,,,361.74,361.74,HUMANA CHOICE PLUS,MGD,361.74,,,,,,,case rate,361.74,361.74,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,AETNA,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,BCBS,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,CIGNA,COM,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,TRICARE,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,UNITED HEALTHCARE,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,UNITED HEALTHCARE,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,VA,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,VA TRICARE,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,WELLMED,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,HUMANA,MGD,202.57,,,,,,,per diem,202.57,202.57,"Per diem rate, code is bundled with other services"
PT EVAL HIGH COMPLEXITY 60 MIN,34000045,CDM,424,RC,97163,CPT,,,,Inpatient,,,202.57,202.57,HUMANA CHOICE PLUS,MGD,202.57,,,,,,,case rate,202.57,202.57,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,AETNA,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,BCBS,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,CIGNA,COM,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,TRICARE,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,UNITED HEALTHCARE,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,UNITED HEALTHCARE,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,VA,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,VA TRICARE,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,WELLMED,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,HUMANA,MGD,302.89,,,,,,,per diem,302.89,302.89,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 15 MINUTE     ,34000046,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,302.89,302.89,HUMANA CHOICE PLUS,MGD,302.89,,,,,,,case rate,302.89,302.89,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,AETNA,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,BCBS,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,CIGNA,COM,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,TRICARE,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,UNITED HEALTHCARE,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,UNITED HEALTHCARE,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,VA,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,VA TRICARE,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,WELLMED,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,HUMANA,MGD,383.81,,,,,,,per diem,383.81,383.81,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 30 MIN        ,34000047,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,383.81,383.81,HUMANA CHOICE PLUS,MGD,383.81,,,,,,,case rate,383.81,383.81,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,AETNA,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,BCBS,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,CIGNA,COM,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,TRICARE,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,UNITED HEALTHCARE,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,UNITED HEALTHCARE,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,VA,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,VA TRICARE,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,WELLMED,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,HUMANA,MGD,388.13,,,,,,,per diem,388.13,388.13,"Per diem rate, code is bundled with other services"
PT INITIAL EVAL 45 MIN        ,34000048,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,388.13,388.13,HUMANA CHOICE PLUS,MGD,388.13,,,,,,,case rate,388.13,388.13,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,AETNA,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,CIGNA,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,TRICARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,UNITED HEALTHCARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,UNITED HEALTHCARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,VA,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,VA TRICARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,WELLMED,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,HUMANA,MGD,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
PT EVAL 60 MIN                ,34000049,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,331.02,331.02,HUMANA CHOICE PLUS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34000050,CDM,420,RC,97116,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,AETNA,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,BCBS,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,CIGNA,COM,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,TRICARE,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,UNITED HEALTHCARE,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,UNITED HEALTHCARE,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,VA,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,VA TRICARE,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,WELLMED,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,HUMANA,MGD,67.86,,,,,,,per diem,67.86,67.86,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34000070,CDM,420,RC,97010,CPT,,,GP,Inpatient,,,67.86,67.86,HUMANA CHOICE PLUS,MGD,67.86,,,,,,,case rate,67.86,67.86,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,AETNA,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,BCBS,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,CIGNA,COM,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,TRICARE,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,UNITED HEALTHCARE,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,UNITED HEALTHCARE,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,VA,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,VA TRICARE,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,WELLMED,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,HUMANA,MGD,39.32,,,,,,,per diem,39.32,39.32,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34000090,CDM,420,RC,97016,CPT,,,GP,Inpatient,,,39.32,39.32,HUMANA CHOICE PLUS,MGD,39.32,,,,,,,case rate,39.32,39.32,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,AETNA,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,BCBS,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,CIGNA,COM,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,TRICARE,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,UNITED HEALTHCARE,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,UNITED HEALTHCARE,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,VA,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,VA TRICARE,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,WELLMED,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,HUMANA,MGD,99.93,,,,,,,per diem,99.93,99.93,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34000100,CDM,420,RC,97124,CPT,,,GP,Inpatient,,,99.93,99.93,HUMANA CHOICE PLUS,MGD,99.93,,,,,,,case rate,99.93,99.93,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34000120,CDM,420,RC,97018,CPT,,,GP,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,AETNA,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,CIGNA,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,TRICARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,UNITED HEALTHCARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,UNITED HEALTHCARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,VA,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,VA TRICARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,WELLMED,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,HUMANA,MGD,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
PHYSICAL THERAPY RE-EVALUATION,34000140,CDM,424,RC,97164,CPT,,,GP,Inpatient,,,184.23,184.23,HUMANA CHOICE PLUS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,AETNA,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,CIGNA,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,TRICARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,UNITED HEALTHCARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,UNITED HEALTHCARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,VA,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,VA TRICARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,WELLMED,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,HUMANA,MGD,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000155,CDM,423,RC,97150,CPT,,,GP,Inpatient,,,120.37,120.37,HUMANA CHOICE PLUS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,AETNA,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,BCBS,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,CIGNA,COM,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,TRICARE,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,UNITED HEALTHCARE,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,UNITED HEALTHCARE,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,VA,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,VA TRICARE,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,WELLMED,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,HUMANA,MGD,114.17,,,,,,,per diem,114.17,114.17,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000156,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,114.17,114.17,HUMANA CHOICE PLUS,MGD,114.17,,,,,,,case rate,114.17,114.17,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,AETNA,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,BCBS,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,CIGNA,COM,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,TRICARE,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,UNITED HEALTHCARE,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,UNITED HEALTHCARE,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,VA,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,VA TRICARE,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,WELLMED,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,HUMANA,MGD,116.63,,,,,,,per diem,116.63,116.63,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE-GROUP   ,34000157,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,116.63,116.63,HUMANA CHOICE PLUS,MGD,116.63,,,,,,,case rate,116.63,116.63,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,AETNA,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,CIGNA,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,TRICARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,UNITED HEALTHCARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,UNITED HEALTHCARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,VA,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,VA TRICARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,WELLMED,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,HUMANA,MGD,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROC-GROUP 15 MIN ,34000158,CDM,420,RC,97150,CPT,,,GP,Inpatient,,,90.58,90.58,HUMANA CHOICE PLUS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34000176,CDM,420,RC,97533,CPT,,,GP,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,AETNA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,CIGNA,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,VA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,VA TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,WELLMED,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,HUMANA,MGD,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34000270,CDM,420,RC,97022,CPT,,,GP,Inpatient,,,76.66,76.66,HUMANA CHOICE PLUS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,AETNA,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,BCBS,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,CIGNA,COM,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,TRICARE,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,UNITED HEALTHCARE,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,UNITED HEALTHCARE,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,VA,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,VA TRICARE,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,WELLMED,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,HUMANA,MGD,78.5,,,,,,,per diem,78.5,78.5,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34000290,CDM,420,RC,97034,CPT,,,GP,Inpatient,,,78.5,78.5,HUMANA CHOICE PLUS,MGD,78.5,,,,,,,case rate,78.5,78.5,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34000305,CDM,420,RC,97024,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,AETNA,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,BCBS,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,CIGNA,COM,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,TRICARE,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,UNITED HEALTHCARE,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,UNITED HEALTHCARE,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,VA,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,VA TRICARE,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,WELLMED,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,HUMANA,MGD,100.98,,,,,,,per diem,100.98,100.98,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34000465,CDM,420,RC,97033,CPT,,,GP,Inpatient,,,100.98,100.98,HUMANA CHOICE PLUS,MGD,100.98,,,,,,,case rate,100.98,100.98,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,AETNA,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,BCBS,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,CIGNA,COM,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,TRICARE,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,UNITED HEALTHCARE,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,UNITED HEALTHCARE,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,VA,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,VA TRICARE,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,WELLMED,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,HUMANA,MGD,118.44,,,,,,,per diem,118.44,118.44,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34000470,CDM,420,RC,97762,CPT,,,GP,Inpatient,,,118.44,118.44,HUMANA CHOICE PLUS,MGD,118.44,,,,,,,case rate,118.44,118.44,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,AETNA,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,BCBS,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,CIGNA,COM,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,TRICARE,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,UNITED HEALTHCARE,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,UNITED HEALTHCARE,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,VA,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,VA TRICARE,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,WELLMED,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,HUMANA,MGD,90.85,,,,,,,per diem,90.85,90.85,"Per diem rate, code is bundled with other services"
TRACTION                      ,34000560,CDM,420,RC,97012,CPT,,,GP,Inpatient,,,90.85,90.85,HUMANA CHOICE PLUS,MGD,90.85,,,,,,,case rate,90.85,90.85,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
ULTRAVIOLET                   ,34000565,CDM,420,RC,97028,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,AETNA,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,BCBS,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,CIGNA,COM,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,TRICARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,UNITED HEALTHCARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,UNITED HEALTHCARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,VA,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,VA TRICARE,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,WELLMED,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,HUMANA,MGD,120.37,,,,,,,per diem,120.37,120.37,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34000650,CDM,420,RC,97750,CPT,,,GP,Inpatient,,,120.37,120.37,HUMANA CHOICE PLUS,MGD,120.37,,,,,,,case rate,120.37,120.37,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,AETNA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,CIGNA,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,VA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,VA TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,WELLMED,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA,MGD,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34000702,CDM,420,RC,97761,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA CHOICE PLUS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34000790,CDM,420,RC,97112,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,AETNA,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,BCBS,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,CIGNA,COM,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,TRICARE,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,UNITED HEALTHCARE,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,UNITED HEALTHCARE,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,VA,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,VA TRICARE,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,WELLMED,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,HUMANA,MGD,84.64,,,,,,,per diem,84.64,84.64,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34010000,CDM,420,RC,95831,CPT,,,GP,Inpatient,,,84.64,84.64,HUMANA CHOICE PLUS,MGD,84.64,,,,,,,case rate,84.64,84.64,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,AETNA,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,BCBS,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,CIGNA,COM,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,TRICARE,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,UNITED HEALTHCARE,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,UNITED HEALTHCARE,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,VA,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,VA TRICARE,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,WELLMED,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,HUMANA,MGD,78.17,,,,,,,per diem,78.17,78.17,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34010001,CDM,420,RC,95832,CPT,,,GP,Inpatient,,,78.17,78.17,HUMANA CHOICE PLUS,MGD,78.17,,,,,,,case rate,78.17,78.17,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,AETNA,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,BCBS,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,CIGNA,COM,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,TRICARE,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,UNITED HEALTHCARE,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,UNITED HEALTHCARE,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,VA,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,VA TRICARE,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,WELLMED,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,HUMANA,MGD,95.4,,,,,,,per diem,95.4,95.4,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34010002,CDM,420,RC,95833,CPT,,,GP,Inpatient,,,95.4,95.4,HUMANA CHOICE PLUS,MGD,95.4,,,,,,,case rate,95.4,95.4,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,AETNA,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,BCBS,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,CIGNA,COM,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,TRICARE,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,UNITED HEALTHCARE,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,UNITED HEALTHCARE,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,VA,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,VA TRICARE,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,WELLMED,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,HUMANA,MGD,107.74,,,,,,,per diem,107.74,107.74,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34010003,CDM,420,RC,95834,CPT,,,GP,Inpatient,,,107.74,107.74,HUMANA CHOICE PLUS,MGD,107.74,,,,,,,case rate,107.74,107.74,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,AETNA,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,BCBS,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,CIGNA,COM,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,TRICARE,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,UNITED HEALTHCARE,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,UNITED HEALTHCARE,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,VA,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,VA TRICARE,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,WELLMED,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,HUMANA,MGD,78.96,,,,,,,per diem,78.96,78.96,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34010006,CDM,420,RC,95851,CPT,,,GP,Inpatient,,,78.96,78.96,HUMANA CHOICE PLUS,MGD,78.96,,,,,,,case rate,78.96,78.96,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,AETNA,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,BCBS,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,CIGNA,COM,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,TRICARE,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,UNITED HEALTHCARE,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,UNITED HEALTHCARE,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,VA,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,VA TRICARE,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,WELLMED,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,HUMANA,MGD,65.27,,,,,,,per diem,65.27,65.27,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34010007,CDM,420,RC,95852,CPT,,,GP,Inpatient,,,65.27,65.27,HUMANA CHOICE PLUS,MGD,65.27,,,,,,,case rate,65.27,65.27,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34010020,CDM,420,RC,97140,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34010040,CDM,420,RC,97110,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34010075,CDM,420,RC,97542,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT EDUCAT/TRAINING 30/MIN     ,34010076,CDM,420,RC,98960,CPT,,,,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,AETNA,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,BCBS,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,CIGNA,COM,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,TRICARE,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,UNITED HEALTHCARE,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,UNITED HEALTHCARE,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,VA,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,VA TRICARE,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,WELLMED,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,HUMANA,MGD,93.59,,,,,,,per diem,93.59,93.59,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34010090,CDM,420,RC,97035,CPT,,,GP,Inpatient,,,93.59,93.59,HUMANA CHOICE PLUS,MGD,93.59,,,,,,,case rate,93.59,93.59,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,AETNA,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,BCBS,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,CIGNA,COM,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,TRICARE,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,UNITED HEALTHCARE,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,UNITED HEALTHCARE,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,VA,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,VA TRICARE,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,WELLMED,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,HUMANA,MGD,141.53,,,,,,,per diem,141.53,141.53,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34010105,CDM,420,RC,97032,CPT,,,GP,Inpatient,,,141.53,141.53,HUMANA CHOICE PLUS,MGD,141.53,,,,,,,case rate,141.53,141.53,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,AETNA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,CIGNA,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,VA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,VA TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,WELLMED,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA,MGD,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
HOME MGT TRAINING 15 MIN      ,34010130,CDM,420,RC,97535,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA CHOICE PLUS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34010155,CDM,420,RC,97760,CPT,,,GP,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34010160,CDM,420,RC,97530,CPT,,,GP,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,AETNA,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,BCBS,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,CIGNA,COM,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,TRICARE,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,UNITED HEALTHCARE,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,UNITED HEALTHCARE,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,VA,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,VA TRICARE,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,WELLMED,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,HUMANA,MGD,90.02,,,,,,,per diem,90.02,90.02,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34010185,CDM,420,RC,97755,CPT,,,GP,Inpatient,,,90.02,90.02,HUMANA CHOICE PLUS,MGD,90.02,,,,,,,case rate,90.02,90.02,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34010195,CDM,420,RC,97036,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,AETNA,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,BCBS,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,CIGNA,COM,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,TRICARE,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,UNITED HEALTHCARE,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,UNITED HEALTHCARE,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,VA,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,VA TRICARE,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,WELLMED,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,HUMANA,MGD,160.99,,,,,,,per diem,160.99,160.99,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34010200,CDM,420,RC,29125,CPT,,,GP,Inpatient,,,160.99,160.99,HUMANA CHOICE PLUS,MGD,160.99,,,,,,,case rate,160.99,160.99,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,AETNA,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,BCBS,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,CIGNA,COM,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,TRICARE,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,UNITED HEALTHCARE,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,UNITED HEALTHCARE,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,VA,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,VA TRICARE,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,WELLMED,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,HUMANA,MGD,167.34,,,,,,,per diem,167.34,167.34,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34010205,CDM,420,RC,29126,CPT,,,GP,Inpatient,,,167.34,167.34,HUMANA CHOICE PLUS,MGD,167.34,,,,,,,case rate,167.34,167.34,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,AETNA,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,BCBS,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,CIGNA,COM,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,TRICARE,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,UNITED HEALTHCARE,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,UNITED HEALTHCARE,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,VA,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,VA TRICARE,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,WELLMED,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,HUMANA,MGD,167.43,,,,,,,per diem,167.43,167.43,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34010210,CDM,420,RC,29130,CPT,,,GP,Inpatient,,,167.43,167.43,HUMANA CHOICE PLUS,MGD,167.43,,,,,,,case rate,167.43,167.43,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,AETNA,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,BCBS,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,CIGNA,COM,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,TRICARE,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,UNITED HEALTHCARE,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,UNITED HEALTHCARE,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,VA,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,VA TRICARE,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,WELLMED,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,HUMANA,MGD,118.67,,,,,,,per diem,118.67,118.67,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34010215,CDM,420,RC,29131,CPT,,,GP,Inpatient,,,118.67,118.67,HUMANA CHOICE PLUS,MGD,118.67,,,,,,,case rate,118.67,118.67,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING THORAX              ,34010220,CDM,420,RC,29200,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,AETNA,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,CIGNA,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,TRICARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,UNITED HEALTHCARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,UNITED HEALTHCARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,VA,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,VA TRICARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,WELLMED,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,HUMANA,MGD,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34010230,CDM,420,RC,29240,CPT,,,GP,Inpatient,,,157.44,157.44,HUMANA CHOICE PLUS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34010235,CDM,420,RC,29260,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,AETNA,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,BCBS,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,CIGNA,COM,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,TRICARE,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,UNITED HEALTHCARE,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,UNITED HEALTHCARE,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,VA,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,VA TRICARE,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,WELLMED,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,HUMANA,MGD,170.96,,,,,,,per diem,170.96,170.96,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT LEG        ,34010240,CDM,420,RC,29515,CPT,,,GP,Inpatient,,,170.96,170.96,HUMANA CHOICE PLUS,MGD,170.96,,,,,,,case rate,170.96,170.96,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HIP                 ,34010245,CDM,420,RC,29520,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,AETNA,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,BCBS,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,CIGNA,COM,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,TRICARE,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,UNITED HEALTHCARE,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,UNITED HEALTHCARE,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,VA,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,VA TRICARE,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,WELLMED,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,HUMANA,MGD,147.07,,,,,,,per diem,147.07,147.07,"Per diem rate, code is bundled with other services"
STRAPPING KNEE                ,34010250,CDM,420,RC,29530,CPT,,,GP,Inpatient,,,147.07,147.07,HUMANA CHOICE PLUS,MGD,147.07,,,,,,,case rate,147.07,147.07,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,AETNA,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,CIGNA,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,TRICARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,UNITED HEALTHCARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,UNITED HEALTHCARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,VA,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,VA TRICARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,WELLMED,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,HUMANA,MGD,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
STRAPPING ANKLE AND/OR FOOT   ,34010255,CDM,420,RC,29540,CPT,,,GP,Inpatient,,,144.13,144.13,HUMANA CHOICE PLUS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING TOES                ,34010260,CDM,420,RC,29550,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,AETNA,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,BCBS,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,CIGNA,COM,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,TRICARE,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,UNITED HEALTHCARE,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,UNITED HEALTHCARE,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,VA,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,VA TRICARE,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,WELLMED,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,HUMANA,MGD,70.94,,,,,,,per diem,70.94,70.94,"Per diem rate, code is bundled with other services"
ELEC STIM WOUND UNATTENDED    ,34010270,CDM,420,RC,G0281,HCPCS,,,,Inpatient,,,70.94,70.94,HUMANA CHOICE PLUS,MGD,70.94,,,,,,,case rate,70.94,70.94,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,AETNA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,CIGNA,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,VA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,VA TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,WELLMED,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA,MGD,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34010280,CDM,420,RC,97537,CPT,,,GP,Inpatient,,,95.17,95.17,HUMANA CHOICE PLUS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,AETNA,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,BCBS,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,CIGNA,COM,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,TRICARE,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,UNITED HEALTHCARE,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,UNITED HEALTHCARE,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,VA,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,VA TRICARE,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,WELLMED,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,HUMANA,MGD,203.84,,,,,,,per diem,203.84,203.84,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER<=50SQCM  ,34010285,CDM,420,RC,97605,CPT,,,GP,Inpatient,,,203.84,203.84,HUMANA CHOICE PLUS,MGD,203.84,,,,,,,case rate,203.84,203.84,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP >50 SQ CM     ,34010286,CDM,420,RC,97608,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,AETNA,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,BCBS,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,CIGNA,COM,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,TRICARE,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,UNITED HEALTHCARE,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,UNITED HEALTHCARE,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,VA,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,VA TRICARE,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,WELLMED,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,HUMANA,MGD,221.58,,,,,,,per diem,221.58,221.58,"Per diem rate, code is bundled with other services"
NPWT DISP EQUIP <=50 SQ CM    ,34010287,CDM,420,RC,97607,CPT,,,GP,Inpatient,,,221.58,221.58,HUMANA CHOICE PLUS,MGD,221.58,,,,,,,case rate,221.58,221.58,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,AETNA,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,BCBS,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,CIGNA,COM,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,TRICARE,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,UNITED HEALTHCARE,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,UNITED HEALTHCARE,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,VA,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,VA TRICARE,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,WELLMED,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,HUMANA,MGD,150.19,,,,,,,per diem,150.19,150.19,"Per diem rate, code is bundled with other services"
NEG PRESS WOUND THER >50SQCM  ,34010290,CDM,420,RC,97606,CPT,,,GP,Inpatient,,,150.19,150.19,HUMANA CHOICE PLUS,MGD,150.19,,,,,,,case rate,150.19,150.19,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,AETNA,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,BCBS,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,CIGNA,COM,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,TRICARE,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,UNITED HEALTHCARE,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,UNITED HEALTHCARE,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,VA,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,VA TRICARE,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,WELLMED,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,HUMANA,MGD,71.88,,,,,,,per diem,71.88,71.88,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34010295,CDM,420,RC,90901,CPT,,,GP,Inpatient,,,71.88,71.88,HUMANA CHOICE PLUS,MGD,71.88,,,,,,,case rate,71.88,71.88,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,AETNA,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,CIGNA,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,TRICARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,UNITED HEALTHCARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,UNITED HEALTHCARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,VA,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,VA TRICARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,WELLMED,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,HUMANA,MGD,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34020001,CDM,420,RC,97597,CPT,,,GP,Inpatient,,,368.43,368.43,HUMANA CHOICE PLUS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,AETNA,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,BCBS,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,CIGNA,COM,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,TRICARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,UNITED HEALTHCARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,UNITED HEALTHCARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,VA,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,VA TRICARE,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,WELLMED,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,HUMANA,MGD,368.43,,,,,,,per diem,368.43,368.43,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34020002,CDM,420,RC,97598,CPT,,,GP,Inpatient,,,368.43,368.43,HUMANA CHOICE PLUS,MGD,368.43,,,,,,,case rate,368.43,368.43,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,AETNA,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,BCBS,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,CIGNA,COM,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,TRICARE,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,UNITED HEALTHCARE,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,UNITED HEALTHCARE,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,VA,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,VA TRICARE,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,WELLMED,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,HUMANA,MGD,97.02,,,,,,,per diem,97.02,97.02,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34020003,CDM,420,RC,95992,CPT,,,,Inpatient,,,97.02,97.02,HUMANA CHOICE PLUS,MGD,97.02,,,,,,,case rate,97.02,97.02,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,AETNA,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,BCBS,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,CIGNA,COM,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,TRICARE,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,UNITED HEALTHCARE,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,UNITED HEALTHCARE,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,VA,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,VA TRICARE,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,WELLMED,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,HUMANA,MGD,2.26,,,,,,,per diem,2.26,2.26,"Per diem rate, code is bundled with other services"
DAILY CLINIC NOTE 15MIN       ,34020004,CDM,420,RC,,,,,,Inpatient,,,2.26,2.26,HUMANA CHOICE PLUS,MGD,2.26,,,,,,,case rate,2.26,2.26,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,AETNA,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,CIGNA,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,TRICARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,UNITED HEALTHCARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,UNITED HEALTHCARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,VA,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,VA TRICARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,WELLMED,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,HUMANA,MGD,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
1 EXT W/ OR W/O PARASPINA     ,34020005,CDM,420,RC,95860,CPT,,,,Inpatient,,,199.86,199.86,HUMANA CHOICE PLUS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,AETNA,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,BCBS,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,CIGNA,COM,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,TRICARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,UNITED HEALTHCARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,UNITED HEALTHCARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,VA,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,VA TRICARE,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,WELLMED,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,HUMANA,MGD,199.86,,,,,,,per diem,199.86,199.86,"Per diem rate, code is bundled with other services"
2 EXT W/ OR W/O PARASPINA     ,34020006,CDM,420,RC,95861,CPT,,,,Inpatient,,,199.86,199.86,HUMANA CHOICE PLUS,MGD,199.86,,,,,,,case rate,199.86,199.86,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,AETNA,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,BCBS,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,CIGNA,COM,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,TRICARE,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,UNITED HEALTHCARE,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,UNITED HEALTHCARE,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,VA,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,VA TRICARE,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,WELLMED,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,HUMANA,MGD,115.27,,,,,,,per diem,115.27,115.27,"Per diem rate, code is bundled with other services"
NERVE COND SENSORY            ,34020007,CDM,420,RC,,,,,,Inpatient,,,115.27,115.27,HUMANA CHOICE PLUS,MGD,115.27,,,,,,,case rate,115.27,115.27,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
HOME EVALUATION 15 MIN        ,34020008,CDM,424,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,AETNA,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,BCBS,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,CIGNA,COM,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,TRICARE,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,UNITED HEALTHCARE,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,UNITED HEALTHCARE,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,VA,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,VA TRICARE,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,WELLMED,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,HUMANA,MGD,150.85,,,,,,,per diem,150.85,150.85,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15      ,34020009,CDM,420,RC,97750,CPT,,,,Inpatient,,,150.85,150.85,HUMANA CHOICE PLUS,MGD,150.85,,,,,,,case rate,150.85,150.85,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,AETNA,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,BCBS,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,CIGNA,COM,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,TRICARE,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,UNITED HEALTHCARE,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,UNITED HEALTHCARE,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,VA,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,VA TRICARE,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,WELLMED,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,HUMANA,MGD,171.54,,,,,,,per diem,171.54,171.54,"Per diem rate, code is bundled with other services"
PT ADL/FUNCTINAL ACT 15 MIN   ,34020010,CDM,420,RC,,,,,,Inpatient,,,171.54,171.54,HUMANA CHOICE PLUS,MGD,171.54,,,,,,,case rate,171.54,171.54,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,AETNA,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,CIGNA,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,TRICARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,UNITED HEALTHCARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,UNITED HEALTHCARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,VA,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,VA TRICARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,WELLMED,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,HUMANA,MGD,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT GAIT TRAINING II 15 MIN    ,34020011,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,HUMANA CHOICE PLUS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,AETNA,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,BCBS,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,CIGNA,COM,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,TRICARE,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,UNITED HEALTHCARE,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,UNITED HEALTHCARE,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,VA,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,VA TRICARE,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,WELLMED,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,HUMANA,MGD,188.04,,,,,,,per diem,188.04,188.04,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED BAL TRAIN I 15,34020012,CDM,420,RC,,,,,,Inpatient,,,188.04,188.04,HUMANA CHOICE PLUS,MGD,188.04,,,,,,,case rate,188.04,188.04,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,AETNA,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,BCBS,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,CIGNA,COM,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,TRICARE,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,UNITED HEALTHCARE,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,UNITED HEALTHCARE,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,VA,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,VA TRICARE,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,WELLMED,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,HUMANA,MGD,205.53,,,,,,,per diem,205.53,205.53,"Per diem rate, code is bundled with other services"
PT MUSCLE RE-ED/BAL TR II 15  ,34020013,CDM,420,RC,,,,,,Inpatient,,,205.53,205.53,HUMANA CHOICE PLUS,MGD,205.53,,,,,,,case rate,205.53,205.53,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,AETNA,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,CIGNA,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,TRICARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,UNITED HEALTHCARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,UNITED HEALTHCARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,VA,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,VA TRICARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,WELLMED,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,HUMANA,MGD,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT PHONOPHORESIS 15MIN        ,34020014,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,HUMANA CHOICE PLUS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,AETNA,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,BCBS,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,CIGNA,COM,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,TRICARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,UNITED HEALTHCARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,UNITED HEALTHCARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,VA,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,VA TRICARE,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,WELLMED,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,HUMANA,MGD,170.27,,,,,,,per diem,170.27,170.27,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT I 15 MIN   ,34020015,CDM,420,RC,,,,,,Inpatient,,,170.27,170.27,HUMANA CHOICE PLUS,MGD,170.27,,,,,,,case rate,170.27,170.27,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,AETNA,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,BCBS,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,CIGNA,COM,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,TRICARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,UNITED HEALTHCARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,UNITED HEALTHCARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,VA,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,VA TRICARE,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,WELLMED,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,HUMANA,MGD,210.69,,,,,,,per diem,210.69,210.69,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC ACT II 15 MIN  ,34020016,CDM,420,RC,,,,,,Inpatient,,,210.69,210.69,HUMANA CHOICE PLUS,MGD,210.69,,,,,,,case rate,210.69,210.69,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,AETNA,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,BCBS,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,CIGNA,COM,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,TRICARE,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,UNITED HEALTHCARE,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,UNITED HEALTHCARE,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,VA,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,VA TRICARE,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,WELLMED,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,HUMANA,MGD,221.22,,,,,,,per diem,221.22,221.22,"Per diem rate, code is bundled with other services"
PT THERAPEUTIC EXER II 15 MIN ,34020017,CDM,420,RC,,,,,,Inpatient,,,221.22,221.22,HUMANA CHOICE PLUS,MGD,221.22,,,,,,,case rate,221.22,221.22,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,AETNA,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,BCBS,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,CIGNA,COM,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,TRICARE,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,UNITED HEALTHCARE,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,UNITED HEALTHCARE,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,VA,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,VA TRICARE,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,WELLMED,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,HUMANA,MGD,302.88,,,,,,,per diem,302.88,302.88,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020018,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,302.88,302.88,HUMANA CHOICE PLUS,MGD,302.88,,,,,,,case rate,302.88,302.88,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,AETNA,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,BCBS,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,CIGNA,COM,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,TRICARE,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,UNITED HEALTHCARE,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,UNITED HEALTHCARE,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,VA,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,VA TRICARE,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,WELLMED,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,HUMANA,MGD,252.41,,,,,,,per diem,252.41,252.41,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75MIN,34020019,CDM,424,RC,97163,CPT,,,GP,Inpatient,,,252.41,252.41,HUMANA CHOICE PLUS,MGD,252.41,,,,,,,case rate,252.41,252.41,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,AETNA,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,BCBS,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,CIGNA,COM,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,TRICARE,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,UNITED HEALTHCARE,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,UNITED HEALTHCARE,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,VA,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,VA TRICARE,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,WELLMED,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,HUMANA,MGD,50.48,,,,,,,per diem,50.48,50.48,"Per diem rate, code is bundled with other services"
PT EVAL - LOW COMPLEX - 15 MIN,34020020,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,50.48,50.48,HUMANA CHOICE PLUS,MGD,50.48,,,,,,,case rate,50.48,50.48,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,AETNA,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,BCBS,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,CIGNA,COM,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,TRICARE,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,UNITED HEALTHCARE,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,UNITED HEALTHCARE,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,VA,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,VA TRICARE,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,WELLMED,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,HUMANA,MGD,167.52,,,,,,,per diem,167.52,167.52,"Per diem rate, code is bundled with other services"
PT EVAL - MOD COMPLEX - 30 MIN,34020021,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,167.52,167.52,HUMANA CHOICE PLUS,MGD,167.52,,,,,,,case rate,167.52,167.52,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,AETNA,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,BCBS,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,CIGNA,COM,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,TRICARE,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,UNITED HEALTHCARE,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,UNITED HEALTHCARE,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,VA,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,VA TRICARE,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,WELLMED,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,HUMANA,MGD,151.44,,,,,,,per diem,151.44,151.44,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 45 MI,34020022,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,151.44,151.44,HUMANA CHOICE PLUS,MGD,151.44,,,,,,,case rate,151.44,151.44,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,AETNA,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,BCBS,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,CIGNA,COM,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,TRICARE,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,UNITED HEALTHCARE,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,UNITED HEALTHCARE,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,VA,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,VA TRICARE,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,WELLMED,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,HUMANA,MGD,285.3,,,,,,,per diem,285.3,285.3,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX 60 MIN ,34020023,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,285.3,285.3,HUMANA CHOICE PLUS,MGD,285.3,,,,,,,case rate,285.3,285.3,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,AETNA,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,BCBS,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,CIGNA,COM,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,TRICARE,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,UNITED HEALTHCARE,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,UNITED HEALTHCARE,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,VA,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,VA TRICARE,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,WELLMED,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,HUMANA,MGD,348.75,,,,,,,per diem,348.75,348.75,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 75 MI,34020024,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,348.75,348.75,HUMANA CHOICE PLUS,MGD,348.75,,,,,,,case rate,348.75,348.75,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,AETNA,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,BCBS,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,CIGNA,COM,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,TRICARE,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,UNITED HEALTHCARE,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,UNITED HEALTHCARE,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,VA,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,VA TRICARE,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,WELLMED,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,HUMANA,MGD,412.18,,,,,,,per diem,412.18,412.18,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 90 MI,34020025,CDM,424,RC,97001,CPT,,,GP,Inpatient,,,412.18,412.18,HUMANA CHOICE PLUS,MGD,412.18,,,,,,,case rate,412.18,412.18,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,AETNA,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,CIGNA,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,TRICARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,UNITED HEALTHCARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,UNITED HEALTHCARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,VA,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,VA TRICARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,WELLMED,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,HUMANA,MGD,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
PT MASSAGE 15 MIN             ,34020026,CDM,424,RC,,,,,,Inpatient,,,158.8,158.8,HUMANA CHOICE PLUS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,AETNA,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,CIGNA,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,TRICARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,UNITED HEALTHCARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,UNITED HEALTHCARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,VA,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,VA TRICARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,WELLMED,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,HUMANA,MGD,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 15 MIN        ,34020027,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,HUMANA CHOICE PLUS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,AETNA,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,BCBS,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,CIGNA,COM,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,TRICARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,UNITED HEALTHCARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,UNITED HEALTHCARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,VA,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,VA TRICARE,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,WELLMED,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,HUMANA,MGD,372.07,,,,,,,per diem,372.07,372.07,"Per diem rate, code is bundled with other services"
PT REEVALUATION 60 MIN        ,34020028,CDM,424,RC,,,,,,Inpatient,,,372.07,372.07,HUMANA CHOICE PLUS,MGD,372.07,,,,,,,case rate,372.07,372.07,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,AETNA,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,BCBS,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,CIGNA,COM,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,TRICARE,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,UNITED HEALTHCARE,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,UNITED HEALTHCARE,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,VA,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,VA TRICARE,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,WELLMED,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,HUMANA,MGD,357.7,,,,,,,per diem,357.7,357.7,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND > 50      ,34020029,CDM,420,RC,,,,,,Inpatient,,,357.7,357.7,HUMANA CHOICE PLUS,MGD,357.7,,,,,,,case rate,357.7,357.7,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,AETNA,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,BCBS,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,CIGNA,COM,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,TRICARE,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,UNITED HEALTHCARE,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,UNITED HEALTHCARE,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,VA,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,VA TRICARE,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,WELLMED,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,HUMANA,MGD,255.2,,,,,,,per diem,255.2,255.2,"Per diem rate, code is bundled with other services"
NON SEL TISSUE DEBRIDEMNT     ,34020030,CDM,420,RC,,,,,,Inpatient,,,255.2,255.2,HUMANA CHOICE PLUS,MGD,255.2,,,,,,,case rate,255.2,255.2,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,AETNA,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,BCBS,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,CIGNA,COM,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,TRICARE,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,UNITED HEALTHCARE,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,UNITED HEALTHCARE,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,VA,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,VA TRICARE,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,WELLMED,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,HUMANA,MGD,154.8,,,,,,,per diem,154.8,154.8,"Per diem rate, code is bundled with other services"
GAIT TRAINING LITE 15 MIN     ,34020031,CDM,420,RC,,,,,,Inpatient,,,154.8,154.8,HUMANA CHOICE PLUS,MGD,154.8,,,,,,,case rate,154.8,154.8,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,AETNA,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,BCBS,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,CIGNA,COM,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,TRICARE,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,UNITED HEALTHCARE,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,UNITED HEALTHCARE,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,VA,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,VA TRICARE,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,WELLMED,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,HUMANA,MGD,126.62,,,,,,,per diem,126.62,126.62,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN EA      ,34020032,CDM,420,RC,,,,,,Inpatient,,,126.62,126.62,HUMANA CHOICE PLUS,MGD,126.62,,,,,,,case rate,126.62,126.62,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,AETNA,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,BCBS,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,CIGNA,COM,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,TRICARE,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,UNITED HEALTHCARE,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,UNITED HEALTHCARE,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,VA,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,VA TRICARE,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,WELLMED,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,HUMANA,MGD,115.94,,,,,,,per diem,115.94,115.94,"Per diem rate, code is bundled with other services"
PT PROSTHETIC TRAINING 15     ,34020033,CDM,420,RC,,,,,,Inpatient,,,115.94,115.94,HUMANA CHOICE PLUS,MGD,115.94,,,,,,,case rate,115.94,115.94,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,AETNA,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,BCBS,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,CIGNA,COM,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,TRICARE,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,UNITED HEALTHCARE,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,UNITED HEALTHCARE,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,VA,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,VA TRICARE,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,WELLMED,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,HUMANA,MGD,496.62,,,,,,,per diem,496.62,496.62,"Per diem rate, code is bundled with other services"
PT DEBRIDE WOUND NON          ,34020034,CDM,420,RC,,,,,,Inpatient,,,496.62,496.62,HUMANA CHOICE PLUS,MGD,496.62,,,,,,,case rate,496.62,496.62,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,AETNA,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,BCBS,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,CIGNA,COM,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,TRICARE,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,UNITED HEALTHCARE,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,UNITED HEALTHCARE,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,VA,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,VA TRICARE,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,WELLMED,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,HUMANA,MGD,111.8,,,,,,,per diem,111.8,111.8,"Per diem rate, code is bundled with other services"
PT ORTHO/PROSTH CHECK 15      ,34020035,CDM,420,RC,,,,,,Inpatient,,,111.8,111.8,HUMANA CHOICE PLUS,MGD,111.8,,,,,,,case rate,111.8,111.8,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,AETNA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,CIGNA,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,WELLMED,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA,MGD,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT < 20       ,34020036,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA CHOICE PLUS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,AETNA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,CIGNA,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,WELLMED,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA,MGD,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
SELECT DEBRIDEMENT > 20       ,34020037,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA CHOICE PLUS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,AETNA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,BCBS,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,CIGNA,COM,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,UNITED HEALTHCARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,VA TRICARE,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,WELLMED,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA,MGD,337.45,,,,,,,per diem,337.45,337.45,"Per diem rate, code is bundled with other services"
VACUUM ASSIST WOUND < 50      ,34020038,CDM,420,RC,,,,,,Inpatient,,,337.45,337.45,HUMANA CHOICE PLUS,MGD,337.45,,,,,,,case rate,337.45,337.45,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,AETNA,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,BCBS,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,CIGNA,COM,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,TRICARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,UNITED HEALTHCARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,UNITED HEALTHCARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,VA,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,VA TRICARE,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,WELLMED,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,HUMANA,MGD,104.31,,,,,,,per diem,104.31,104.31,"Per diem rate, code is bundled with other services"
PT ORTHOTIC FITTING 15 MIN    ,34020039,CDM,420,RC,97504,CPT,,,GP,Inpatient,,,104.31,104.31,HUMANA CHOICE PLUS,MGD,104.31,,,,,,,case rate,104.31,104.31,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,AETNA,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,BCBS,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,CIGNA,COM,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,TRICARE,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,UNITED HEALTHCARE,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,UNITED HEALTHCARE,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,VA,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,VA TRICARE,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,WELLMED,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,HUMANA,MGD,71.94,,,,,,,per diem,71.94,71.94,"Per diem rate, code is bundled with other services"
PATIENT CONFERENCE            ,34020040,CDM,420,RC,,,,,,Inpatient,,,71.94,71.94,HUMANA CHOICE PLUS,MGD,71.94,,,,,,,case rate,71.94,71.94,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,AETNA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,BCBS,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,CIGNA,COM,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,UNITED HEALTHCARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,VA,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,VA TRICARE,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,WELLMED,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA,MGD,27.56,,,,,,,per diem,27.56,27.56,"Per diem rate, code is bundled with other services"
GROUP THERAPY VISIT           ,34020043,CDM,941,RC,,,,,,Inpatient,,,27.56,27.56,HUMANA CHOICE PLUS,MGD,27.56,,,,,,,case rate,27.56,27.56,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,AETNA,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,BCBS,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,CIGNA,COM,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,TRICARE,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,UNITED HEALTHCARE,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,UNITED HEALTHCARE,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,VA,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,VA TRICARE,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,WELLMED,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,HUMANA,MGD,965.79,,,,,,,per diem,965.79,965.79,"Per diem rate, code is bundled with other services"
HCHG ED PHYS CARE LEVEL 4     ,34020047,CDM,981,RC,,,,,,Inpatient,,,965.79,965.79,HUMANA CHOICE PLUS,MGD,965.79,,,,,,,case rate,965.79,965.79,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,AETNA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,CIGNA,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,VA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,VA TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,WELLMED,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,HUMANA,MGD,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTHOTIC/PROS USE - SUBSE/ENC ,34020048,CDM,420,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,HUMANA CHOICE PLUS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,AETNA,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,CIGNA,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,TRICARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,UNITED HEALTHCARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,UNITED HEALTHCARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,VA,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,VA TRICARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,WELLMED,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,HUMANA,MGD,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34020049,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,HUMANA CHOICE PLUS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,AETNA,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,BCBS,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,CIGNA,COM,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,TRICARE,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,UNITED HEALTHCARE,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,UNITED HEALTHCARE,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,VA,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,VA TRICARE,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,WELLMED,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,HUMANA,MGD,147.98,,,,,,,per diem,147.98,147.98,"Per diem rate, code is bundled with other services"
GAIT TRAINING THERAPY         ,34020050,CDM,420,RC,97116,CPT,,,,Inpatient,,,147.98,147.98,HUMANA CHOICE PLUS,MGD,147.98,,,,,,,case rate,147.98,147.98,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,AETNA,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,CIGNA,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,TRICARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,UNITED HEALTHCARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,UNITED HEALTHCARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,VA,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,VA TRICARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,WELLMED,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,HUMANA,MGD,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
THERAPEUTIC IVNTJ W/FOC COG   ,34020051,CDM,420,RC,97127,CPT,,,,Inpatient,,,264.6,264.6,HUMANA CHOICE PLUS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,AETNA,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,BCBS,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,CIGNA,COM,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,TRICARE,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,UNITED HEALTHCARE,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,UNITED HEALTHCARE,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,VA,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,VA TRICARE,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,WELLMED,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,HUMANA,MGD,467.46,,,,,,,per diem,467.46,467.46,"Per diem rate, code is bundled with other services"
PT EVAL - HIGH COMPLEX - 60 MI,34020053,CDM,424,RC,,,,,,Inpatient,,,467.46,467.46,HUMANA CHOICE PLUS,MGD,467.46,,,,,,,case rate,467.46,467.46,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,AETNA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,CIGNA,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,VA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,VA TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,WELLMED,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,HUMANA,MGD,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34020055,CDM,420,RC,,,,,,Inpatient,,,79,79,HUMANA CHOICE PLUS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,AETNA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,CIGNA,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,VA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,VA TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,WELLMED,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,HUMANA,MGD,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34020056,CDM,420,RC,,,,,,Inpatient,,,79,79,HUMANA CHOICE PLUS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,AETNA,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,BCBS,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,CIGNA,COM,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,TRICARE,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,UNITED HEALTHCARE,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,UNITED HEALTHCARE,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,VA,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,VA TRICARE,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,WELLMED,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,HUMANA,MGD,47.96,,,,,,,per diem,47.96,47.96,"Per diem rate, code is bundled with other services"
T-BAR                         ,34020057,CDM,420,RC,,,,,,Inpatient,,,47.96,47.96,HUMANA CHOICE PLUS,MGD,47.96,,,,,,,case rate,47.96,47.96,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,AETNA,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,BCBS,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,CIGNA,COM,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,TRICARE,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,UNITED HEALTHCARE,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,UNITED HEALTHCARE,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,VA,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,VA TRICARE,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,WELLMED,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,HUMANA,MGD,98.46,,,,,,,per diem,98.46,98.46,"Per diem rate, code is bundled with other services"
CAST RIGID TOTAL CON          ,34020058,CDM,420,RC,,,,,,Inpatient,,,98.46,98.46,HUMANA CHOICE PLUS,MGD,98.46,,,,,,,case rate,98.46,98.46,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE ED           ,34020059,CDM,420,RC,97112,CPT,,,,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,AETNA,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,BCBS,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,CIGNA,COM,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,TRICARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,UNITED HEALTHCARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,UNITED HEALTHCARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,VA,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,VA TRICARE,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,WELLMED,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,HUMANA,MGD,116.04,,,,,,,per diem,116.04,116.04,"Per diem rate, code is bundled with other services"
THERAPEUTIC 1 OR MR           ,34020060,CDM,420,RC,97110,CPT,,,,Inpatient,,,116.04,116.04,HUMANA CHOICE PLUS,MGD,116.04,,,,,,,case rate,116.04,116.04,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,AETNA,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,BCBS,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,CIGNA,COM,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,TRICARE,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,UNITED HEALTHCARE,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,UNITED HEALTHCARE,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,VA,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,VA TRICARE,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,WELLMED,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,HUMANA,MGD,155.38,,,,,,,per diem,155.38,155.38,"Per diem rate, code is bundled with other services"
GAIT TRAINING                 ,34020061,CDM,420,RC,97116,CPT,,,,Inpatient,,,155.38,155.38,HUMANA CHOICE PLUS,MGD,155.38,,,,,,,case rate,155.38,155.38,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34020064,CDM,420,RC,97014,CPT,,,GP,Inpatient,,,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,AETNA,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,BCBS,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,CIGNA,COM,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,TRICARE,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,UNITED HEALTHCARE,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,UNITED HEALTHCARE,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,VA,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,VA TRICARE,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,WELLMED,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,HUMANA,MGD,0.01,,,,,,,per diem,0.01,0.01,"Per diem rate, code is bundled with other services"
BODY POS DISCH STATUS 20-39%  ,34033126,CDM,420,RC,G8982,HCPCS,,,,Inpatient,,,0.01,0.01,HUMANA CHOICE PLUS,MGD,0.01,,,,,,,case rate,0.01,0.01,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,AETNA,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,BCBS,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,CIGNA,COM,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,TRICARE,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,UNITED HEALTHCARE,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,UNITED HEALTHCARE,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,VA,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,VA TRICARE,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,WELLMED,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,HUMANA,MGD,80.49,,,,,,,per diem,80.49,80.49,"Per diem rate, code is bundled with other services"
INFRARED                      ,34050015,CDM,420,RC,97026,CPT,,,GP,Inpatient,,,80.49,80.49,HUMANA CHOICE PLUS,MGD,80.49,,,,,,,case rate,80.49,80.49,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
UNLISTED MOD ATTENDED 15MIN   ,34050040,CDM,420,RC,97039,CPT,,,GP,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,AETNA,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,BCBS,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,CIGNA,COM,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,TRICARE,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,UNITED HEALTHCARE,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,UNITED HEALTHCARE,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,VA,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,VA TRICARE,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,WELLMED,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,HUMANA,MGD,268.57,,,,,,,per diem,268.57,268.57,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,34050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,268.57,268.57,HUMANA CHOICE PLUS,MGD,268.57,,,,,,,case rate,268.57,268.57,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,AETNA,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,BCBS,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,CIGNA,COM,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,TRICARE,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,UNITED HEALTHCARE,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,UNITED HEALTHCARE,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,VA,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,VA TRICARE,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,WELLMED,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,HUMANA,MGD,534.86,,,,,,,per diem,534.86,534.86,"Per diem rate, code is bundled with other services"
WORK HARD/COND INIT 2 HRS     ,34050105,CDM,420,RC,97545,CPT,,,GP,Inpatient,,,534.86,534.86,HUMANA CHOICE PLUS,MGD,534.86,,,,,,,case rate,534.86,534.86,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,AETNA,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,CIGNA,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,TRICARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,UNITED HEALTHCARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,UNITED HEALTHCARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,VA,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,VA TRICARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,WELLMED,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,HUMANA,MGD,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34050140,CDM,420,RC,97113,CPT,,,GP,Inpatient,,,98.19,98.19,HUMANA CHOICE PLUS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING HAND OR FINGER      ,34050180,CDM,420,RC,29280,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY CYLNDR CAST THIGH-ANKLE ,34050200,CDM,420,RC,29365,CPT,,,GP,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,AETNA,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,BCBS,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,CIGNA,COM,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,TRICARE,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,UNITED HEALTHCARE,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,UNITED HEALTHCARE,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,VA,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,VA TRICARE,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,WELLMED,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,HUMANA,MGD,108.42,,,,,,,per diem,108.42,108.42,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34050220,CDM,420,RC,G0283,HCPCS,,,,Inpatient,,,108.42,108.42,HUMANA CHOICE PLUS,MGD,108.42,,,,,,,case rate,108.42,108.42,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
MIST THERAPY                  ,34099979,CDM,420,RC,97610,CPT,,,,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,AETNA,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,BCBS,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,CIGNA,COM,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,TRICARE,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,UNITED HEALTHCARE,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,UNITED HEALTHCARE,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,VA,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,VA TRICARE,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,WELLMED,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,HUMANA,MGD,89.01,,,,,,,per diem,89.01,89.01,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34099980,CDM,420,RC,64550,CPT,,,GP,Inpatient,,,89.01,89.01,HUMANA CHOICE PLUS,MGD,89.01,,,,,,,case rate,89.01,89.01,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,AETNA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,BCBS,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,CIGNA,COM,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,UNITED HEALTHCARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,VA,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,VA TRICARE,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,WELLMED,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA,MGD,151.2,,,,,,,per diem,151.2,151.2,"Per diem rate, code is bundled with other services"
REC THERAPY EVALUATION        ,34099993,CDM,941,RC,,,,,,Inpatient,,,151.2,151.2,HUMANA CHOICE PLUS,MGD,151.2,,,,,,,case rate,151.2,151.2,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,AETNA,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,BCBS,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,CIGNA,COM,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,TRICARE,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,UNITED HEALTHCARE,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,UNITED HEALTHCARE,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,VA,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,VA TRICARE,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,WELLMED,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,HUMANA,MGD,131.42,,,,,,,per diem,131.42,131.42,"Per diem rate, code is bundled with other services"
PHYSICAL THER UNLISTED 15 MIN ,34099999,CDM,420,RC,97139,CPT,,,GP,Inpatient,,,131.42,131.42,HUMANA CHOICE PLUS,MGD,131.42,,,,,,,case rate,131.42,131.42,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34200011,CDM,430,RC,97533,CPT,,,GO,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
NEUROMUSCULAR RE-ED 15 MIN    ,34200030,CDM,430,RC,97112,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,AETNA,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,BCBS,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,CIGNA,COM,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,TRICARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,UNITED HEALTHCARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,UNITED HEALTHCARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,VA,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,VA TRICARE,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,WELLMED,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,HUMANA,MGD,102.21,,,,,,,per diem,102.21,102.21,"Per diem rate, code is bundled with other services"
ELEC STIM NOT WOUND UNATTENDED,34200043,CDM,430,RC,97014,CPT,G0283,HCPCS,GOGO,Inpatient,,,102.21,102.21,HUMANA CHOICE PLUS,MGD,102.21,,,,,,,case rate,102.21,102.21,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 30 MIN   ,34200050,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,AETNA,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,CIGNA,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,TRICARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,UNITED HEALTHCARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,UNITED HEALTHCARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,VA,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,VA TRICARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,WELLMED,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,HUMANA,MGD,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 45 MIN   ,34200051,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,HUMANA CHOICE PLUS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,AETNA,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,BCBS,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,CIGNA,COM,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,TRICARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,UNITED HEALTHCARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,UNITED HEALTHCARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,VA,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,VA TRICARE,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,WELLMED,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,HUMANA,MGD,335.02,,,,,,,per diem,335.02,335.02,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 60 MIN   ,34200052,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,335.02,335.02,HUMANA CHOICE PLUS,MGD,335.02,,,,,,,case rate,335.02,335.02,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
THER PROCEDURE-GROUP 15 MIN   ,34200053,CDM,433,RC,97150,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,AETNA,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,BCBS,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,CIGNA,COM,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,TRICARE,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,UNITED HEALTHCARE,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,UNITED HEALTHCARE,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,VA,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,VA TRICARE,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,WELLMED,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,HUMANA,MGD,25.08,,,,,,,per diem,25.08,25.08,"Per diem rate, code is bundled with other services"
HOT/COLD PACKS APPLICATION    ,34200055,CDM,430,RC,97010,CPT,,,GO,Inpatient,,,25.08,25.08,HUMANA CHOICE PLUS,MGD,25.08,,,,,,,case rate,25.08,25.08,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
MANUAL THERAPY 15 MIN         ,34200061,CDM,430,RC,97140,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
MASSAGE 15 MIN                ,34200070,CDM,430,RC,97124,CPT,,,GO,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,AETNA,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,BCBS,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,CIGNA,COM,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,TRICARE,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,UNITED HEALTHCARE,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,UNITED HEALTHCARE,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,VA,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,VA TRICARE,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,WELLMED,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,HUMANA,MGD,80.73,,,,,,,per diem,80.73,80.73,"Per diem rate, code is bundled with other services"
PARAFFIN BATH                 ,34200083,CDM,430,RC,97018,CPT,,,GO,Inpatient,,,80.73,80.73,HUMANA CHOICE PLUS,MGD,80.73,,,,,,,case rate,80.73,80.73,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISE 15 MIN   ,34200110,CDM,430,RC,97110,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,AETNA,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,BCBS,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,CIGNA,COM,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,TRICARE,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,UNITED HEALTHCARE,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,UNITED HEALTHCARE,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,VA,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,VA TRICARE,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,WELLMED,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,HUMANA,MGD,178.51,,,,,,,per diem,178.51,178.51,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG ARM         ,34200134,CDM,430,RC,29105,CPT,,,GO,Inpatient,,,178.51,178.51,HUMANA CHOICE PLUS,MGD,178.51,,,,,,,case rate,178.51,178.51,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
APPLY SPLINT LONG LEG         ,34200135,CDM,430,RC,29505,CPT,,,GO,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
ORTHOTIC PROSTH CHECK 15 MIN  ,34200136,CDM,430,RC,97762,CPT,,,GO,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECH      ,34200137,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,AETNA,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,BCBS,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,CIGNA,COM,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,TRICARE,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,UNITED HEALTHCARE,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,UNITED HEALTHCARE,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,VA,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,VA TRICARE,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,WELLMED,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,HUMANA,MGD,180.31,,,,,,,per diem,180.31,180.31,"Per diem rate, code is bundled with other services"
ADL FUNCTIONAL ACT 15 MIN     ,34200138,CDM,430,RC,,,,,,Inpatient,,,180.31,180.31,HUMANA CHOICE PLUS,MGD,180.31,,,,,,,case rate,180.31,180.31,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,AETNA,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,BCBS,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,CIGNA,COM,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,TRICARE,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,UNITED HEALTHCARE,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,UNITED HEALTHCARE,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,VA,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,VA TRICARE,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,WELLMED,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,HUMANA,MGD,166.54,,,,,,,per diem,166.54,166.54,"Per diem rate, code is bundled with other services"
ADL SELF CAR MGT TR 15 MIN    ,34200139,CDM,430,RC,,,,,,Inpatient,,,166.54,166.54,HUMANA CHOICE PLUS,MGD,166.54,,,,,,,case rate,166.54,166.54,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,AETNA,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,BCBS,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,CIGNA,COM,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,TRICARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,UNITED HEALTHCARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,UNITED HEALTHCARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,VA,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,VA TRICARE,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,WELLMED,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,HUMANA,MGD,158.8,,,,,,,per diem,158.8,158.8,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEV 15 MIN   ,34200140,CDM,430,RC,,,,,,Inpatient,,,158.8,158.8,HUMANA CHOICE PLUS,MGD,158.8,,,,,,,case rate,158.8,158.8,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,AETNA,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,BCBS,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,CIGNA,COM,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,TRICARE,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,UNITED HEALTHCARE,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,UNITED HEALTHCARE,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,VA,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,VA TRICARE,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,WELLMED,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,HUMANA,MGD,179.16,,,,,,,per diem,179.16,179.16,"Per diem rate, code is bundled with other services"
MUSCLE RE-ED BAL TR 15 MIN    ,34200141,CDM,430,RC,,,,,,Inpatient,,,179.16,179.16,HUMANA CHOICE PLUS,MGD,179.16,,,,,,,case rate,179.16,179.16,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,AETNA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,BCBS,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,CIGNA,COM,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,UNITED HEALTHCARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,VA,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,VA TRICARE,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,WELLMED,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,HUMANA,MGD,89.71,,,,,,,per diem,89.71,89.71,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MIN    ,34200142,CDM,430,RC,,,,,,Inpatient,,,89.71,89.71,HUMANA CHOICE PLUS,MGD,89.71,,,,,,,case rate,89.71,89.71,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,AETNA,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,CIGNA,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,TRICARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,UNITED HEALTHCARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,UNITED HEALTHCARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,VA,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,VA TRICARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,WELLMED,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,HUMANA,MGD,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACT II 15 MIN     ,34200143,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,HUMANA CHOICE PLUS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,AETNA,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,BCBS,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,CIGNA,COM,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,TRICARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,UNITED HEALTHCARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,UNITED HEALTHCARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,VA,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,VA TRICARE,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,WELLMED,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,HUMANA,MGD,200.66,,,,,,,per diem,200.66,200.66,"Per diem rate, code is bundled with other services"
THERAPY EXERCISE II 15 MIN    ,34200144,CDM,430,RC,,,,,,Inpatient,,,200.66,200.66,HUMANA CHOICE PLUS,MGD,200.66,,,,,,,case rate,200.66,200.66,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,AETNA,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,BCBS,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,CIGNA,COM,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,TRICARE,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,UNITED HEALTHCARE,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,UNITED HEALTHCARE,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,VA,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,VA TRICARE,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,WELLMED,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,HUMANA,MGD,519.4,,,,,,,per diem,519.4,519.4,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 90 MI,34200145,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,519.4,519.4,HUMANA CHOICE PLUS,MGD,519.4,,,,,,,case rate,519.4,519.4,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,AETNA,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,BCBS,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,CIGNA,COM,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,TRICARE,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,UNITED HEALTHCARE,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,UNITED HEALTHCARE,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,VA,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,VA TRICARE,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,WELLMED,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,HUMANA,MGD,560.56,,,,,,,per diem,560.56,560.56,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 75 MI,34200146,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,560.56,560.56,HUMANA CHOICE PLUS,MGD,560.56,,,,,,,case rate,560.56,560.56,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,AETNA,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,BCBS,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,CIGNA,COM,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,TRICARE,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,UNITED HEALTHCARE,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,UNITED HEALTHCARE,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,VA,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,VA TRICARE,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,WELLMED,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,HUMANA,MGD,628.7,,,,,,,per diem,628.7,628.7,"Per diem rate, code is bundled with other services"
OT EVAL - HIGH COMPLEX - 60 MI,34200147,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,628.7,628.7,HUMANA CHOICE PLUS,MGD,628.7,,,,,,,case rate,628.7,628.7,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,AETNA,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,BCBS,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,CIGNA,COM,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,TRICARE,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,UNITED HEALTHCARE,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,UNITED HEALTHCARE,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,VA,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,VA TRICARE,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,WELLMED,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,HUMANA,MGD,565.23,,,,,,,per diem,565.23,565.23,"Per diem rate, code is bundled with other services"
OT EVAL - MOD COMPLEX - 45 MIN,34200148,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,565.23,565.23,HUMANA CHOICE PLUS,MGD,565.23,,,,,,,case rate,565.23,565.23,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,AETNA,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,BCBS,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,CIGNA,COM,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,TRICARE,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,UNITED HEALTHCARE,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,UNITED HEALTHCARE,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,VA,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,VA TRICARE,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,WELLMED,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,HUMANA,MGD,567.28,,,,,,,per diem,567.28,567.28,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 15 MIN,34200149,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,567.28,567.28,HUMANA CHOICE PLUS,MGD,567.28,,,,,,,case rate,567.28,567.28,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,AETNA,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,BCBS,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,CIGNA,COM,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,TRICARE,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,UNITED HEALTHCARE,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,UNITED HEALTHCARE,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,VA,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,VA TRICARE,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,WELLMED,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,HUMANA,MGD,604.09,,,,,,,per diem,604.09,604.09,"Per diem rate, code is bundled with other services"
OT EVAL - LOW COMPLEX - 30 MIN,34200150,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,604.09,604.09,HUMANA CHOICE PLUS,MGD,604.09,,,,,,,case rate,604.09,604.09,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,AETNA,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,BCBS,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,CIGNA,COM,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,TRICARE,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,UNITED HEALTHCARE,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,UNITED HEALTHCARE,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,VA,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,VA TRICARE,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,WELLMED,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,HUMANA,MGD,117.21,,,,,,,per diem,117.21,117.21,"Per diem rate, code is bundled with other services"
ELECTRICAL STIMULATION AT     ,34200151,CDM,430,RC,,,,,,Inpatient,,,117.21,117.21,HUMANA CHOICE PLUS,MGD,117.21,,,,,,,case rate,117.21,117.21,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,AETNA,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,CIGNA,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,TRICARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,UNITED HEALTHCARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,UNITED HEALTHCARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,VA,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,VA TRICARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,WELLMED,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,HUMANA,MGD,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200152,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,HUMANA CHOICE PLUS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,AETNA,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,BCBS,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,CIGNA,COM,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,TRICARE,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,UNITED HEALTHCARE,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,UNITED HEALTHCARE,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,VA,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,VA TRICARE,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,WELLMED,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,HUMANA,MGD,151.87,,,,,,,per diem,151.87,151.87,"Per diem rate, code is bundled with other services"
GROUP THERAPEUTIC 15 min      ,34200153,CDM,430,RC,,,,,,Inpatient,,,151.87,151.87,HUMANA CHOICE PLUS,MGD,151.87,,,,,,,case rate,151.87,151.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,AETNA,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,BCBS,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,CIGNA,COM,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,TRICARE,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,UNITED HEALTHCARE,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,UNITED HEALTHCARE,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,VA,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,VA TRICARE,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,WELLMED,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,HUMANA,MGD,334.87,,,,,,,per diem,334.87,334.87,"Per diem rate, code is bundled with other services"
OT ORTHOTIC FITTING 15 MI     ,34200154,CDM,430,RC,,,,,,Inpatient,,,334.87,334.87,HUMANA CHOICE PLUS,MGD,334.87,,,,,,,case rate,334.87,334.87,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,AETNA,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,BCBS,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,CIGNA,COM,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,TRICARE,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,UNITED HEALTHCARE,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,UNITED HEALTHCARE,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,VA,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,VA TRICARE,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,WELLMED,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,HUMANA,MGD,364.65,,,,,,,per diem,364.65,364.65,"Per diem rate, code is bundled with other services"
OT THERAPEUTIC ACTIV          ,34200155,CDM,430,RC,,,,,,Inpatient,,,364.65,364.65,HUMANA CHOICE PLUS,MGD,364.65,,,,,,,case rate,364.65,364.65,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,AETNA,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,BCBS,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,CIGNA,COM,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,TRICARE,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,UNITED HEALTHCARE,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,UNITED HEALTHCARE,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,VA,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,VA TRICARE,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,WELLMED,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,HUMANA,MGD,103.32,,,,,,,per diem,103.32,103.32,"Per diem rate, code is bundled with other services"
SENSORY INTEGRATION TECHN     ,34200156,CDM,430,RC,,,,,,Inpatient,,,103.32,103.32,HUMANA CHOICE PLUS,MGD,103.32,,,,,,,case rate,103.32,103.32,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,AETNA,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,BCBS,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,CIGNA,COM,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,TRICARE,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,UNITED HEALTHCARE,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,UNITED HEALTHCARE,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,VA,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,VA TRICARE,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,WELLMED,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,HUMANA,MGD,104.48,,,,,,,per diem,104.48,104.48,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200157,CDM,430,RC,,,,,,Inpatient,,,104.48,104.48,HUMANA CHOICE PLUS,MGD,104.48,,,,,,,case rate,104.48,104.48,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,AETNA,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,BCBS,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,CIGNA,COM,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,TRICARE,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,UNITED HEALTHCARE,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,UNITED HEALTHCARE,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,VA,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,VA TRICARE,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,WELLMED,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,HUMANA,MGD,195.1,,,,,,,per diem,195.1,195.1,"Per diem rate, code is bundled with other services"
OT ED/TRAIN SELF MGM          ,34200158,CDM,430,RC,,,,,,Inpatient,,,195.1,195.1,HUMANA CHOICE PLUS,MGD,195.1,,,,,,,case rate,195.1,195.1,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,AETNA,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,BCBS,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,CIGNA,COM,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,TRICARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,UNITED HEALTHCARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,UNITED HEALTHCARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,VA,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,VA TRICARE,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,WELLMED,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,HUMANA,MGD,39.65,,,,,,,per diem,39.65,39.65,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES 15      ,34200159,CDM,430,RC,,,,,,Inpatient,,,39.65,39.65,HUMANA CHOICE PLUS,MGD,39.65,,,,,,,case rate,39.65,39.65,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,AETNA,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,BCBS,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,CIGNA,COM,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,TRICARE,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,UNITED HEALTHCARE,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,UNITED HEALTHCARE,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,VA,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,VA TRICARE,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,WELLMED,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,HUMANA,MGD,174.2,,,,,,,per diem,174.2,174.2,"Per diem rate, code is bundled with other services"
THERAPEUTIC ACTIVITIES 15     ,34200160,CDM,430,RC,,,,,,Inpatient,,,174.2,174.2,HUMANA CHOICE PLUS,MGD,174.2,,,,,,,case rate,174.2,174.2,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,AETNA,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,BCBS,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,CIGNA,COM,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,TRICARE,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,UNITED HEALTHCARE,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,UNITED HEALTHCARE,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,VA,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,VA TRICARE,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,WELLMED,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,HUMANA,MGD,218.7,,,,,,,per diem,218.7,218.7,"Per diem rate, code is bundled with other services"
OT EQUIPMENT EVAL 15 MIN      ,34200161,CDM,430,RC,,,,,,Inpatient,,,218.7,218.7,HUMANA CHOICE PLUS,MGD,218.7,,,,,,,case rate,218.7,218.7,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,AETNA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,BCBS,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,CIGNA,COM,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,UNITED HEALTHCARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,VA,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,VA TRICARE,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,WELLMED,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA,MGD,92.06,,,,,,,per diem,92.06,92.06,"Per diem rate, code is bundled with other services"
OT ORTHO/PROSTH CHECK 15      ,34200162,CDM,430,RC,,,,,,Inpatient,,,92.06,92.06,HUMANA CHOICE PLUS,MGD,92.06,,,,,,,case rate,92.06,92.06,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,AETNA,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,BCBS,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,CIGNA,COM,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,TRICARE,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,UNITED HEALTHCARE,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,UNITED HEALTHCARE,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,VA,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,VA TRICARE,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,WELLMED,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,HUMANA,MGD,96.47,,,,,,,per diem,96.47,96.47,"Per diem rate, code is bundled with other services"
OT PATIENT CONFERENCE         ,34200163,CDM,430,RC,,,,,,Inpatient,,,96.47,96.47,HUMANA CHOICE PLUS,MGD,96.47,,,,,,,case rate,96.47,96.47,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,AETNA,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,BCBS,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,CIGNA,COM,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,TRICARE,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,UNITED HEALTHCARE,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,UNITED HEALTHCARE,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,VA,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,VA TRICARE,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,WELLMED,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,HUMANA,MGD,86.93,,,,,,,per diem,86.93,86.93,"Per diem rate, code is bundled with other services"
COGNITIVE SKILLS DEVELOPMENT  ,34200171,CDM,430,RC,G0515,CPT,G0515,HCPCS,,Inpatient,,,86.93,86.93,HUMANA CHOICE PLUS,MGD,86.93,,,,,,,case rate,86.93,86.93,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,AETNA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,CIGNA,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,VA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,VA TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,WELLMED,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,HUMANA,MGD,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
ORTH/PROSTH MGT/TRAIN SBSQ ENC,34200172,CDM,430,RC,97763,CPT,,,,Inpatient,,,131.9,131.9,HUMANA CHOICE PLUS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,AETNA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,CIGNA,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,VA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,VA TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,WELLMED,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,HUMANA,MGD,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34200173,CDM,430,RC,,,,,,Inpatient,,,79,79,HUMANA CHOICE PLUS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,AETNA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,CIGNA,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,VA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,VA TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,WELLMED,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA,MGD,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
HOT OR COLD PCKS              ,34200174,CDM,430,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA CHOICE PLUS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
TRACTION MECHANICAL           ,34200175,CDM,430,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,AETNA,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,BCBS,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,CIGNA,COM,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,TRICARE,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,UNITED HEALTHCARE,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,UNITED HEALTHCARE,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,VA,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,VA TRICARE,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,WELLMED,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,HUMANA,MGD,90.04,,,,,,,per diem,90.04,90.04,"Per diem rate, code is bundled with other services"
TRACTION                      ,34200177,CDM,430,RC,97012,CPT,,,GO,Inpatient,,,90.04,90.04,HUMANA CHOICE PLUS,MGD,90.04,,,,,,,case rate,90.04,90.04,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,AETNA,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,CIGNA,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,TRICARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,UNITED HEALTHCARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,UNITED HEALTHCARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,VA,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,VA TRICARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,WELLMED,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,HUMANA,MGD,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
GAIT TRAINING 15 MIN          ,34200178,CDM,430,RC,97116,CPT,,,GO,Inpatient,,,97.13,97.13,HUMANA CHOICE PLUS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,AETNA,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,BCBS,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,CIGNA,COM,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,TRICARE,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,UNITED HEALTHCARE,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,UNITED HEALTHCARE,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,VA,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,VA TRICARE,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,WELLMED,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,HUMANA,MGD,92.73,,,,,,,per diem,92.73,92.73,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34210000,CDM,430,RC,97755,CPT,,,GO,Inpatient,,,92.73,92.73,HUMANA CHOICE PLUS,MGD,92.73,,,,,,,case rate,92.73,92.73,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,AETNA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,CIGNA,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,VA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,VA TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,WELLMED,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA,MGD,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
WHIRLPOOL                     ,34210005,CDM,430,RC,97022,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA CHOICE PLUS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,AETNA,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,CIGNA,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,TRICARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,UNITED HEALTHCARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,UNITED HEALTHCARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,VA,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,VA TRICARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,WELLMED,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,HUMANA,MGD,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
IONTOPHORESIS 15 MIN          ,34210035,CDM,430,RC,97033,CPT,,,GO,Inpatient,,,153.3,153.3,HUMANA CHOICE PLUS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,AETNA,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,BCBS,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,CIGNA,COM,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,TRICARE,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,UNITED HEALTHCARE,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,UNITED HEALTHCARE,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,VA,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,VA TRICARE,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,WELLMED,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,HUMANA,MGD,91.74,,,,,,,per diem,91.74,91.74,"Per diem rate, code is bundled with other services"
ULTRASOUND 15 MIN             ,34210040,CDM,430,RC,97035,CPT,,,GO,Inpatient,,,91.74,91.74,HUMANA CHOICE PLUS,MGD,91.74,,,,,,,case rate,91.74,91.74,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,AETNA,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,BCBS,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,CIGNA,COM,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,TRICARE,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,UNITED HEALTHCARE,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,UNITED HEALTHCARE,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,VA,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,VA TRICARE,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,WELLMED,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,HUMANA,MGD,108.26,,,,,,,per diem,108.26,108.26,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34210053,CDM,430,RC,97129,CPT,,,GO,Inpatient,,,108.26,108.26,HUMANA CHOICE PLUS,MGD,108.26,,,,,,,case rate,108.26,108.26,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34210055,CDM,430,RC,97532,CPT,G0515,HCPCS,GOGO,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
WHEELCHAIR TRAINING 15 MIN    ,34210075,CDM,430,RC,97542,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34210090,CDM,430,RC,97537,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,AETNA,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,BCBS,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,CIGNA,COM,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,TRICARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,UNITED HEALTHCARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,UNITED HEALTHCARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,VA,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,VA TRICARE,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,WELLMED,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,HUMANA,MGD,90.58,,,,,,,per diem,90.58,90.58,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34210130,CDM,430,RC,97535,CPT,,,GO,Inpatient,,,90.58,90.58,HUMANA CHOICE PLUS,MGD,90.58,,,,,,,case rate,90.58,90.58,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
SELF CARE MGT TRAINING 15 MIN ,34210131,CDM,430,RC,97535,CPT,,,,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,AETNA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,BCBS,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,CIGNA,COM,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,UNITED HEALTHCARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,VA,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,VA TRICARE,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,WELLMED,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA,MGD,102.93,,,,,,,per diem,102.93,102.93,"Per diem rate, code is bundled with other services"
THER ACT DIRECT 15 MIN        ,34210150,CDM,430,RC,97530,CPT,,,GO,Inpatient,,,102.93,102.93,HUMANA CHOICE PLUS,MGD,102.93,,,,,,,case rate,102.93,102.93,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,AETNA,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,BCBS,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,CIGNA,COM,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,TRICARE,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,UNITED HEALTHCARE,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,UNITED HEALTHCARE,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,VA,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,VA TRICARE,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,WELLMED,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,HUMANA,MGD,50.47,,,,,,,per diem,50.47,50.47,"Per diem rate, code is bundled with other services"
ELEC STIM UNATTENDED          ,34210195,CDM,432,RC,97014,CPT,G0281,HCPCS,GO,Inpatient,,,50.47,50.47,HUMANA CHOICE PLUS,MGD,50.47,,,,,,,case rate,50.47,50.47,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,AETNA,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,BCBS,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,CIGNA,COM,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,TRICARE,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,UNITED HEALTHCARE,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,UNITED HEALTHCARE,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,VA,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,VA TRICARE,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,WELLMED,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,HUMANA,MGD,152.95,,,,,,,per diem,152.95,152.95,"Per diem rate, code is bundled with other services"
ELEC STIM ATTENDED 15 MIN     ,34210215,CDM,430,RC,97032,CPT,,,GO,Inpatient,,,152.95,152.95,HUMANA CHOICE PLUS,MGD,152.95,,,,,,,case rate,152.95,152.95,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
WHIRLPOOL HUBBARD TANK 15MIN  ,34210260,CDM,430,RC,97036,CPT,,,GO,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,AETNA,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,BCBS,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,CIGNA,COM,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,TRICARE,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,UNITED HEALTHCARE,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,UNITED HEALTHCARE,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,VA,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,VA TRICARE,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,WELLMED,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,HUMANA,MGD,148.53,,,,,,,per diem,148.53,148.53,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM STATIC ,34210265,CDM,430,RC,29125,CPT,,,GO,Inpatient,,,148.53,148.53,HUMANA CHOICE PLUS,MGD,148.53,,,,,,,case rate,148.53,148.53,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,AETNA,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,BCBS,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,CIGNA,COM,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,TRICARE,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,UNITED HEALTHCARE,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,UNITED HEALTHCARE,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,VA,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,VA TRICARE,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,WELLMED,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,HUMANA,MGD,164.15,,,,,,,per diem,164.15,164.15,"Per diem rate, code is bundled with other services"
APPLY SPLINT SHORT ARM DYNAM  ,34210270,CDM,430,RC,29126,CPT,,,GO,Inpatient,,,164.15,164.15,HUMANA CHOICE PLUS,MGD,164.15,,,,,,,case rate,164.15,164.15,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,AETNA,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,BCBS,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,CIGNA,COM,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,TRICARE,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,UNITED HEALTHCARE,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,UNITED HEALTHCARE,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,VA,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,VA TRICARE,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,WELLMED,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,HUMANA,MGD,117.06,,,,,,,per diem,117.06,117.06,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER STATIC    ,34210275,CDM,430,RC,29130,CPT,,,GO,Inpatient,,,117.06,117.06,HUMANA CHOICE PLUS,MGD,117.06,,,,,,,case rate,117.06,117.06,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,AETNA,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,BCBS,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,CIGNA,COM,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,TRICARE,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,UNITED HEALTHCARE,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,UNITED HEALTHCARE,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,VA,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,VA TRICARE,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,WELLMED,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,HUMANA,MGD,123.07,,,,,,,per diem,123.07,123.07,"Per diem rate, code is bundled with other services"
APPLY SPLINT FINGER DYNAM     ,34210280,CDM,430,RC,29131,CPT,,,GO,Inpatient,,,123.07,123.07,HUMANA CHOICE PLUS,MGD,123.07,,,,,,,case rate,123.07,123.07,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,AETNA,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,BCBS,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,CIGNA,COM,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,TRICARE,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,UNITED HEALTHCARE,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,UNITED HEALTHCARE,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,VA,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,VA TRICARE,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,WELLMED,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,HUMANA,MGD,127.32,,,,,,,per diem,127.32,127.32,"Per diem rate, code is bundled with other services"
STRAPPING SHOULDER            ,34210285,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,127.32,127.32,HUMANA CHOICE PLUS,MGD,127.32,,,,,,,case rate,127.32,127.32,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,AETNA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,BCBS,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,CIGNA,COM,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,UNITED HEALTHCARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,VA,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,VA TRICARE,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,WELLMED,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,HUMANA,MGD,146.19,,,,,,,per diem,146.19,146.19,"Per diem rate, code is bundled with other services"
STRAPPING ELBOW OR WRIST      ,34210290,CDM,430,RC,29260,CPT,,,GO,Inpatient,,,146.19,146.19,HUMANA CHOICE PLUS,MGD,146.19,,,,,,,case rate,146.19,146.19,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,AETNA,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,BCBS,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,CIGNA,COM,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,TRICARE,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,UNITED HEALTHCARE,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,UNITED HEALTHCARE,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,VA,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,VA TRICARE,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,WELLMED,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,HUMANA,MGD,127.25,,,,,,,per diem,127.25,127.25,"Per diem rate, code is bundled with other services"
MUSCLE TEST EXTREMITY/TRUNK   ,34210300,CDM,430,RC,95831,CPT,,,GO,Inpatient,,,127.25,127.25,HUMANA CHOICE PLUS,MGD,127.25,,,,,,,case rate,127.25,127.25,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,AETNA,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,BCBS,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,CIGNA,COM,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,TRICARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,UNITED HEALTHCARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,UNITED HEALTHCARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,VA,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,VA TRICARE,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,WELLMED,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,HUMANA,MGD,144.13,,,,,,,per diem,144.13,144.13,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/O HANDS    ,34210305,CDM,430,RC,95833,CPT,,,GO,Inpatient,,,144.13,144.13,HUMANA CHOICE PLUS,MGD,144.13,,,,,,,case rate,144.13,144.13,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,AETNA,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,BCBS,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,CIGNA,COM,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,TRICARE,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,UNITED HEALTHCARE,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,UNITED HEALTHCARE,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,VA,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,VA TRICARE,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,WELLMED,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,HUMANA,MGD,156.15,,,,,,,per diem,156.15,156.15,"Per diem rate, code is bundled with other services"
MUSCLE TEST BODY W/HANDS      ,34210310,CDM,430,RC,95834,CPT,,,GO,Inpatient,,,156.15,156.15,HUMANA CHOICE PLUS,MGD,156.15,,,,,,,case rate,156.15,156.15,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,AETNA,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,BCBS,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,CIGNA,COM,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,TRICARE,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,UNITED HEALTHCARE,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,UNITED HEALTHCARE,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,VA,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,VA TRICARE,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,WELLMED,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,HUMANA,MGD,64.9,,,,,,,per diem,64.9,64.9,"Per diem rate, code is bundled with other services"
ROM TESTING EXTREMITY/TRUNK   ,34210315,CDM,430,RC,95851,CPT,,,GO,Inpatient,,,64.9,64.9,HUMANA CHOICE PLUS,MGD,64.9,,,,,,,case rate,64.9,64.9,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,AETNA,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,BCBS,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,CIGNA,COM,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,TRICARE,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,UNITED HEALTHCARE,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,UNITED HEALTHCARE,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,VA,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,VA TRICARE,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,WELLMED,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,HUMANA,MGD,59.19,,,,,,,per diem,59.19,59.19,"Per diem rate, code is bundled with other services"
ROM TESTING HAND              ,34210320,CDM,430,RC,95852,CPT,,,GO,Inpatient,,,59.19,59.19,HUMANA CHOICE PLUS,MGD,59.19,,,,,,,case rate,59.19,59.19,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,AETNA,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,BCBS,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,CIGNA,COM,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,TRICARE,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,UNITED HEALTHCARE,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,UNITED HEALTHCARE,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,VA,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,VA TRICARE,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,WELLMED,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,HUMANA,MGD,64.73,,,,,,,per diem,64.73,64.73,"Per diem rate, code is bundled with other services"
MUSCLE TEST HAND              ,34210325,CDM,430,RC,95832,CPT,,,GO,Inpatient,,,64.73,64.73,HUMANA CHOICE PLUS,MGD,64.73,,,,,,,case rate,64.73,64.73,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,AETNA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,CIGNA,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,VA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,VA TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,WELLMED,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA,MGD,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
INFRARED                      ,34210330,CDM,430,RC,97026,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA CHOICE PLUS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,AETNA,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,BCBS,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,CIGNA,COM,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,TRICARE,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,UNITED HEALTHCARE,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,UNITED HEALTHCARE,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,VA,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,VA TRICARE,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,WELLMED,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,HUMANA,MGD,72.37,,,,,,,per diem,72.37,72.37,"Per diem rate, code is bundled with other services"
DIATHERMY                     ,34210335,CDM,430,RC,97024,CPT,,,GO,Inpatient,,,72.37,72.37,HUMANA CHOICE PLUS,MGD,72.37,,,,,,,case rate,72.37,72.37,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,AETNA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,CIGNA,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,VA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,VA TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,WELLMED,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA,MGD,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34210340,CDM,430,RC,96125,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA CHOICE PLUS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,AETNA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,CIGNA,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,VA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,VA TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,WELLMED,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA,MGD,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
AQUATIC THERAPY W/EXER 15 MIN ,34210345,CDM,430,RC,97113,CPT,,,GO,Inpatient,,,76.66,76.66,HUMANA CHOICE PLUS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,AETNA,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,BCBS,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,CIGNA,COM,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,TRICARE,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,UNITED HEALTHCARE,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,UNITED HEALTHCARE,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,VA,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,VA TRICARE,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,WELLMED,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,HUMANA,MGD,94.05,,,,,,,per diem,94.05,94.05,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORM TEST 15MIN   ,34210355,CDM,430,RC,97750,CPT,,,GO,Inpatient,,,94.05,94.05,HUMANA CHOICE PLUS,MGD,94.05,,,,,,,case rate,94.05,94.05,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,AETNA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,BCBS,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,CIGNA,COM,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,UNITED HEALTHCARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,VA,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,VA TRICARE,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,WELLMED,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,HUMANA,MGD,95.17,,,,,,,per diem,95.17,95.17,"Per diem rate, code is bundled with other services"
PROSTHETIC TRAIN - INITIAL    ,34210360,CDM,430,RC,97761,CPT,,,GO,Inpatient,,,95.17,95.17,HUMANA CHOICE PLUS,MGD,95.17,,,,,,,case rate,95.17,95.17,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,AETNA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,CIGNA,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,VA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,VA TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,WELLMED,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA,MGD,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34210365,CDM,430,RC,92610,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA CHOICE PLUS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,AETNA,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,BCBS,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,CIGNA,COM,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,TRICARE,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,UNITED HEALTHCARE,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,UNITED HEALTHCARE,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,VA,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,VA TRICARE,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,WELLMED,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,HUMANA,MGD,558.78,,,,,,,per diem,558.78,558.78,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWIN-RADIO-OPA   ,34210370,CDM,430,RC,92611,CPT,,,GO,Inpatient,,,558.78,558.78,HUMANA CHOICE PLUS,MGD,558.78,,,,,,,case rate,558.78,558.78,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,AETNA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,BCBS,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,CIGNA,COM,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,UNITED HEALTHCARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,VA,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,VA TRICARE,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,WELLMED,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA,MGD,292.38,,,,,,,per diem,292.38,292.38,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34210375,CDM,430,RC,92526,CPT,,,GO,Inpatient,,,292.38,292.38,HUMANA CHOICE PLUS,MGD,292.38,,,,,,,case rate,292.38,292.38,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,AETNA,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,BCBS,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,CIGNA,COM,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,TRICARE,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,UNITED HEALTHCARE,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,UNITED HEALTHCARE,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,VA,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,VA TRICARE,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,WELLMED,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,HUMANA,MGD,69.68,,,,,,,per diem,69.68,69.68,"Per diem rate, code is bundled with other services"
VASOPNEUMATIC DEVICES         ,34210380,CDM,430,RC,97016,CPT,,,GO,Inpatient,,,69.68,69.68,HUMANA CHOICE PLUS,MGD,69.68,,,,,,,case rate,69.68,69.68,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,AETNA,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,BCBS,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,CIGNA,COM,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,TRICARE,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,UNITED HEALTHCARE,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,UNITED HEALTHCARE,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,VA,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,VA TRICARE,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,WELLMED,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,HUMANA,MGD,76.19,,,,,,,per diem,76.19,76.19,"Per diem rate, code is bundled with other services"
CONTRAST BATH 15 MIN          ,34210385,CDM,430,RC,97034,CPT,,,GO,Inpatient,,,76.19,76.19,HUMANA CHOICE PLUS,MGD,76.19,,,,,,,case rate,76.19,76.19,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,AETNA,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,BCBS,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,CIGNA,COM,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,TRICARE,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,UNITED HEALTHCARE,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,UNITED HEALTHCARE,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,VA,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,VA TRICARE,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,WELLMED,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,HUMANA,MGD,79.23,,,,,,,per diem,79.23,79.23,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE 1ST 20 SQ CM ,34220001,CDM,430,RC,97597,CPT,,,GO,Inpatient,,,79.23,79.23,HUMANA CHOICE PLUS,MGD,79.23,,,,,,,case rate,79.23,79.23,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,AETNA,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,BCBS,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,CIGNA,COM,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,TRICARE,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,UNITED HEALTHCARE,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,UNITED HEALTHCARE,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,VA,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,VA TRICARE,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,WELLMED,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,HUMANA,MGD,201.38,,,,,,,per diem,201.38,201.38,"Per diem rate, code is bundled with other services"
SELECTIV DEBRIDE EA AD 20SQ CM,34220002,CDM,430,RC,97598,CPT,,,GO,Inpatient,,,201.38,201.38,HUMANA CHOICE PLUS,MGD,201.38,,,,,,,case rate,201.38,201.38,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,AETNA,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,BCBS,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,CIGNA,COM,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,TRICARE,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,UNITED HEALTHCARE,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,UNITED HEALTHCARE,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,VA,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,VA TRICARE,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,WELLMED,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,HUMANA,MGD,150.61,,,,,,,per diem,150.61,150.61,"Per diem rate, code is bundled with other services"
ORTHOTIC FIT/TRAIN -INITIAL   ,34250050,CDM,430,RC,97760,CPT,,,GO,Inpatient,,,150.61,150.61,HUMANA CHOICE PLUS,MGD,150.61,,,,,,,case rate,150.61,150.61,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,AETNA,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,BCBS,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,CIGNA,COM,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,TRICARE,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,UNITED HEALTHCARE,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,UNITED HEALTHCARE,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,VA,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,VA TRICARE,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,WELLMED,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,HUMANA,MGD,150.58,,,,,,,per diem,150.58,150.58,"Per diem rate, code is bundled with other services"
STRAPPING-SHOULDER            ,34250065,CDM,430,RC,29240,CPT,,,GO,Inpatient,,,150.58,150.58,HUMANA CHOICE PLUS,MGD,150.58,,,,,,,case rate,150.58,150.58,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,AETNA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,BCBS,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,CIGNA,COM,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,UNITED HEALTHCARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,VA,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,VA TRICARE,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,WELLMED,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,HUMANA,MGD,73.1,,,,,,,per diem,73.1,73.1,"Per diem rate, code is bundled with other services"
BIOFEEDBACK INCONT TRAINING   ,34250084,CDM,430,RC,90911,CPT,,,GO,Inpatient,,,73.1,73.1,HUMANA CHOICE PLUS,MGD,73.1,,,,,,,case rate,73.1,73.1,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,AETNA,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,CIGNA,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,TRICARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,UNITED HEALTHCARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,UNITED HEALTHCARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,VA,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,VA TRICARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,WELLMED,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,HUMANA,MGD,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
BIOFEEDBACK TRAINING          ,34250085,CDM,430,RC,90901,CPT,,,GO,Inpatient,,,100.83,100.83,HUMANA CHOICE PLUS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,AETNA,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,BCBS,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,CIGNA,COM,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,TRICARE,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,UNITED HEALTHCARE,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,UNITED HEALTHCARE,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,VA,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,VA TRICARE,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,WELLMED,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,HUMANA,MGD,379.85,,,,,,,per diem,379.85,379.85,"Per diem rate, code is bundled with other services"
OT EVALUATION LOW COMPLEXITY  ,34250127,CDM,434,RC,97165,CPT,,,GO,Inpatient,,,379.85,379.85,HUMANA CHOICE PLUS,MGD,379.85,,,,,,,case rate,379.85,379.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,AETNA,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,CIGNA,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,TRICARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,UNITED HEALTHCARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,UNITED HEALTHCARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,VA,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,VA TRICARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,WELLMED,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,HUMANA,MGD,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION MOD COMPLEXITY  ,34250128,CDM,434,RC,97166,CPT,,,GO,Inpatient,,,292.85,292.85,HUMANA CHOICE PLUS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,AETNA,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,BCBS,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,CIGNA,COM,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,TRICARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,UNITED HEALTHCARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,UNITED HEALTHCARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,VA,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,VA TRICARE,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,WELLMED,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,HUMANA,MGD,292.85,,,,,,,per diem,292.85,292.85,"Per diem rate, code is bundled with other services"
OT EVALUATION HIGH COMPLEXITY ,34250129,CDM,434,RC,97167,CPT,,,GO,Inpatient,,,292.85,292.85,HUMANA CHOICE PLUS,MGD,292.85,,,,,,,case rate,292.85,292.85,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,AETNA,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,BCBS,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,CIGNA,COM,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,TRICARE,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,UNITED HEALTHCARE,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,UNITED HEALTHCARE,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,VA,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,VA TRICARE,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,WELLMED,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,HUMANA,MGD,291.77,,,,,,,per diem,291.77,291.77,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY RE-EVAL       ,34250130,CDM,434,RC,97168,CPT,,,GO,Inpatient,,,291.77,291.77,HUMANA CHOICE PLUS,MGD,291.77,,,,,,,case rate,291.77,291.77,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,AETNA,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,BCBS,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,CIGNA,COM,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,TRICARE,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,UNITED HEALTHCARE,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,UNITED HEALTHCARE,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,VA,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,VA TRICARE,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,WELLMED,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,HUMANA,MGD,358,,,,,,,per diem,358,358,"Per diem rate, code is bundled with other services"
OT EVAL HIGH COMPLEXITY 60 MIN,34250131,CDM,430,RC,97167,CPT,,,,Inpatient,,,358,358,HUMANA CHOICE PLUS,MGD,358,,,,,,,case rate,358,358,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,AETNA,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,BCBS,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,CIGNA,COM,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,TRICARE,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,UNITED HEALTHCARE,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,UNITED HEALTHCARE,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,VA,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,VA TRICARE,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,WELLMED,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,HUMANA,MGD,286.8,,,,,,,per diem,286.8,286.8,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 15 MIN   ,34250135,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,286.8,286.8,HUMANA CHOICE PLUS,MGD,286.8,,,,,,,case rate,286.8,286.8,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,AETNA,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,BCBS,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,CIGNA,COM,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,TRICARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,UNITED HEALTHCARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,UNITED HEALTHCARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,VA,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,VA TRICARE,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,WELLMED,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,HUMANA,MGD,331.02,,,,,,,per diem,331.02,331.02,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 60 MIN   ,34250136,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,331.02,331.02,HUMANA CHOICE PLUS,MGD,331.02,,,,,,,case rate,331.02,331.02,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,AETNA,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,BCBS,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,CIGNA,COM,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,TRICARE,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,UNITED HEALTHCARE,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,UNITED HEALTHCARE,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,VA,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,VA TRICARE,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,WELLMED,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,HUMANA,MGD,335.61,,,,,,,per diem,335.61,335.61,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 30 MIN   ,34250137,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,335.61,335.61,HUMANA CHOICE PLUS,MGD,335.61,,,,,,,case rate,335.61,335.61,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,AETNA,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,BCBS,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,CIGNA,COM,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,TRICARE,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,UNITED HEALTHCARE,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,UNITED HEALTHCARE,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,VA,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,VA TRICARE,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,WELLMED,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,HUMANA,MGD,283.46,,,,,,,per diem,283.46,283.46,"Per diem rate, code is bundled with other services"
OCCUPAT THERAPY EVAL 45 MIN   ,34250138,CDM,434,RC,97003,CPT,,,GO,Inpatient,,,283.46,283.46,HUMANA CHOICE PLUS,MGD,283.46,,,,,,,case rate,283.46,283.46,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,AETNA,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,BCBS,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,CIGNA,COM,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,TRICARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,UNITED HEALTHCARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,UNITED HEALTHCARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,VA,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,VA TRICARE,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,WELLMED,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,HUMANA,MGD,184.23,,,,,,,per diem,184.23,184.23,"Per diem rate, code is bundled with other services"
TENS APPLY/EDUCATE            ,34299980,CDM,430,RC,64550,CPT,,,GO,Inpatient,,,184.23,184.23,HUMANA CHOICE PLUS,MGD,184.23,,,,,,,case rate,184.23,184.23,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,AETNA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,BCBS,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,CIGNA,COM,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,UNITED HEALTHCARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,VA,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,VA TRICARE,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,WELLMED,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA,MGD,98.03,,,,,,,per diem,98.03,98.03,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34299985,CDM,430,RC,98960,CPT,,,GO,Inpatient,,,98.03,98.03,HUMANA CHOICE PLUS,MGD,98.03,,,,,,,case rate,98.03,98.03,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,AETNA,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,BCBS,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,CIGNA,COM,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,TRICARE,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,UNITED HEALTHCARE,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,UNITED HEALTHCARE,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,VA,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,VA TRICARE,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,WELLMED,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,HUMANA,MGD,486.5,,,,,,,per diem,486.5,486.5,"Per diem rate, code is bundled with other services"
WORK HARDENING INIT 2 HRS     ,34299986,CDM,430,RC,97545,CPT,,,GO,Inpatient,,,486.5,486.5,HUMANA CHOICE PLUS,MGD,486.5,,,,,,,case rate,486.5,486.5,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,AETNA,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,BCBS,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,CIGNA,COM,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,TRICARE,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,UNITED HEALTHCARE,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,UNITED HEALTHCARE,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,VA,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,VA TRICARE,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,WELLMED,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,HUMANA,MGD,145.6,,,,,,,per diem,145.6,145.6,"Per diem rate, code is bundled with other services"
WORK HARDENING EA AD 30MIN    ,34299987,CDM,430,RC,97546,CPT,,,GO,Inpatient,,,145.6,145.6,HUMANA CHOICE PLUS,MGD,145.6,,,,,,,case rate,145.6,145.6,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,AETNA,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,BCBS,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,CIGNA,COM,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,TRICARE,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,UNITED HEALTHCARE,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,UNITED HEALTHCARE,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,VA,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,VA TRICARE,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,WELLMED,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,HUMANA,MGD,77.76,,,,,,,per diem,77.76,77.76,"Per diem rate, code is bundled with other services"
OCCUP THER UNLISTED 15 MIN    ,34299999,CDM,430,RC,97139,CPT,,,GO,Inpatient,,,77.76,77.76,HUMANA CHOICE PLUS,MGD,77.76,,,,,,,case rate,77.76,77.76,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,AETNA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,CIGNA,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,VA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,VA TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,WELLMED,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,HUMANA,MGD,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
THER INT COG FUNC 1ST 15 MIN  ,34600013,CDM,440,RC,97129,CPT,,,GN,Inpatient,,,103.95,103.95,HUMANA CHOICE PLUS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,AETNA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,CIGNA,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,VA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,VA TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,WELLMED,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,HUMANA,MGD,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
COGNITIVE TRAINING 15 MIN     ,34600016,CDM,440,RC,97532,CPT,G0515,HCPCS,GNGN,Inpatient,,,199.15,199.15,HUMANA CHOICE PLUS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,AETNA,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,BCBS,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,CIGNA,COM,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,TRICARE,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,UNITED HEALTHCARE,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,UNITED HEALTHCARE,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,VA,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,VA TRICARE,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,WELLMED,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,HUMANA,MGD,85.41,,,,,,,per diem,85.41,85.41,"Per diem rate, code is bundled with other services"
SENSORY STIMULATION 15 MIN    ,34600019,CDM,440,RC,97533,CPT,,,GN,Inpatient,,,85.41,85.41,HUMANA CHOICE PLUS,MGD,85.41,,,,,,,case rate,85.41,85.41,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,AETNA,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,BCBS,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,CIGNA,COM,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,TRICARE,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,UNITED HEALTHCARE,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,UNITED HEALTHCARE,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,VA,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,VA TRICARE,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,WELLMED,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,HUMANA,MGD,306.72,,,,,,,per diem,306.72,306.72,"Per diem rate, code is bundled with other services"
EVAL SPEECH FLUENCY           ,34600030,CDM,444,RC,92521,CPT,,,GN,Inpatient,,,306.72,306.72,HUMANA CHOICE PLUS,MGD,306.72,,,,,,,case rate,306.72,306.72,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,AETNA,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,BCBS,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,CIGNA,COM,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,TRICARE,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,UNITED HEALTHCARE,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,UNITED HEALTHCARE,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,VA,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,VA TRICARE,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,WELLMED,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,HUMANA,MGD,426,,,,,,,per diem,426,426,"Per diem rate, code is bundled with other services"
EVAL SPEECH SOUND PRODUCTION  ,34600031,CDM,440,RC,92522,CPT,,,GN,Inpatient,,,426,426,HUMANA CHOICE PLUS,MGD,426,,,,,,,case rate,426,426,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,AETNA,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,BCBS,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,CIGNA,COM,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,TRICARE,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,UNITED HEALTHCARE,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,UNITED HEALTHCARE,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,VA,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,VA TRICARE,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,WELLMED,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,HUMANA,MGD,419.23,,,,,,,per diem,419.23,419.23,"Per diem rate, code is bundled with other services"
EVAL SOUND PROD/LANG CMP EXP  ,34600032,CDM,440,RC,92523,CPT,,,GN,Inpatient,,,419.23,419.23,HUMANA CHOICE PLUS,MGD,419.23,,,,,,,case rate,419.23,419.23,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,AETNA,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,BCBS,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,CIGNA,COM,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,TRICARE,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,UNITED HEALTHCARE,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,UNITED HEALTHCARE,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,VA,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,VA TRICARE,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,WELLMED,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,HUMANA,MGD,314.39,,,,,,,per diem,314.39,314.39,"Per diem rate, code is bundled with other services"
BEH QUAL ANALYSIS VOICE/RESON ,34600034,CDM,440,RC,92524,CPT,,,GN,Inpatient,,,314.39,314.39,HUMANA CHOICE PLUS,MGD,314.39,,,,,,,case rate,314.39,314.39,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,AETNA,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,BCBS,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,CIGNA,COM,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,TRICARE,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,UNITED HEALTHCARE,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,UNITED HEALTHCARE,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,VA,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,VA TRICARE,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,WELLMED,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,HUMANA,MGD,418.23,,,,,,,per diem,418.23,418.23,"Per diem rate, code is bundled with other services"
TX SWALLOWING/ORAL DYSFUN     ,34600120,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,418.23,418.23,HUMANA CHOICE PLUS,MGD,418.23,,,,,,,case rate,418.23,418.23,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,AETNA,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,BCBS,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,CIGNA,COM,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,TRICARE,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,UNITED HEALTHCARE,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,UNITED HEALTHCARE,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,VA,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,VA TRICARE,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,WELLMED,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,HUMANA,MGD,94.86,,,,,,,per diem,94.86,94.86,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 15 MIN     ,34600134,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,94.86,94.86,HUMANA CHOICE PLUS,MGD,94.86,,,,,,,case rate,94.86,94.86,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,AETNA,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,CIGNA,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,TRICARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,UNITED HEALTHCARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,UNITED HEALTHCARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,VA,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,VA TRICARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,WELLMED,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,HUMANA,MGD,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 30 MIN     ,34600135,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,380.1,380.1,HUMANA CHOICE PLUS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,AETNA,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,BCBS,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,CIGNA,COM,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,TRICARE,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,UNITED HEALTHCARE,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,UNITED HEALTHCARE,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,VA,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,VA TRICARE,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,WELLMED,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,HUMANA,MGD,153.36,,,,,,,per diem,153.36,153.36,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 45 MIN     ,34600136,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,153.36,153.36,HUMANA CHOICE PLUS,MGD,153.36,,,,,,,case rate,153.36,153.36,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,AETNA,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,BCBS,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,CIGNA,COM,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,TRICARE,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,UNITED HEALTHCARE,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,UNITED HEALTHCARE,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,VA,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,VA TRICARE,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,WELLMED,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,HUMANA,MGD,369.03,,,,,,,per diem,369.03,369.03,"Per diem rate, code is bundled with other services"
SPEECH GROUP TRTMT 60 MIN     ,34600137,CDM,443,RC,92508,CPT,,,GN,Inpatient,,,369.03,369.03,HUMANA CHOICE PLUS,MGD,369.03,,,,,,,case rate,369.03,369.03,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,AETNA,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,BCBS,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,CIGNA,COM,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,TRICARE,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,UNITED HEALTHCARE,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,UNITED HEALTHCARE,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,VA,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,VA TRICARE,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,WELLMED,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,HUMANA,MGD,72.25,,,,,,,per diem,72.25,72.25,"Per diem rate, code is bundled with other services"
SELF CARE/HOME MGT 15 MIN     ,34600141,CDM,440,RC,97535,CPT,,,GN,Inpatient,,,72.25,72.25,HUMANA CHOICE PLUS,MGD,72.25,,,,,,,case rate,72.25,72.25,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,AETNA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,CIGNA,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,VA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,VA TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,WELLMED,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,HUMANA,MGD,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 15 MIN    ,34600145,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,HUMANA CHOICE PLUS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,AETNA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,CIGNA,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,VA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,VA TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,WELLMED,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,HUMANA,MGD,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 30 MIN    ,34600146,CDM,440,RC,92522,CPT,,,,Inpatient,,,199.15,199.15,HUMANA CHOICE PLUS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,AETNA,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,BCBS,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,CIGNA,COM,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,TRICARE,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,UNITED HEALTHCARE,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,UNITED HEALTHCARE,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,VA,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,VA TRICARE,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,WELLMED,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,HUMANA,MGD,298.42,,,,,,,per diem,298.42,298.42,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 45 MIN    ,34600147,CDM,440,RC,92522,CPT,,,,Inpatient,,,298.42,298.42,HUMANA CHOICE PLUS,MGD,298.42,,,,,,,case rate,298.42,298.42,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,AETNA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,CIGNA,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,VA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,VA TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,WELLMED,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,HUMANA,MGD,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
SPEECH/HEARING EVAL 60 MIN    ,34600148,CDM,440,RC,92522,CPT,,,,Inpatient,,,398.31,398.31,HUMANA CHOICE PLUS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,AETNA,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,BCBS,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,CIGNA,COM,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,TRICARE,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,UNITED HEALTHCARE,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,UNITED HEALTHCARE,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,VA,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,VA TRICARE,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,WELLMED,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,HUMANA,MGD,191.38,,,,,,,per diem,191.38,191.38,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600149,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,191.38,191.38,HUMANA CHOICE PLUS,MGD,191.38,,,,,,,case rate,191.38,191.38,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,AETNA,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,BCBS,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,CIGNA,COM,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,TRICARE,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,UNITED HEALTHCARE,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,UNITED HEALTHCARE,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,VA,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,VA TRICARE,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,WELLMED,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,HUMANA,MGD,164.81,,,,,,,per diem,164.81,164.81,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 30 MIN      ,34600150,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,164.81,164.81,HUMANA CHOICE PLUS,MGD,164.81,,,,,,,case rate,164.81,164.81,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,AETNA,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,BCBS,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,CIGNA,COM,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,TRICARE,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,UNITED HEALTHCARE,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,UNITED HEALTHCARE,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,VA,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,VA TRICARE,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,WELLMED,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,HUMANA,MGD,254.61,,,,,,,per diem,254.61,254.61,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 45 MIN      ,34600151,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,254.61,254.61,HUMANA CHOICE PLUS,MGD,254.61,,,,,,,case rate,254.61,254.61,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,AETNA,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,BCBS,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,CIGNA,COM,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,TRICARE,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,UNITED HEALTHCARE,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,UNITED HEALTHCARE,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,VA,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,VA TRICARE,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,WELLMED,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,HUMANA,MGD,260.04,,,,,,,per diem,260.04,260.04,"Per diem rate, code is bundled with other services"
DYSPHAGIA THERAPY 60 MIN      ,34600152,CDM,440,RC,92526,CPT,,,GN,Inpatient,,,260.04,260.04,HUMANA CHOICE PLUS,MGD,260.04,,,,,,,case rate,260.04,260.04,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,AETNA,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,BCBS,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,CIGNA,COM,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,TRICARE,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,UNITED HEALTHCARE,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,UNITED HEALTHCARE,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,VA,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,VA TRICARE,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,WELLMED,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,HUMANA,MGD,375.45,,,,,,,per diem,375.45,375.45,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 15 MIN   ,34600153,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,375.45,375.45,HUMANA CHOICE PLUS,MGD,375.45,,,,,,,case rate,375.45,375.45,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,AETNA,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,BCBS,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,CIGNA,COM,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,TRICARE,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,UNITED HEALTHCARE,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,UNITED HEALTHCARE,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,VA,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,VA TRICARE,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,WELLMED,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,HUMANA,MGD,386.18,,,,,,,per diem,386.18,386.18,"Per diem rate, code is bundled with other services"
CLIN SWALL/DYSPH EVAL 15 MIN  ,34600154,CDM,444,RC,92610,CPT,,,,Inpatient,,,386.18,386.18,HUMANA CHOICE PLUS,MGD,386.18,,,,,,,case rate,386.18,386.18,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,AETNA,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,BCBS,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,CIGNA,COM,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,TRICARE,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,UNITED HEALTHCARE,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,UNITED HEALTHCARE,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,VA,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,VA TRICARE,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,WELLMED,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,HUMANA,MGD,130.39,,,,,,,per diem,130.39,130.39,"Per diem rate, code is bundled with other services"
THERAPEUTIC EXERCISES         ,34600155,CDM,440,RC,97110,CPT,,,,Inpatient,,,130.39,130.39,HUMANA CHOICE PLUS,MGD,130.39,,,,,,,case rate,130.39,130.39,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,AETNA,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,BCBS,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,CIGNA,COM,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,TRICARE,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,UNITED HEALTHCARE,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,UNITED HEALTHCARE,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,VA,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,VA TRICARE,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,WELLMED,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,HUMANA,MGD,159.79,,,,,,,per diem,159.79,159.79,"Per diem rate, code is bundled with other services"
SPEECH/LANG THERAPY 30 MIN    ,34600156,CDM,440,RC,92507,CPT,,,,Inpatient,,,159.79,159.79,HUMANA CHOICE PLUS,MGD,159.79,,,,,,,case rate,159.79,159.79,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,AETNA,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,BCBS,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,CIGNA,COM,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,TRICARE,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,UNITED HEALTHCARE,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,UNITED HEALTHCARE,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,VA,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,VA TRICARE,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,WELLMED,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,HUMANA,MGD,297.17,,,,,,,per diem,297.17,297.17,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 45 MIN   ,34600157,CDM,440,RC,92507,CPT,,,,Inpatient,,,297.17,297.17,HUMANA CHOICE PLUS,MGD,297.17,,,,,,,case rate,297.17,297.17,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,AETNA,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,BCBS,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,CIGNA,COM,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,TRICARE,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,UNITED HEALTHCARE,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,UNITED HEALTHCARE,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,VA,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,VA TRICARE,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,WELLMED,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,HUMANA,MGD,278.72,,,,,,,per diem,278.72,278.72,"Per diem rate, code is bundled with other services"
SPEECH/LANGUAGE THER 60 MIN   ,34600158,CDM,440,RC,92507,CPT,,,,Inpatient,,,278.72,278.72,HUMANA CHOICE PLUS,MGD,278.72,,,,,,,case rate,278.72,278.72,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,AETNA,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,BCBS,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,CIGNA,COM,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,TRICARE,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,UNITED HEALTHCARE,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,UNITED HEALTHCARE,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,VA,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,VA TRICARE,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,WELLMED,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,HUMANA,MGD,439.66,,,,,,,per diem,439.66,439.66,"Per diem rate, code is bundled with other services"
BEDSIDE SWALLOW/FUNCTION EVAL ,34600159,CDM,444,RC,,,,,,Inpatient,,,439.66,439.66,HUMANA CHOICE PLUS,MGD,439.66,,,,,,,case rate,439.66,439.66,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,AETNA,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,BCBS,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,CIGNA,COM,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,TRICARE,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,UNITED HEALTHCARE,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,UNITED HEALTHCARE,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,VA,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,VA TRICARE,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,WELLMED,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,HUMANA,MGD,234.48,,,,,,,per diem,234.48,234.48,"Per diem rate, code is bundled with other services"
EVAL SPEECH PRODUCTION 60 MIN ,34600160,CDM,444,RC,,,,,,Inpatient,,,234.48,234.48,HUMANA CHOICE PLUS,MGD,234.48,,,,,,,case rate,234.48,234.48,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 75 MIN ,34600161,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 60 MIN ,34600162,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 45 MIN ,34600163,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
SPEECH SOUND LANG COMP 30 MIN ,34600164,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 30 MIN          ,34600165,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 45 MIN          ,34600166,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,AETNA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,BCBS,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,CIGNA,COM,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,UNITED HEALTHCARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,VA TRICARE,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,WELLMED,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA,MGD,484.44,,,,,,,per diem,484.44,484.44,"Per diem rate, code is bundled with other services"
ST EVALUATION 60 MIN          ,34600167,CDM,444,RC,,,,,,Inpatient,,,484.44,484.44,HUMANA CHOICE PLUS,MGD,484.44,,,,,,,case rate,484.44,484.44,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,AETNA,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,BCBS,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,CIGNA,COM,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,TRICARE,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,UNITED HEALTHCARE,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,UNITED HEALTHCARE,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,VA,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,VA TRICARE,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,WELLMED,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,HUMANA,MGD,175.99,,,,,,,per diem,175.99,175.99,"Per diem rate, code is bundled with other services"
SPEECH DEVICE ADAPTATION/TRAIN,34600168,CDM,440,RC,92609,CPT,,,,Inpatient,,,175.99,175.99,HUMANA CHOICE PLUS,MGD,175.99,,,,,,,case rate,175.99,175.99,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,AETNA,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,BCBS,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,CIGNA,COM,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,TRICARE,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,UNITED HEALTHCARE,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,UNITED HEALTHCARE,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,VA,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,VA TRICARE,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,WELLMED,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,HUMANA,MGD,159.41,,,,,,,per diem,159.41,159.41,"Per diem rate, code is bundled with other services"
ELECTRICAL MUSCLE STIMULATION ,34600169,CDM,440,RC,92609,CPT,,,,Inpatient,,,159.41,159.41,HUMANA CHOICE PLUS,MGD,159.41,,,,,,,case rate,159.41,159.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,AETNA,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,BCBS,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,CIGNA,COM,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,TRICARE,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,UNITED HEALTHCARE,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,UNITED HEALTHCARE,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,VA,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,VA TRICARE,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,WELLMED,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,HUMANA,MGD,150.41,,,,,,,per diem,150.41,150.41,"Per diem rate, code is bundled with other services"
ELECTRODES                    ,34600170,CDM,440,RC,A4556,HCPCS,,,,Inpatient,,,150.41,150.41,HUMANA CHOICE PLUS,MGD,150.41,,,,,,,case rate,150.41,150.41,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,AETNA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,BCBS,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,CIGNA,COM,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,UNITED HEALTHCARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,VA,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,VA TRICARE,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,WELLMED,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA,MGD,69.46,,,,,,,per diem,69.46,69.46,"Per diem rate, code is bundled with other services"
SPL PATIENT CONFERENCE        ,34600174,CDM,440,RC,,,,,,Inpatient,,,69.46,69.46,HUMANA CHOICE PLUS,MGD,69.46,,,,,,,case rate,69.46,69.46,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,AETNA,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,BCBS,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,CIGNA,COM,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,TRICARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,UNITED HEALTHCARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,UNITED HEALTHCARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,VA,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,VA TRICARE,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,WELLMED,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,HUMANA,MGD,60.64,,,,,,,per diem,60.64,60.64,"Per diem rate, code is bundled with other services"
SPEEH/HEARING THERAPHY 15 MIN ,34600179,CDM,440,RC,,,,,,Inpatient,,,60.64,60.64,HUMANA CHOICE PLUS,MGD,60.64,,,,,,,case rate,60.64,60.64,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,AETNA,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,BCBS,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,CIGNA,COM,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,TRICARE,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,UNITED HEALTHCARE,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,UNITED HEALTHCARE,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,VA,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,VA TRICARE,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,WELLMED,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,HUMANA,MGD,96.03,,,,,,,per diem,96.03,96.03,"Per diem rate, code is bundled with other services"
COGNITIVE INITIAL 15 MIN      ,34600180,CDM,440,RC,97129,CPT,,,,Inpatient,,,96.03,96.03,HUMANA CHOICE PLUS,MGD,96.03,,,,,,,case rate,96.03,96.03,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,AETNA,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,CIGNA,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,TRICARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,UNITED HEALTHCARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,UNITED HEALTHCARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,VA,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,VA TRICARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,WELLMED,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,HUMANA,MGD,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING-RADIO-OPA  ,34600181,CDM,440,RC,92611,CPT,,,GN,Inpatient,,,394.22,394.22,HUMANA CHOICE PLUS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,AETNA,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,BCBS,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,CIGNA,COM,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,TRICARE,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,UNITED HEALTHCARE,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,UNITED HEALTHCARE,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,VA,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,VA TRICARE,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,WELLMED,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,HUMANA,MGD,91.46,,,,,,,per diem,91.46,91.46,"Per diem rate, code is bundled with other services"
COGNITIVE ADDITIONAL 15 MIN   ,34600182,CDM,440,RC,97130,CPT,,,,Inpatient,,,91.46,91.46,HUMANA CHOICE PLUS,MGD,91.46,,,,,,,case rate,91.46,91.46,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,AETNA,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,BCBS,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,CIGNA,COM,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,TRICARE,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,UNITED HEALTHCARE,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,UNITED HEALTHCARE,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,VA,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,VA TRICARE,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,WELLMED,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,HUMANA,MGD,94.2,,,,,,,per diem,94.2,94.2,"Per diem rate, code is bundled with other services"
COG TREAT 15M MEDICA          ,34600183,CDM,440,RC,,,,,,Inpatient,,,94.2,94.2,HUMANA CHOICE PLUS,MGD,94.2,,,,,,,case rate,94.2,94.2,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,AETNA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,CIGNA,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,VA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,VA TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,WELLMED,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,HUMANA,MGD,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING NONMC            ,34600184,CDM,440,RC,,,,,,Inpatient,,,79,79,HUMANA CHOICE PLUS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,AETNA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,BCBS,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,CIGNA,COM,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,UNITED HEALTHCARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,VA,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,VA TRICARE,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,WELLMED,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,HUMANA,MGD,79,,,,,,,per diem,79,79,"Per diem rate, code is bundled with other services"
COG TRAINING MC 15M           ,34600185,CDM,440,RC,,,,,,Inpatient,,,79,79,HUMANA CHOICE PLUS,MGD,79,,,,,,,case rate,79,79,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,AETNA,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,BCBS,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,CIGNA,COM,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,TRICARE,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,UNITED HEALTHCARE,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,UNITED HEALTHCARE,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,VA,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,VA TRICARE,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,WELLMED,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,HUMANA,MGD,104.74,,,,,,,per diem,104.74,104.74,"Per diem rate, code is bundled with other services"
THER SVCS NON SP GEN          ,34600186,CDM,440,RC,,,,,,Inpatient,,,104.74,104.74,HUMANA CHOICE PLUS,MGD,104.74,,,,,,,case rate,104.74,104.74,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,AETNA,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,BCBS,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,CIGNA,COM,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,TRICARE,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,UNITED HEALTHCARE,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,UNITED HEALTHCARE,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,VA,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,VA TRICARE,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,WELLMED,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,HUMANA,MGD,92.14,,,,,,,per diem,92.14,92.14,"Per diem rate, code is bundled with other services"
VESTIBULAR REHAB              ,34600187,CDM,440,RC,95992,CPT,,,GN,Inpatient,,,92.14,92.14,HUMANA CHOICE PLUS,MGD,92.14,,,,,,,case rate,92.14,92.14,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,AETNA,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,BCBS,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,CIGNA,COM,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,TRICARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,UNITED HEALTHCARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,UNITED HEALTHCARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,VA,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,VA TRICARE,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,WELLMED,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,HUMANA,MGD,118.39,,,,,,,per diem,118.39,118.39,"Per diem rate, code is bundled with other services"
TEST PHYSICAL PERFORM 15 MIN  ,34600188,CDM,440,RC,97750,CPT,,,GN,Inpatient,,,118.39,118.39,HUMANA CHOICE PLUS,MGD,118.39,,,,,,,case rate,118.39,118.39,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,AETNA,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,BCBS,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,CIGNA,COM,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,TRICARE,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,UNITED HEALTHCARE,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,UNITED HEALTHCARE,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,VA,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,VA TRICARE,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,WELLMED,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,HUMANA,MGD,91.09,,,,,,,per diem,91.09,91.09,"Per diem rate, code is bundled with other services"
OTHOTIC FIT/TRAIN SUBSEQ15MIN ,34600189,CDM,440,RC,97763,CPT,,,GN,Inpatient,,,91.09,91.09,HUMANA CHOICE PLUS,MGD,91.09,,,,,,,case rate,91.09,91.09,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,AETNA,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,CIGNA,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,TRICARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,UNITED HEALTHCARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,UNITED HEALTHCARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,VA,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,VA TRICARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,WELLMED,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,HUMANA,MGD,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
MOD OF PROSTH COMMUN DEVICE   ,34600280,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,HUMANA CHOICE PLUS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,AETNA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,BCBS,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,CIGNA,COM,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,UNITED HEALTHCARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,VA,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,VA TRICARE,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,WELLMED,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,HUMANA,MGD,199.15,,,,,,,per diem,199.15,199.15,"Per diem rate, code is bundled with other services"
SPEECH LANGUAGE TREATMENT     ,34600290,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,199.15,199.15,HUMANA CHOICE PLUS,MGD,199.15,,,,,,,case rate,199.15,199.15,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,AETNA,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,BCBS,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,CIGNA,COM,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,TRICARE,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,UNITED HEALTHCARE,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,UNITED HEALTHCARE,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,VA,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,VA TRICARE,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,WELLMED,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,HUMANA,MGD,698.38,,,,,,,per diem,698.38,698.38,"Per diem rate, code is bundled with other services"
FIBEROPTIC EVAL SWALLOWING    ,34600400,CDM,440,RC,92612,CPT,,,GN,Inpatient,,,698.38,698.38,HUMANA CHOICE PLUS,MGD,698.38,,,,,,,case rate,698.38,698.38,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,AETNA,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,BCBS,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,CIGNA,COM,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,TRICARE,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,UNITED HEALTHCARE,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,UNITED HEALTHCARE,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,VA,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,VA TRICARE,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,WELLMED,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,HUMANA,MGD,188.01,,,,,,,per diem,188.01,188.01,"Per diem rate, code is bundled with other services"
FIBEROPTIC LARYNG SENSORY TEST,34600410,CDM,440,RC,92614,CPT,,,GN,Inpatient,,,188.01,188.01,HUMANA CHOICE PLUS,MGD,188.01,,,,,,,case rate,188.01,188.01,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,AETNA,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,BCBS,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,CIGNA,COM,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,TRICARE,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,UNITED HEALTHCARE,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,UNITED HEALTHCARE,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,VA,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,VA TRICARE,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,WELLMED,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,HUMANA,MGD,314,,,,,,,per diem,314,314,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 15 MIN ,34600420,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,314,314,HUMANA CHOICE PLUS,MGD,314,,,,,,,case rate,314,314,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,AETNA,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,BCBS,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,CIGNA,COM,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,TRICARE,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,UNITED HEALTHCARE,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,UNITED HEALTHCARE,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,VA,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,VA TRICARE,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,WELLMED,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,HUMANA,MGD,270.71,,,,,,,per diem,270.71,270.71,"Per diem rate, code is bundled with other services"
EVAL OF SWALLOWING BLUE DYE   ,34600421,CDM,440,RC,92610,CPT,,,GN,Inpatient,,,270.71,270.71,HUMANA CHOICE PLUS,MGD,270.71,,,,,,,case rate,270.71,270.71,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,AETNA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,CIGNA,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,VA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,VA TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,WELLMED,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,HUMANA,MGD,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 30 MIN ,34600422,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,HUMANA CHOICE PLUS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,AETNA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,BCBS,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,CIGNA,COM,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,UNITED HEALTHCARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,VA,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,VA TRICARE,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,WELLMED,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,HUMANA,MGD,398.31,,,,,,,per diem,398.31,398.31,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 45 MIN ,34600423,CDM,440,RC,92610,CPT,,,,Inpatient,,,398.31,398.31,HUMANA CHOICE PLUS,MGD,398.31,,,,,,,case rate,398.31,398.31,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,AETNA,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,BCBS,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,CIGNA,COM,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,TRICARE,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,UNITED HEALTHCARE,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,UNITED HEALTHCARE,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,VA,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,VA TRICARE,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,WELLMED,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,HUMANA,MGD,430.88,,,,,,,per diem,430.88,430.88,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/ORAL FUNC 60 MIN ,34600424,CDM,440,RC,,,,,,Inpatient,,,430.88,430.88,HUMANA CHOICE PLUS,MGD,430.88,,,,,,,case rate,430.88,430.88,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,AETNA,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,BCBS,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,CIGNA,COM,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,TRICARE,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,UNITED HEALTHCARE,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,UNITED HEALTHCARE,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,VA,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,VA TRICARE,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,WELLMED,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,HUMANA,MGD,382.75,,,,,,,per diem,382.75,382.75,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE 1ST HR     ,34600440,CDM,444,RC,92607,CPT,,,GN,Inpatient,,,382.75,382.75,HUMANA CHOICE PLUS,MGD,382.75,,,,,,,case rate,382.75,382.75,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,AETNA,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,BCBS,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,CIGNA,COM,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,TRICARE,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,UNITED HEALTHCARE,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,UNITED HEALTHCARE,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,VA,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,VA TRICARE,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,WELLMED,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,HUMANA,MGD,148.08,,,,,,,per diem,148.08,148.08,"Per diem rate, code is bundled with other services"
EVAL SPEECH DEVICE ADDL 30 MIN,34600445,CDM,444,RC,92608,CPT,,,GN,Inpatient,,,148.08,148.08,HUMANA CHOICE PLUS,MGD,148.08,,,,,,,case rate,148.08,148.08,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,AETNA,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,BCBS,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,CIGNA,COM,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,TRICARE,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,UNITED HEALTHCARE,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,UNITED HEALTHCARE,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,VA,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,VA TRICARE,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,WELLMED,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,HUMANA,MGD,168.92,,,,,,,per diem,168.92,168.92,"Per diem rate, code is bundled with other services"
THERAPY SPEECH GEN DEVICE     ,34600450,CDM,440,RC,92609,CPT,,,GN,Inpatient,,,168.92,168.92,HUMANA CHOICE PLUS,MGD,168.92,,,,,,,case rate,168.92,168.92,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,AETNA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,CIGNA,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,VA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,VA TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,WELLMED,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,HUMANA,MGD,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
ASSISTIVE TECH ASSESS 15 MIN  ,34600500,CDM,440,RC,97755,CPT,,,GN,Inpatient,,,103.95,103.95,HUMANA CHOICE PLUS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,AETNA,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,BCBS,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,CIGNA,COM,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,TRICARE,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,UNITED HEALTHCARE,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,UNITED HEALTHCARE,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,VA,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,VA TRICARE,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,WELLMED,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,HUMANA,MGD,301.59,,,,,,,per diem,301.59,301.59,"Per diem rate, code is bundled with other services"
EVAL SWALLOW/LARYN SENSORY    ,34600505,CDM,440,RC,92616,CPT,,,GN,Inpatient,,,301.59,301.59,HUMANA CHOICE PLUS,MGD,301.59,,,,,,,case rate,301.59,301.59,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,AETNA,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,BCBS,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,CIGNA,COM,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,TRICARE,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,UNITED HEALTHCARE,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,UNITED HEALTHCARE,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,VA,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,VA TRICARE,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,WELLMED,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,HUMANA,MGD,156.24,,,,,,,per diem,156.24,156.24,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING LIMITED   ,34600510,CDM,440,RC,96110,CPT,,,GN,Inpatient,,,156.24,156.24,HUMANA CHOICE PLUS,MGD,156.24,,,,,,,case rate,156.24,156.24,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,AETNA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,BCBS,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,CIGNA,COM,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,UNITED HEALTHCARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,VA,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,VA TRICARE,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,WELLMED,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,HUMANA,MGD,76.66,,,,,,,per diem,76.66,76.66,"Per diem rate, code is bundled with other services"
DEVELOPMENT TESTING EXTEND    ,34600515,CDM,440,RC,96111,CPT,,,GN,Inpatient,,,76.66,76.66,HUMANA CHOICE PLUS,MGD,76.66,,,,,,,case rate,76.66,76.66,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,AETNA,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,CIGNA,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,TRICARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,UNITED HEALTHCARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,UNITED HEALTHCARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,VA,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,VA TRICARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,WELLMED,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,HUMANA,MGD,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
COMM/WORK REINTEG 15 MIN      ,34600525,CDM,440,RC,97537,CPT,,,GN,Inpatient,,,119.9,119.9,HUMANA CHOICE PLUS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,AETNA,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,BCBS,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,CIGNA,COM,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,TRICARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,UNITED HEALTHCARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,UNITED HEALTHCARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,VA,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,VA TRICARE,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,WELLMED,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,HUMANA,MGD,119.9,,,,,,,per diem,119.9,119.9,"Per diem rate, code is bundled with other services"
STANDARD COGNITIVE TEST PER HR,34600530,CDM,440,RC,96125,CPT,,,GN,Inpatient,,,119.9,119.9,HUMANA CHOICE PLUS,MGD,119.9,,,,,,,case rate,119.9,119.9,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,AETNA,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,BCBS,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,CIGNA,COM,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,TRICARE,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,UNITED HEALTHCARE,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,UNITED HEALTHCARE,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,VA,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,VA TRICARE,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,WELLMED,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,HUMANA,MGD,370.15,,,,,,,per diem,370.15,370.15,"Per diem rate, code is bundled with other services"
EVAL OF PROSTH COMM DEVICE    ,34610010,CDM,440,RC,92597,CPT,,,GN,Inpatient,,,370.15,370.15,HUMANA CHOICE PLUS,MGD,370.15,,,,,,,case rate,370.15,370.15,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,AETNA,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,BCBS,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,CIGNA,COM,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,TRICARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,UNITED HEALTHCARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,UNITED HEALTHCARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,VA,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,VA TRICARE,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,WELLMED,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,HUMANA,MGD,394.22,,,,,,,per diem,394.22,394.22,"Per diem rate, code is bundled with other services"
EVAL APHASIA PER HR           ,34650005,CDM,440,RC,96105,CPT,,,GN,Inpatient,,,394.22,394.22,HUMANA CHOICE PLUS,MGD,394.22,,,,,,,case rate,394.22,394.22,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,AETNA,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,BCBS,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,CIGNA,COM,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,TRICARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,UNITED HEALTHCARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,UNITED HEALTHCARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,VA,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,VA TRICARE,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,WELLMED,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,HUMANA,MGD,222.85,,,,,,,per diem,222.85,222.85,"Per diem rate, code is bundled with other services"
AURAL REHAB INDIVIDUAL        ,34650015,CDM,440,RC,92507,CPT,,,GN,Inpatient,,,222.85,222.85,HUMANA CHOICE PLUS,MGD,222.85,,,,,,,case rate,222.85,222.85,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,AETNA,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,BCBS,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,CIGNA,COM,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,TRICARE,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,UNITED HEALTHCARE,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,UNITED HEALTHCARE,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,VA,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,VA TRICARE,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,WELLMED,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,HUMANA,MGD,364.52,,,,,,,per diem,364.52,364.52,"Per diem rate, code is bundled with other services"
MBS EVAL                      ,34650016,CDM,440,RC,,,,,,Inpatient,,,364.52,364.52,HUMANA CHOICE PLUS,MGD,364.52,,,,,,,case rate,364.52,364.52,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,AETNA,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,BCBS,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,CIGNA,COM,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,TRICARE,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,UNITED HEALTHCARE,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,UNITED HEALTHCARE,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,VA,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,VA TRICARE,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,WELLMED,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,HUMANA,MGD,344.57,,,,,,,per diem,344.57,344.57,"Per diem rate, code is bundled with other services"
SWALLOWING TREATMENT          ,34650017,CDM,440,RC,,,,,,Inpatient,,,344.57,344.57,HUMANA CHOICE PLUS,MGD,344.57,,,,,,,case rate,344.57,344.57,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,AETNA,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,BCBS,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,CIGNA,COM,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,TRICARE,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,UNITED HEALTHCARE,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,UNITED HEALTHCARE,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,VA,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,VA TRICARE,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,WELLMED,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,HUMANA,MGD,81.63,,,,,,,per diem,81.63,81.63,"Per diem rate, code is bundled with other services"
DYS TXT W/E-STIM ATTEND 15MIN ,34699980,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,81.63,81.63,HUMANA CHOICE PLUS,MGD,81.63,,,,,,,case rate,81.63,81.63,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,AETNA,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,BCBS,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,CIGNA,COM,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,TRICARE,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,UNITED HEALTHCARE,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,UNITED HEALTHCARE,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,VA,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,VA TRICARE,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,WELLMED,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,HUMANA,MGD,88.37,,,,,,,per diem,88.37,88.37,"Per diem rate, code is bundled with other services"
E-STIM ATTENDED 15MIN         ,34699981,CDM,440,RC,97032,CPT,,,GN,Inpatient,,,88.37,88.37,HUMANA CHOICE PLUS,MGD,88.37,,,,,,,case rate,88.37,88.37,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
PT/FAMILY TRAINING EA 30 MIN  ,34699985,CDM,440,RC,98960,CPT,,,GN,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,AETNA,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,BCBS,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,CIGNA,COM,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,TRICARE,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,UNITED HEALTHCARE,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,UNITED HEALTHCARE,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,VA,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,VA TRICARE,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,WELLMED,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,HUMANA,MGD,658.71,,,,,,,per diem,658.71,658.71,"Per diem rate, code is bundled with other services"
ART LINE INSERTION            ,36000016,CDM,300,RC,36600,CPT,,,,Inpatient,,,658.71,658.71,HUMANA CHOICE PLUS,MGD,658.71,,,,,,,case rate,658.71,658.71,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,AETNA,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,BCBS,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,CIGNA,COM,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,TRICARE,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,UNITED HEALTHCARE,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,UNITED HEALTHCARE,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,VA,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,VA TRICARE,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,WELLMED,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,HUMANA,MGD,142.92,,,,,,,per diem,142.92,142.92,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT FIRST HR     ,36000070,CDM,410,RC,94644,CPT,,,,Inpatient,,,142.92,142.92,HUMANA CHOICE PLUS,MGD,142.92,,,,,,,case rate,142.92,142.92,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,AETNA,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,CIGNA,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,TRICARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,UNITED HEALTHCARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,UNITED HEALTHCARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,VA,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,VA TRICARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,WELLMED,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,HUMANA,MGD,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CONT INHAL TRTMT EA AD HR     ,36000071,CDM,410,RC,94645,CPT,,,,Inpatient,,,198.45,198.45,HUMANA CHOICE PLUS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,AETNA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,CIGNA,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,VA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,VA TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,WELLMED,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,HUMANA,MGD,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
IPPB-INITIAL/EZPAP            ,36000090,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,HUMANA CHOICE PLUS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,AETNA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,BCBS,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,CIGNA,COM,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,UNITED HEALTHCARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,VA,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,VA TRICARE,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,WELLMED,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,HUMANA,MGD,98.18,,,,,,,per diem,98.18,98.18,"Per diem rate, code is bundled with other services"
MDI                           ,36000091,CDM,410,RC,94640,CPT,,,,Inpatient,,,98.18,98.18,HUMANA CHOICE PLUS,MGD,98.18,,,,,,,case rate,98.18,98.18,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEBULIZER                     ,36000092,CDM,410,RC,,,,,,Inpatient,,,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
NEW INSTRUCT NEB/MDI          ,36000100,CDM,410,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,AETNA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,BCBS,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,CIGNA,COM,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,UNITED HEALTHCARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,VA,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,VA TRICARE,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,WELLMED,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA,MGD,37.32,,,,,,,per diem,37.32,37.32,"Per diem rate, code is bundled with other services"
SMOKING CESSATION > 10 MIN    ,36000101,CDM,410,RC,,,,,,Inpatient,,,37.32,37.32,HUMANA CHOICE PLUS,MGD,37.32,,,,,,,case rate,37.32,37.32,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,AETNA,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,BCBS,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,CIGNA,COM,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,TRICARE,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,UNITED HEALTHCARE,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,UNITED HEALTHCARE,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,VA,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,VA TRICARE,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,WELLMED,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,HUMANA,MGD,469.63,,,,,,,per diem,469.63,469.63,"Per diem rate, code is bundled with other services"
CPAP INITIAL SETUP            ,36000105,CDM,410,RC,,,,,,Inpatient,,,469.63,469.63,HUMANA CHOICE PLUS,MGD,469.63,,,,,,,case rate,469.63,469.63,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,AETNA,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,BCBS,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,CIGNA,COM,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,TRICARE,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,UNITED HEALTHCARE,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,UNITED HEALTHCARE,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,VA,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,VA TRICARE,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,WELLMED,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,HUMANA,MGD,464.92,,,,,,,per diem,464.92,464.92,"Per diem rate, code is bundled with other services"
OXYGEN DAILY                  ,36000106,CDM,410,RC,,,,,,Inpatient,,,464.92,464.92,HUMANA CHOICE PLUS,MGD,464.92,,,,,,,case rate,464.92,464.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,AETNA,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,BCBS,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,CIGNA,COM,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,TRICARE,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,UNITED HEALTHCARE,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,UNITED HEALTHCARE,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,VA,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,VA TRICARE,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,WELLMED,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,HUMANA,MGD,702.92,,,,,,,per diem,702.92,702.92,"Per diem rate, code is bundled with other services"
ECH0CARDIOLOGY                ,36000107,CDM,480,RC,,,,,,Inpatient,,,702.92,702.92,HUMANA CHOICE PLUS,MGD,702.92,,,,,,,case rate,702.92,702.92,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,AETNA,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,CIGNA,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,TRICARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,UNITED HEALTHCARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,UNITED HEALTHCARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,VA,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,VA TRICARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,WELLMED,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,HUMANA,MGD,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
ARTERIAL BLOOD GAS            ,36000121,CDM,301,RC,82803,CPT,,,,Inpatient,,,326.08,326.08,HUMANA CHOICE PLUS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,AETNA,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,BCBS,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,CIGNA,COM,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,TRICARE,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,UNITED HEALTHCARE,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,UNITED HEALTHCARE,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,VA,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,VA TRICARE,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,WELLMED,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,HUMANA,MGD,168.17,,,,,,,per diem,168.17,168.17,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51701     ,36000123,CDM,410,RC,51701,CPT,,,,Inpatient,,,168.17,168.17,HUMANA CHOICE PLUS,MGD,168.17,,,,,,,case rate,168.17,168.17,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,AETNA,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,BCBS,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,CIGNA,COM,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,TRICARE,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,UNITED HEALTHCARE,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,UNITED HEALTHCARE,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,VA,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,VA TRICARE,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,WELLMED,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,HUMANA,MGD,79.03,,,,,,,per diem,79.03,79.03,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51702     ,36000124,CDM,410,RC,51702,CPT,,,,Inpatient,,,79.03,79.03,HUMANA CHOICE PLUS,MGD,79.03,,,,,,,case rate,79.03,79.03,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,AETNA,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,BCBS,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,CIGNA,COM,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,TRICARE,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,UNITED HEALTHCARE,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,UNITED HEALTHCARE,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,VA,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,VA TRICARE,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,WELLMED,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,HUMANA,MGD,374.81,,,,,,,per diem,374.81,374.81,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 51798     ,36000125,CDM,410,RC,51798,CPT,,,,Inpatient,,,374.81,374.81,HUMANA CHOICE PLUS,MGD,374.81,,,,,,,case rate,374.81,374.81,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,AETNA,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,BCBS,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,CIGNA,COM,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,TRICARE,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,UNITED HEALTHCARE,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,UNITED HEALTHCARE,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,VA,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,VA TRICARE,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,WELLMED,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,HUMANA,MGD,86.77,,,,,,,per diem,86.77,86.77,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82270     ,36000126,CDM,410,RC,82270,CPT,,,,Inpatient,,,86.77,86.77,HUMANA CHOICE PLUS,MGD,86.77,,,,,,,case rate,86.77,86.77,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,AETNA,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,BCBS,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,CIGNA,COM,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,TRICARE,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,UNITED HEALTHCARE,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,UNITED HEALTHCARE,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,VA,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,VA TRICARE,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,WELLMED,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,HUMANA,MGD,98.75,,,,,,,per diem,98.75,98.75,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 82565     ,36000127,CDM,410,RC,82565,CPT,,,,Inpatient,,,98.75,98.75,HUMANA CHOICE PLUS,MGD,98.75,,,,,,,case rate,98.75,98.75,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,AETNA,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,BCBS,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,CIGNA,COM,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,TRICARE,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,UNITED HEALTHCARE,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,UNITED HEALTHCARE,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,VA,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,VA TRICARE,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,WELLMED,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,HUMANA,MGD,92.34,,,,,,,per diem,92.34,92.34,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94640     ,36000128,CDM,410,RC,94640,CPT,,,,Inpatient,,,92.34,92.34,HUMANA CHOICE PLUS,MGD,92.34,,,,,,,case rate,92.34,92.34,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,AETNA,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,BCBS,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,CIGNA,COM,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,TRICARE,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,UNITED HEALTHCARE,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,UNITED HEALTHCARE,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,VA,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,VA TRICARE,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,WELLMED,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,HUMANA,MGD,67.05,,,,,,,per diem,67.05,67.05,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 94799     ,36000129,CDM,410,RC,94799,CPT,,,,Inpatient,,,67.05,67.05,HUMANA CHOICE PLUS,MGD,67.05,,,,,,,case rate,67.05,67.05,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,AETNA,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,BCBS,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,CIGNA,COM,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,TRICARE,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,UNITED HEALTHCARE,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,UNITED HEALTHCARE,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,VA,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,VA TRICARE,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,WELLMED,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,HUMANA,MGD,100.49,,,,,,,per diem,100.49,100.49,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97116     ,36000131,CDM,410,RC,97116,CPT,,,,Inpatient,,,100.49,100.49,HUMANA CHOICE PLUS,MGD,100.49,,,,,,,case rate,100.49,100.49,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,AETNA,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,BCBS,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,CIGNA,COM,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,TRICARE,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,UNITED HEALTHCARE,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,UNITED HEALTHCARE,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,VA,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,VA TRICARE,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,WELLMED,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,HUMANA,MGD,286.79,,,,,,,per diem,286.79,286.79,"Per diem rate, code is bundled with other services"
BIPAP DAILY                   ,36000132,CDM,410,RC,94660,CPT,,,,Inpatient,,,286.79,286.79,HUMANA CHOICE PLUS,MGD,286.79,,,,,,,case rate,286.79,286.79,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,AETNA,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,BCBS,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,CIGNA,COM,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,TRICARE,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,UNITED HEALTHCARE,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,UNITED HEALTHCARE,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,VA,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,VA TRICARE,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,WELLMED,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,HUMANA,MGD,239.69,,,,,,,per diem,239.69,239.69,"Per diem rate, code is bundled with other services"
RESPIRATORY THERAPY 97602     ,36000134,CDM,410,RC,97602,CPT,,,,Inpatient,,,239.69,239.69,HUMANA CHOICE PLUS,MGD,239.69,,,,,,,case rate,239.69,239.69,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,AETNA,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,CIGNA,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,TRICARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UNITED HEALTHCARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UNITED HEALTHCARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,VA,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,VA TRICARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,WELLMED,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,HUMANA,MGD,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
CPAP DAILY                    ,36000136,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,HUMANA CHOICE PLUS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,AETNA,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,BCBS,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,CIGNA,COM,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,TRICARE,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,UNITED HEALTHCARE,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,UNITED HEALTHCARE,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,VA,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,VA TRICARE,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,WELLMED,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,HUMANA,MGD,80.83,,,,,,,per diem,80.83,80.83,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION INIT  ,36000140,CDM,410,RC,94667,CPT,,,,Inpatient,,,80.83,80.83,HUMANA CHOICE PLUS,MGD,80.83,,,,,,,case rate,80.83,80.83,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,AETNA,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,BCBS,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,CIGNA,COM,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,TRICARE,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,UNITED HEALTHCARE,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,UNITED HEALTHCARE,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,VA,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,VA TRICARE,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,WELLMED,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,HUMANA,MGD,282.48,,,,,,,per diem,282.48,282.48,"Per diem rate, code is bundled with other services"
HC RT HEATED HIGH FLOW TH     ,36000141,CDM,410,RC,,,,,,Inpatient,,,282.48,282.48,HUMANA CHOICE PLUS,MGD,282.48,,,,,,,case rate,282.48,282.48,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACIC GAS VOLUME           ,36000147,CDM,460,RC,94726,CPT,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
VENT CIRCUIT                  ,36000149,CDM,410,RC,,,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
INH TX EA SUBSEQ TX/DAY       ,36000154,CDM,410,RC,,,,,,Inpatient,,,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,AETNA,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,BCBS,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,CIGNA,COM,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,TRICARE,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,UNITED HEALTHCARE,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,UNITED HEALTHCARE,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,VA,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,VA TRICARE,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,WELLMED,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,HUMANA,MGD,143.85,,,,,,,per diem,143.85,143.85,"Per diem rate, code is bundled with other services"
INH TX INITIAL EA DAY         ,36000155,CDM,410,RC,,,,,,Inpatient,,,143.85,143.85,HUMANA CHOICE PLUS,MGD,143.85,,,,,,,case rate,143.85,143.85,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
RT ASSESSMENT COMPLETE        ,36000156,CDM,410,RC,,,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,AETNA,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,BCBS,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,CIGNA,COM,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,TRICARE,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,UNITED HEALTHCARE,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,UNITED HEALTHCARE,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,VA,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,VA TRICARE,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,WELLMED,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,HUMANA,MGD,51.66,,,,,,,per diem,51.66,51.66,"Per diem rate, code is bundled with other services"
NUTRITIONAL CONS PER 15 MIN   ,36000157,CDM,410,RC,97802,CPT,,,,Inpatient,,,51.66,51.66,HUMANA CHOICE PLUS,MGD,51.66,,,,,,,case rate,51.66,51.66,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,AETNA,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,BCBS,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,CIGNA,COM,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,TRICARE,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,UNITED HEALTHCARE,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,UNITED HEALTHCARE,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,VA,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,VA TRICARE,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,WELLMED,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,HUMANA,MGD,207.33,,,,,,,per diem,207.33,207.33,"Per diem rate, code is bundled with other services"
SUCTION - CLEARANCE OF AIRWAY ,36000158,CDM,361,RC,31720,CPT,,,,Inpatient,,,207.33,207.33,HUMANA CHOICE PLUS,MGD,207.33,,,,,,,case rate,207.33,207.33,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,AETNA,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,BCBS,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,CIGNA,COM,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,TRICARE,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,UNITED HEALTHCARE,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,UNITED HEALTHCARE,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,VA,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,VA TRICARE,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,WELLMED,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,HUMANA,MGD,449.4,,,,,,,per diem,449.4,449.4,"Per diem rate, code is bundled with other services"
CARDIAC OUTPUT                ,36000165,CDM,410,RC,93562,CPT,,,,Inpatient,,,449.4,449.4,HUMANA CHOICE PLUS,MGD,449.4,,,,,,,case rate,449.4,449.4,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,AETNA,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,BCBS,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,CIGNA,COM,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,TRICARE,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,UNITED HEALTHCARE,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,UNITED HEALTHCARE,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,VA,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,VA TRICARE,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,WELLMED,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,HUMANA,MGD,134.11,,,,,,,per diem,134.11,134.11,"Per diem rate, code is bundled with other services"
CHEST WALL MANIPULATION SUBSEQ,36000180,CDM,410,RC,94668,CPT,,,,Inpatient,,,134.11,134.11,HUMANA CHOICE PLUS,MGD,134.11,,,,,,,case rate,134.11,134.11,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,AETNA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,CIGNA,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,VA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,VA TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,WELLMED,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,HUMANA,MGD,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CARBON DIOXIDE-EXPIRED GAS    ,36000191,CDM,460,RC,94770,CPT,,,,Inpatient,,,442.32,442.32,HUMANA CHOICE PLUS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,AETNA,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,BCBS,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,CIGNA,COM,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,TRICARE,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,UNITED HEALTHCARE,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,UNITED HEALTHCARE,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,VA,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,VA TRICARE,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,WELLMED,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,HUMANA,MGD,324.45,,,,,,,per diem,324.45,324.45,"Per diem rate, code is bundled with other services"
TCPO2 SINGLE LEVEL            ,36000200,CDM,410,RC,93922,CPT,,,,Inpatient,,,324.45,324.45,HUMANA CHOICE PLUS,MGD,324.45,,,,,,,case rate,324.45,324.45,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,AETNA,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,BCBS,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,CIGNA,COM,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,TRICARE,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,UNITED HEALTHCARE,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,UNITED HEALTHCARE,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,VA,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,VA TRICARE,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,WELLMED,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,HUMANA,MGD,1035.66,,,,,,,per diem,1035.66,1035.66,"Per diem rate, code is bundled with other services"
TCPO2 MULTIPLE LEVELS         ,36000205,CDM,410,RC,93923,CPT,,,,Inpatient,,,1035.66,1035.66,HUMANA CHOICE PLUS,MGD,1035.66,,,,,,,case rate,1035.66,1035.66,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,AETNA,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,BCBS,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,CIGNA,COM,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,TRICARE,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,UNITED HEALTHCARE,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,UNITED HEALTHCARE,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,VA,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,VA TRICARE,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,WELLMED,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,HUMANA,MGD,10.92,,,,,,,per diem,10.92,10.92,"Per diem rate, code is bundled with other services"
PREFILL NEBULIZER KIT         ,36000206,CDM,410,RC,,,,,,Inpatient,,,10.92,10.92,HUMANA CHOICE PLUS,MGD,10.92,,,,,,,case rate,10.92,10.92,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,AETNA,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,CIGNA,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,TRICARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,UNITED HEALTHCARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,UNITED HEALTHCARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,VA,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,VA TRICARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,WELLMED,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,HUMANA,MGD,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
HIGH EFFECIENCY NEBULIZER     ,36000207,CDM,410,RC,,,,,,Inpatient,,,12.25,12.25,HUMANA CHOICE PLUS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,AETNA,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,BCBS,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,CIGNA,COM,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,TRICARE,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,UNITED HEALTHCARE,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,UNITED HEALTHCARE,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,VA,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,VA TRICARE,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,WELLMED,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,HUMANA,MGD,7.27,,,,,,,per diem,7.27,7.27,"Per diem rate, code is bundled with other services"
PREFILL HUMID FOR INHALA      ,36000209,CDM,410,RC,,,,,,Inpatient,,,7.27,7.27,HUMANA CHOICE PLUS,MGD,7.27,,,,,,,case rate,7.27,7.27,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,AETNA,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,BCBS,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,CIGNA,COM,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,TRICARE,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,UNITED HEALTHCARE,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,UNITED HEALTHCARE,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,VA,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,VA TRICARE,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,WELLMED,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,HUMANA,MGD,5.79,,,,,,,per diem,5.79,5.79,"Per diem rate, code is bundled with other services"
STER H2O INHALATION 500ML     ,36000210,CDM,410,RC,,,,,,Inpatient,,,5.79,5.79,HUMANA CHOICE PLUS,MGD,5.79,,,,,,,case rate,5.79,5.79,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,AETNA,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,BCBS,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,CIGNA,COM,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,TRICARE,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,UNITED HEALTHCARE,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,UNITED HEALTHCARE,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,VA,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,VA TRICARE,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,WELLMED,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,HUMANA,MGD,14.03,,,,,,,per diem,14.03,14.03,"Per diem rate, code is bundled with other services"
INLINE NEB T W/VLV 22MM       ,36000211,CDM,410,RC,,,,,,Inpatient,,,14.03,14.03,HUMANA CHOICE PLUS,MGD,14.03,,,,,,,case rate,14.03,14.03,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,AETNA,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,BCBS,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,CIGNA,COM,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,TRICARE,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,UNITED HEALTHCARE,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,UNITED HEALTHCARE,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,VA,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,VA TRICARE,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,WELLMED,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,HUMANA,MGD,396.9,,,,,,,per diem,396.9,396.9,"Per diem rate, code is bundled with other services"
DECANULATE                    ,36000212,CDM,410,RC,,,,,,Inpatient,,,396.9,396.9,HUMANA CHOICE PLUS,MGD,396.9,,,,,,,case rate,396.9,396.9,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,AETNA,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,BCBS,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,CIGNA,COM,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,TRICARE,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,UNITED HEALTHCARE,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,UNITED HEALTHCARE,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,VA,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,VA TRICARE,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,WELLMED,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,HUMANA,MGD,57.32,,,,,,,per diem,57.32,57.32,"Per diem rate, code is bundled with other services"
SUCTIONING                    ,36000214,CDM,410,RC,,,,,,Inpatient,,,57.32,57.32,HUMANA CHOICE PLUS,MGD,57.32,,,,,,,case rate,57.32,57.32,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,AETNA,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,CIGNA,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,TRICARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,UNITED HEALTHCARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,UNITED HEALTHCARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,VA,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,VA TRICARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,WELLMED,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,HUMANA,MGD,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
"TEACHING BREATHING 15""        ",36000215,CDM,410,RC,,,,,,Inpatient,,,109.78,109.78,HUMANA CHOICE PLUS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,AETNA,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,BCBS,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,CIGNA,COM,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,TRICARE,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,UNITED HEALTHCARE,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,UNITED HEALTHCARE,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,VA,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,VA TRICARE,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,WELLMED,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,HUMANA,MGD,183.75,,,,,,,per diem,183.75,183.75,"Per diem rate, code is bundled with other services"
TRACH CARE                    ,36000216,CDM,410,RC,,,,,,Inpatient,,,183.75,183.75,HUMANA CHOICE PLUS,MGD,183.75,,,,,,,case rate,183.75,183.75,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,AETNA,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,BCBS,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,CIGNA,COM,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,TRICARE,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,UNITED HEALTHCARE,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,UNITED HEALTHCARE,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,VA,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,VA TRICARE,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,WELLMED,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,HUMANA,MGD,78.26,,,,,,,per diem,78.26,78.26,"Per diem rate, code is bundled with other services"
THER PROC INPT 30 MIN         ,36000217,CDM,410,RC,,,,,,Inpatient,,,78.26,78.26,HUMANA CHOICE PLUS,MGD,78.26,,,,,,,case rate,78.26,78.26,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,AETNA,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,BCBS,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,CIGNA,COM,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,TRICARE,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,UNITED HEALTHCARE,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,UNITED HEALTHCARE,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,VA,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,VA TRICARE,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,WELLMED,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,HUMANA,MGD,455.36,,,,,,,per diem,455.36,455.36,"Per diem rate, code is bundled with other services"
CPAP/BIPAP CONTINUOUS         ,36000219,CDM,410,RC,,,,,,Inpatient,,,455.36,455.36,HUMANA CHOICE PLUS,MGD,455.36,,,,,,,case rate,455.36,455.36,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,AETNA,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,BCBS,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,CIGNA,COM,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,TRICARE,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,UNITED HEALTHCARE,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,UNITED HEALTHCARE,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,VA,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,VA TRICARE,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,WELLMED,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,HUMANA,MGD,106.05,,,,,,,per diem,106.05,106.05,"Per diem rate, code is bundled with other services"
G0238 THER PROC INCR RESP FUNC,36000295,CDM,410,RC,,,,,,Inpatient,,,106.05,106.05,HUMANA CHOICE PLUS,MGD,106.05,,,,,,,case rate,106.05,106.05,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,AETNA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,CIGNA,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,VA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,VA TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,WELLMED,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA,MGD,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
ADDITIONAL TIME INCREMENT     ,36000304,CDM,410,RC,,,,,,Inpatient,,,73.5,73.5,HUMANA CHOICE PLUS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,AETNA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,CIGNA,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,VA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,VA TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,WELLMED,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA,MGD,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
NASOTRAC SUCTION THE          ,36000321,CDM,410,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA CHOICE PLUS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,AETNA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,BCBS,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,CIGNA,COM,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,UNITED HEALTHCARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,VA,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,VA TRICARE,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,WELLMED,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA,MGD,220.5,,,,,,,per diem,220.5,220.5,"Per diem rate, code is bundled with other services"
RESPIRATORY ASSESSMENT        ,36000322,CDM,410,RC,,,,,,Inpatient,,,220.5,220.5,HUMANA CHOICE PLUS,MGD,220.5,,,,,,,case rate,220.5,220.5,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,AETNA,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,CIGNA,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,TRICARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,UNITED HEALTHCARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,UNITED HEALTHCARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,VA,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,VA TRICARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,WELLMED,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,HUMANA,MGD,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
CODE BLUE AIRWAY MAINT        ,36000323,CDM,410,RC,,,,,,Inpatient,,,525,525,HUMANA CHOICE PLUS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,AETNA,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,CIGNA,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,TRICARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,UNITED HEALTHCARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,UNITED HEALTHCARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,VA,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,VA TRICARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,WELLMED,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,HUMANA,MGD,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
EKG                           ,36000324,CDM,460,RC,,,,,,Inpatient,,,241.5,241.5,HUMANA CHOICE PLUS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,AETNA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,CIGNA,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,VA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,VA TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,WELLMED,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,HUMANA,MGD,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
HAND HELD NEB SUBS            ,36000325,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,HUMANA CHOICE PLUS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,AETNA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,CIGNA,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,VA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,VA TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,WELLMED,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,HUMANA,MGD,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
MDI SUBSEQUENT                ,36000326,CDM,410,RC,94640,CPT,,,,Inpatient,,,80.77,80.77,HUMANA CHOICE PLUS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,AETNA,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,BCBS,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,CIGNA,COM,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,TRICARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UNITED HEALTHCARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,UNITED HEALTHCARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,VA,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,VA TRICARE,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,WELLMED,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,HUMANA,MGD,38.16,,,,,,,per diem,38.16,38.16,"Per diem rate, code is bundled with other services"
BIPAP                         ,36000327,CDM,410,RC,94660,CPT,,,,Inpatient,,,38.16,38.16,HUMANA CHOICE PLUS,MGD,38.16,,,,,,,case rate,38.16,38.16,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
INITIAL HAND HELD NE          ,36000328,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OX SINGLE               ,36000329,CDM,460,RC,,,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETER CHECK          ,36000330,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,AETNA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,CIGNA,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,VA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,VA TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,WELLMED,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,HUMANA,MGD,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
SELF CARE HOME MANAGEMENT     ,36000340,CDM,410,RC,97535,CPT,,,,Inpatient,,,79.8,79.8,HUMANA CHOICE PLUS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,AETNA,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,BCBS,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,CIGNA,COM,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,TRICARE,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,UNITED HEALTHCARE,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,UNITED HEALTHCARE,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,VA,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,VA TRICARE,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,WELLMED,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,HUMANA,MGD,166.39,,,,,,,per diem,166.39,166.39,"Per diem rate, code is bundled with other services"
INCENTIVE SPIRO TX            ,36000366,CDM,410,RC,94010,CPT,,,,Inpatient,,,166.39,166.39,HUMANA CHOICE PLUS,MGD,166.39,,,,,,,case rate,166.39,166.39,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,AETNA,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,BCBS,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,CIGNA,COM,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,TRICARE,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,UNITED HEALTHCARE,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,UNITED HEALTHCARE,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,VA,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,VA TRICARE,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,WELLMED,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,HUMANA,MGD,173.78,,,,,,,per diem,173.78,173.78,"Per diem rate, code is bundled with other services"
IPPB-SUBSEQ/EZPAP             ,36000380,CDM,410,RC,94640,CPT,,,76,Inpatient,,,173.78,173.78,HUMANA CHOICE PLUS,MGD,173.78,,,,,,,case rate,173.78,173.78,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,AETNA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,CIGNA,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,VA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,VA TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,WELLMED,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,HUMANA,MGD,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE INITIAL  ,36000400,CDM,410,RC,94640,CPT,,,,Inpatient,,,75.17,75.17,HUMANA CHOICE PLUS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
OXYGEN PER HR                 ,36000510,CDM,270,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,AETNA,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,BCBS,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,CIGNA,COM,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,TRICARE,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,UNITED HEALTHCARE,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,UNITED HEALTHCARE,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,VA,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,VA TRICARE,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,WELLMED,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,HUMANA,MGD,173.59,,,,,,,per diem,173.59,173.59,"Per diem rate, code is bundled with other services"
PASSY MUIR VALVE ASSIST       ,36000530,CDM,410,RC,92507,CPT,,,,Inpatient,,,173.59,173.59,HUMANA CHOICE PLUS,MGD,173.59,,,,,,,case rate,173.59,173.59,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PULM COMPLIANCE STUDY         ,36000560,CDM,460,RC,94750,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
"MONITOR/EVAL IPPB, MDI, AERO  ",36000570,CDM,410,RC,94664,CPT,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,AETNA,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,BCBS,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,CIGNA,COM,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,TRICARE,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,UNITED HEALTHCARE,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,UNITED HEALTHCARE,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,VA,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,VA TRICARE,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,WELLMED,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,HUMANA,MGD,551.57,,,,,,,per diem,551.57,551.57,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-CONTINUOUS     ,36000610,CDM,460,RC,94762,CPT,,,,Inpatient,,,551.57,551.57,HUMANA CHOICE PLUS,MGD,551.57,,,,,,,case rate,551.57,551.57,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36000620,CDM,460,RC,94760,CPT,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,AETNA,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,BCBS,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,CIGNA,COM,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,TRICARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,UNITED HEALTHCARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,UNITED HEALTHCARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,VA,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,VA TRICARE,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,WELLMED,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,HUMANA,MGD,525,,,,,,,per diem,525,525,"Per diem rate, code is bundled with other services"
MECHAN CHEST OSCILL SESSION   ,36000625,CDM,460,RC,,,,,,Inpatient,,,525,525,HUMANA CHOICE PLUS,MGD,525,,,,,,,case rate,525,525,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURE INDIV   ,36000672,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,AETNA,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,CIGNA,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,TRICARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,UNITED HEALTHCARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,UNITED HEALTHCARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,VA,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,VA TRICARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,WELLMED,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,HUMANA,MGD,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
INTUBATION                    ,36000675,CDM,410,RC,31500,CPT,,,,Inpatient,,,74.55,74.55,HUMANA CHOICE PLUS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,AETNA,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,BCBS,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,CIGNA,COM,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,TRICARE,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,UNITED HEALTHCARE,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,UNITED HEALTHCARE,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,VA,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,VA TRICARE,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,WELLMED,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,HUMANA,MGD,659.69,,,,,,,per diem,659.69,659.69,"Per diem rate, code is bundled with other services"
CARDIOPULMONARY RESUSCITATION ,36000676,CDM,480,RC,92950,CPT,,,,Inpatient,,,659.69,659.69,HUMANA CHOICE PLUS,MGD,659.69,,,,,,,case rate,659.69,659.69,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,AETNA,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,BCBS,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,CIGNA,COM,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,TRICARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,UNITED HEALTHCARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,UNITED HEALTHCARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,VA,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,VA TRICARE,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,WELLMED,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,HUMANA,MGD,36.75,,,,,,,per diem,36.75,36.75,"Per diem rate, code is bundled with other services"
SPUTUM COLLECTION             ,36000739,CDM,300,RC,89220,CPT,,,,Inpatient,,,36.75,36.75,HUMANA CHOICE PLUS,MGD,36.75,,,,,,,case rate,36.75,36.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
TRACH CHANGE                  ,36000840,CDM,410,RC,31502,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,AETNA,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,BCBS,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,CIGNA,COM,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,TRICARE,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,UNITED HEALTHCARE,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,UNITED HEALTHCARE,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,VA,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,VA TRICARE,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,WELLMED,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,HUMANA,MGD,210.86,,,,,,,per diem,210.86,210.86,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-MULTI CHECKS   ,36000845,CDM,460,RC,94761,CPT,,,,Inpatient,,,210.86,210.86,HUMANA CHOICE PLUS,MGD,210.86,,,,,,,case rate,210.86,210.86,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,AETNA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,BCBS,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,CIGNA,COM,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,UNITED HEALTHCARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,VA,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,VA TRICARE,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,WELLMED,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,HUMANA,MGD,80.77,,,,,,,per diem,80.77,80.77,"Per diem rate, code is bundled with other services"
AEROSOL/VAPOR INHALE SUBSEQ   ,36000880,CDM,410,RC,94640,CPT,,,76,Inpatient,,,80.77,80.77,HUMANA CHOICE PLUS,MGD,80.77,,,,,,,case rate,80.77,80.77,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,AETNA,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,BCBS,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,CIGNA,COM,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,TRICARE,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,UNITED HEALTHCARE,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,UNITED HEALTHCARE,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,VA,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,VA TRICARE,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,WELLMED,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,HUMANA,MGD,109.2,,,,,,,per diem,109.2,109.2,"Per diem rate, code is bundled with other services"
VENTILATOR INITIAL DAILY      ,36000940,CDM,419,RC,94002,CPT,,,,Inpatient,,,109.2,109.2,HUMANA CHOICE PLUS,MGD,109.2,,,,,,,case rate,109.2,109.2,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,AETNA,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,BCBS,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,CIGNA,COM,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,TRICARE,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,UNITED HEALTHCARE,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,UNITED HEALTHCARE,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,VA,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,VA TRICARE,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,WELLMED,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,HUMANA,MGD,95.03,,,,,,,per diem,95.03,95.03,"Per diem rate, code is bundled with other services"
VENTILATOR SUBSEQUENT DAILY   ,36000945,CDM,419,RC,94003,CPT,,,,Inpatient,,,95.03,95.03,HUMANA CHOICE PLUS,MGD,95.03,,,,,,,case rate,95.03,95.03,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,AETNA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,CIGNA,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,VA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,VA TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,WELLMED,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,HUMANA,MGD,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
MAX BREATHING CAPACITY        ,36000980,CDM,410,RC,94200,CPT,,,,Inpatient,,,79.8,79.8,HUMANA CHOICE PLUS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,AETNA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,CIGNA,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,VA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,VA TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,WELLMED,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,HUMANA,MGD,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVALUATION       ,36001045,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,HUMANA CHOICE PLUS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,AETNA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,CIGNA,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,VA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,VA TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,WELLMED,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,HUMANA,MGD,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
BRONCHODIL RESPONSE-PRE & POST,36001050,CDM,460,RC,94060,CPT,,,,Inpatient,,,79.8,79.8,HUMANA CHOICE PLUS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,AETNA,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,BCBS,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,CIGNA,COM,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,TRICARE,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,UNITED HEALTHCARE,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,UNITED HEALTHCARE,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,VA,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,VA TRICARE,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,WELLMED,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,HUMANA,MGD,231.49,,,,,,,per diem,231.49,231.49,"Per diem rate, code is bundled with other services"
WORK HARDENING EA ADDL HR     ,36050065,CDM,420,RC,97546,CPT,,,GP,Inpatient,,,231.49,231.49,HUMANA CHOICE PLUS,MGD,231.49,,,,,,,case rate,231.49,231.49,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,AETNA,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,BCBS,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,CIGNA,COM,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,TRICARE,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,UNITED HEALTHCARE,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,UNITED HEALTHCARE,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,VA,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,VA TRICARE,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,WELLMED,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,HUMANA,MGD,393.25,,,,,,,per diem,393.25,393.25,"Per diem rate, code is bundled with other services"
TRANSTRACHIAL FOLLOW UP       ,36099215,CDM,510,RC,99215,CPT,,,,Inpatient,,,393.25,393.25,HUMANA CHOICE PLUS,MGD,393.25,,,,,,,case rate,393.25,393.25,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,AETNA,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,CIGNA,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,TRICARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,UNITED HEALTHCARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,UNITED HEALTHCARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,VA,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,VA TRICARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,WELLMED,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,HUMANA,MGD,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
PHYSICAL PERFORMANCE TEST     ,36200145,CDM,419,RC,97750,CPT,,,,Inpatient,,,116.8,116.8,HUMANA CHOICE PLUS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,AETNA,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,BCBS,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,CIGNA,COM,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,TRICARE,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,UNITED HEALTHCARE,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,UNITED HEALTHCARE,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,VA,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,VA TRICARE,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,WELLMED,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,HUMANA,MGD,813.75,,,,,,,per diem,813.75,813.75,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-SUBSEQ       ,36200171,CDM,410,RC,94668,CPT,,,,Inpatient,,,813.75,813.75,HUMANA CHOICE PLUS,MGD,813.75,,,,,,,case rate,813.75,813.75,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
CHEST WALL MANIP-INITIAL      ,36200180,CDM,410,RC,94667,CPT,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,AETNA,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,BCBS,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,CIGNA,COM,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,TRICARE,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,UNITED HEALTHCARE,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,UNITED HEALTHCARE,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,VA,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,VA TRICARE,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,WELLMED,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,HUMANA,MGD,840.11,,,,,,,per diem,840.11,840.11,"Per diem rate, code is bundled with other services"
BRONCHOSPASM EVAL METHA       ,36200640,CDM,460,RC,94070,CPT,,,,Inpatient,,,840.11,840.11,HUMANA CHOICE PLUS,MGD,840.11,,,,,,,case rate,840.11,840.11,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
THERAPEUTIC PROCEDURES INDIV  ,36200790,CDM,410,RC,G0238,HCPCS,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,AETNA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,BCBS,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,CIGNA,COM,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,UNITED HEALTHCARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,VA,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,VA TRICARE,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,WELLMED,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,HUMANA,MGD,79.8,,,,,,,per diem,79.8,79.8,"Per diem rate, code is bundled with other services"
PULSE OXIMETRY-SINGLE         ,36200900,CDM,460,RC,94760,CPT,,,,Inpatient,,,79.8,79.8,HUMANA CHOICE PLUS,MGD,79.8,,,,,,,case rate,79.8,79.8,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR ASSESSMENT                 ,36200940,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
PR REASSESSMENT               ,36200950,CDM,419,RC,94799,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
OXYGEN PER HOUR               ,36201000,CDM,270,RC,,,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,AETNA,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,CIGNA,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,TRICARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,UNITED HEALTHCARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,UNITED HEALTHCARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,VA,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,VA TRICARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,WELLMED,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,HUMANA,MGD,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
MAXIMUM BREATHING CAPACITY    ,36201050,CDM,460,RC,94200,CPT,,,,Inpatient,,,133.35,133.35,HUMANA CHOICE PLUS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,AETNA,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,BCBS,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,CIGNA,COM,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,TRICARE,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,UNITED HEALTHCARE,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,UNITED HEALTHCARE,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,VA,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,VA TRICARE,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,WELLMED,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,HUMANA,MGD,316.05,,,,,,,per diem,316.05,316.05,"Per diem rate, code is bundled with other services"
VITAL CAPACITY TOTAL          ,36201320,CDM,460,RC,94150,CPT,,,,Inpatient,,,316.05,316.05,HUMANA CHOICE PLUS,MGD,316.05,,,,,,,case rate,316.05,316.05,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,AETNA,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,CIGNA,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,TRICARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,UNITED HEALTHCARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,UNITED HEALTHCARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,VA,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,VA TRICARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,WELLMED,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,HUMANA,MGD,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
AIRWAY INHALATION TREATMENT   ,36201330,CDM,460,RC,94640,CPT,,,,Inpatient,,,99.75,99.75,HUMANA CHOICE PLUS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,AETNA,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,BCBS,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,CIGNA,COM,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,TRICARE,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,UNITED HEALTHCARE,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,UNITED HEALTHCARE,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,VA,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,VA TRICARE,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,WELLMED,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,HUMANA,MGD,455.7,,,,,,,per diem,455.7,455.7,"Per diem rate, code is bundled with other services"
PULM STRESS TEST - SIMPLE     ,36240010,CDM,460,RC,94620,CPT,,,,Inpatient,,,455.7,455.7,HUMANA CHOICE PLUS,MGD,455.7,,,,,,,case rate,455.7,455.7,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,AETNA,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,CIGNA,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,TRICARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,UNITED HEALTHCARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,UNITED HEALTHCARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,VA,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,VA TRICARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,WELLMED,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,HUMANA,MGD,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
SPIROMETRY/PFT SIMPLE         ,36240100,CDM,460,RC,94010,CPT,,,,Inpatient,,,211.05,211.05,HUMANA CHOICE PLUS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,AETNA,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,BCBS,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,CIGNA,COM,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,TRICARE,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,UNITED HEALTHCARE,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,UNITED HEALTHCARE,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,VA,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,VA TRICARE,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,WELLMED,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,HUMANA,MGD,947.1,,,,,,,per diem,947.1,947.1,"Per diem rate, code is bundled with other services"
AIRFLOW RESISTANCE DETERM     ,36294360,CDM,460,RC,94728,CPT,,,,Inpatient,,,947.1,947.1,HUMANA CHOICE PLUS,MGD,947.1,,,,,,,case rate,947.1,947.1,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,AETNA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,CIGNA,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,VA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,VA TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,WELLMED,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,HUMANA,MGD,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
DECALCIFICATION               ,38000016,CDM,310,RC,88311,CPT,,,,Inpatient,,,200.28,200.28,HUMANA CHOICE PLUS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,AETNA,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,BCBS,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,CIGNA,COM,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,TRICARE,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,UNITED HEALTHCARE,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,UNITED HEALTHCARE,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,VA,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,VA TRICARE,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,WELLMED,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,HUMANA,MGD,515.15,,,,,,,per diem,515.15,515.15,"Per diem rate, code is bundled with other services"
FINE NEEDLE ASP EVAL          ,38000022,CDM,310,RC,88172,CPT,,,,Inpatient,,,515.15,515.15,HUMANA CHOICE PLUS,MGD,515.15,,,,,,,case rate,515.15,515.15,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,AETNA,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,BCBS,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,CIGNA,COM,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,TRICARE,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,UNITED HEALTHCARE,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,UNITED HEALTHCARE,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,VA,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,VA TRICARE,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,WELLMED,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,HUMANA,MGD,986.49,,,,,,,per diem,986.49,986.49,"Per diem rate, code is bundled with other services"
"CELL BLOCK, INTERP COMPLETE   ",38000030,CDM,310,RC,88305,CPT,,,,Inpatient,,,986.49,986.49,HUMANA CHOICE PLUS,MGD,986.49,,,,,,,case rate,986.49,986.49,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CYTO-SMEAR ANY-SOURCE         ,38000040,CDM,310,RC,88160,CPT,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,AETNA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,CIGNA,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,VA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,VA TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,WELLMED,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,HUMANA,MGD,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
CYSTO-SMEAR PREP/SCREENING    ,38000050,CDM,310,RC,88161,CPT,,,,Inpatient,,,79.25,79.25,HUMANA CHOICE PLUS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,AETNA,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,BCBS,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,CIGNA,COM,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,TRICARE,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,UNITED HEALTHCARE,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,UNITED HEALTHCARE,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,VA,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,VA TRICARE,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,WELLMED,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,HUMANA,MGD,849.37,,,,,,,per diem,849.37,849.37,"Per diem rate, code is bundled with other services"
TISSUE CULT. NEOPLASTIC BM-BC ,38000052,CDM,319,RC,88237,CPT,,,,Inpatient,,,849.37,849.37,HUMANA CHOICE PLUS,MGD,849.37,,,,,,,case rate,849.37,849.37,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,AETNA,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,BCBS,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,CIGNA,COM,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,TRICARE,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,UNITED HEALTHCARE,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,UNITED HEALTHCARE,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,VA,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,VA TRICARE,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,WELLMED,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,HUMANA,MGD,717.15,,,,,,,per diem,717.15,717.15,"Per diem rate, code is bundled with other services"
POC CHROM ANALYSIS            ,38000054,CDM,311,RC,88233,CPT,,,,Inpatient,,,717.15,717.15,HUMANA CHOICE PLUS,MGD,717.15,,,,,,,case rate,717.15,717.15,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,AETNA,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,CIGNA,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,TRICARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,UNITED HEALTHCARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,UNITED HEALTHCARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,VA,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,VA TRICARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,WELLMED,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,HUMANA,MGD,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
INTRA-OPERATIVE CONSULTATION  ,38000070,CDM,310,RC,88329,CPT,,,,Inpatient,,,561.2,561.2,HUMANA CHOICE PLUS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,AETNA,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,BCBS,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,CIGNA,COM,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,TRICARE,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,UNITED HEALTHCARE,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,UNITED HEALTHCARE,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,VA,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,VA TRICARE,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,WELLMED,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,HUMANA,MGD,630.82,,,,,,,per diem,630.82,630.82,"Per diem rate, code is bundled with other services"
TISSUE BLOCK-FROZEN SECTION   ,38000080,CDM,310,RC,88331,CPT,,,,Inpatient,,,630.82,630.82,HUMANA CHOICE PLUS,MGD,630.82,,,,,,,case rate,630.82,630.82,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPRXDSE INTRP MULT STAINS    ,38000140,CDM,310,RC,88343,CPT,,,,Inpatient,,,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,AETNA,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,BCBS,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,CIGNA,COM,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,TRICARE,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,UNITED HEALTHCARE,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,UNITED HEALTHCARE,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,VA,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,VA TRICARE,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,WELLMED,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,HUMANA,MGD,1203.24,,,,,,,per diem,1203.24,1203.24,"Per diem rate, code is bundled with other services"
IMPRXDSE-INTRP 1 STAIN        ,38000141,CDM,310,RC,88342,CPT,,,,Inpatient,,,1203.24,1203.24,HUMANA CHOICE PLUS,MGD,1203.24,,,,,,,case rate,1203.24,1203.24,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,AETNA,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,CIGNA,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,TRICARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,UNITED HEALTHCARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,UNITED HEALTHCARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,VA,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,VA TRICARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,WELLMED,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,HUMANA,MGD,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS/SUNDAY/HOL   ,38000466,CDM,804,RC,,,,,,Inpatient,,,1701.77,1701.77,HUMANA CHOICE PLUS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,AETNA,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,CIGNA,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,TRICARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,UNITED HEALTHCARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,UNITED HEALTHCARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,VA,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,VA TRICARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,WELLMED,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,HUMANA,MGD,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL I         ,38000500,CDM,310,RC,88300,CPT,,,,Inpatient,,,416.62,416.62,HUMANA CHOICE PLUS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,AETNA,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,BCBS,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,CIGNA,COM,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,TRICARE,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,UNITED HEALTHCARE,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,UNITED HEALTHCARE,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,VA,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,VA TRICARE,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,WELLMED,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,HUMANA,MGD,787.19,,,,,,,per diem,787.19,787.19,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL II        ,38000501,CDM,310,RC,88302,CPT,,,,Inpatient,,,787.19,787.19,HUMANA CHOICE PLUS,MGD,787.19,,,,,,,case rate,787.19,787.19,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,AETNA,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,BCBS,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,CIGNA,COM,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,TRICARE,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,UNITED HEALTHCARE,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,UNITED HEALTHCARE,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,VA,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,VA TRICARE,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,WELLMED,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,HUMANA,MGD,1105.49,,,,,,,per diem,1105.49,1105.49,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL III       ,38000502,CDM,310,RC,88304,CPT,,,,Inpatient,,,1105.49,1105.49,HUMANA CHOICE PLUS,MGD,1105.49,,,,,,,case rate,1105.49,1105.49,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,AETNA,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,BCBS,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,CIGNA,COM,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,TRICARE,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,UNITED HEALTHCARE,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,UNITED HEALTHCARE,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,VA,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,VA TRICARE,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,WELLMED,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,HUMANA,MGD,394.8,,,,,,,per diem,394.8,394.8,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL IV        ,38000503,CDM,310,RC,88305,CPT,,,,Inpatient,,,394.8,394.8,HUMANA CHOICE PLUS,MGD,394.8,,,,,,,case rate,394.8,394.8,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,AETNA,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,BCBS,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,CIGNA,COM,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,TRICARE,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,UNITED HEALTHCARE,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,UNITED HEALTHCARE,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,VA,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,VA TRICARE,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,WELLMED,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,HUMANA,MGD,916.74,,,,,,,per diem,916.74,916.74,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL V         ,38000504,CDM,310,RC,88307,CPT,,,,Inpatient,,,916.74,916.74,HUMANA CHOICE PLUS,MGD,916.74,,,,,,,case rate,916.74,916.74,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,AETNA,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,CIGNA,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,TRICARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,UNITED HEALTHCARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,UNITED HEALTHCARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,VA,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,VA TRICARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,WELLMED,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,HUMANA,MGD,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
SURGICAL PATH LEVEL VI        ,38000505,CDM,310,RC,88309,CPT,,,,Inpatient,,,1118.12,1118.12,HUMANA CHOICE PLUS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,AETNA,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,CIGNA,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,TRICARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UNITED HEALTHCARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,UNITED HEALTHCARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,VA,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,VA TRICARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,WELLMED,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,HUMANA,MGD,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
ELECTRON MICROSCOPY           ,38000540,CDM,311,RC,88348,CPT,,,,Inpatient,,,2912.05,2912.05,HUMANA CHOICE PLUS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,AETNA,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,BCBS,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,CIGNA,COM,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,TRICARE,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,UNITED HEALTHCARE,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,UNITED HEALTHCARE,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,VA,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,VA TRICARE,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,WELLMED,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,HUMANA,MGD,31.98,,,,,,,per diem,31.98,31.98,"Per diem rate, code is bundled with other services"
IMMUNOHIST CYTO EA ADDL       ,38000547,CDM,310,RC,88341,CPT,,,,Inpatient,,,31.98,31.98,HUMANA CHOICE PLUS,MGD,31.98,,,,,,,case rate,31.98,31.98,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,AETNA,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,CIGNA,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,TRICARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,UNITED HEALTHCARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,UNITED HEALTHCARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,VA,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,VA TRICARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,WELLMED,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,HUMANA,MGD,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
MOLECULAR CYTOGENETICS        ,38000560,CDM,311,RC,88271,CPT,,,,Inpatient,,,131.41,131.41,HUMANA CHOICE PLUS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUORESCENCE            ,38000580,CDM,312,RC,88346,CPT,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,AETNA,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,BCBS,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,CIGNA,COM,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,TRICARE,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,UNITED HEALTHCARE,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,UNITED HEALTHCARE,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,VA,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,VA TRICARE,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,WELLMED,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,HUMANA,MGD,132.74,,,,,,,per diem,132.74,132.74,"Per diem rate, code is bundled with other services"
CYTOPATH NON-GYN CELL PREP    ,38000609,CDM,311,RC,88112,CPT,,,,Inpatient,,,132.74,132.74,HUMANA CHOICE PLUS,MGD,132.74,,,,,,,case rate,132.74,132.74,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,AETNA,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,BCBS,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,CIGNA,COM,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,TRICARE,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,UNITED HEALTHCARE,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,UNITED HEALTHCARE,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,VA,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,VA TRICARE,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,WELLMED,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,HUMANA,MGD,518.7,,,,,,,per diem,518.7,518.7,"Per diem rate, code is bundled with other services"
BONE MARROW SMEAR INTERP      ,38000630,CDM,310,RC,85097,CPT,,,,Inpatient,,,518.7,518.7,HUMANA CHOICE PLUS,MGD,518.7,,,,,,,case rate,518.7,518.7,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,AETNA,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,CIGNA,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,TRICARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,UNITED HEALTHCARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,UNITED HEALTHCARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,VA,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,VA TRICARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,WELLMED,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,HUMANA,MGD,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
CYTOPATH WASH/BRUSH NON-GYN   ,38000635,CDM,311,RC,88104,CPT,,,,Inpatient,,,354.5,354.5,HUMANA CHOICE PLUS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,AETNA,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,BCBS,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,CIGNA,COM,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,TRICARE,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,UNITED HEALTHCARE,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,UNITED HEALTHCARE,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,VA,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,VA TRICARE,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,WELLMED,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,HUMANA,MGD,274.08,,,,,,,per diem,274.08,274.08,"Per diem rate, code is bundled with other services"
CYTOSPIN                      ,38000640,CDM,311,RC,88108,CPT,,,,Inpatient,,,274.08,274.08,HUMANA CHOICE PLUS,MGD,274.08,,,,,,,case rate,274.08,274.08,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,AETNA,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,BCBS,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,CIGNA,COM,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,TRICARE,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,UNITED HEALTHCARE,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,UNITED HEALTHCARE,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,VA,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,VA TRICARE,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,WELLMED,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,HUMANA,MGD,545.5,,,,,,,per diem,545.5,545.5,"Per diem rate, code is bundled with other services"
"FINE NEEDLE ASP, INTERPRET    ",38000650,CDM,311,RC,88173,CPT,,,,Inpatient,,,545.5,545.5,HUMANA CHOICE PLUS,MGD,545.5,,,,,,,case rate,545.5,545.5,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,AETNA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,CIGNA,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,VA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,VA TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,WELLMED,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,HUMANA,MGD,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
TISSUE BLOCK FROZEN SECT ADD  ,38000655,CDM,310,RC,88332,CPT,,,,Inpatient,,,190.64,190.64,HUMANA CHOICE PLUS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,AETNA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,CIGNA,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,VA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,VA TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,WELLMED,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,HUMANA,MGD,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
HEMAPATH ENZYMES              ,38000665,CDM,311,RC,88319,CPT,,,,Inpatient,,,200.28,200.28,HUMANA CHOICE PLUS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,AETNA,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,BCBS,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,CIGNA,COM,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,TRICARE,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,UNITED HEALTHCARE,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,UNITED HEALTHCARE,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,VA,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,VA TRICARE,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,WELLMED,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,HUMANA,MGD,248.17,,,,,,,per diem,248.17,248.17,"Per diem rate, code is bundled with other services"
SPECIAL STAIN GROUP-1         ,38000710,CDM,312,RC,88312,CPT,,,,Inpatient,,,248.17,248.17,HUMANA CHOICE PLUS,MGD,248.17,,,,,,,case rate,248.17,248.17,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,AETNA,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,CIGNA,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,TRICARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,UNITED HEALTHCARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,UNITED HEALTHCARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,VA,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,VA TRICARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,WELLMED,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,HUMANA,MGD,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
STAIN GROUP-II                ,38000715,CDM,312,RC,88313,CPT,,,,Inpatient,,,250.61,250.61,HUMANA CHOICE PLUS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,AETNA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,CIGNA,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,VA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,VA TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,WELLMED,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,HUMANA,MGD,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-1ST MKR-TECH   ,38000730,CDM,300,RC,88184,CPT,,,,Inpatient,,,137.09,137.09,HUMANA CHOICE PLUS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,AETNA,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,CIGNA,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,TRICARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,UNITED HEALTHCARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,UNITED HEALTHCARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,VA,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,VA TRICARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,WELLMED,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,HUMANA,MGD,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
FLOW CYTOMETRY-EA ADD MKR-TECH,38000735,CDM,300,RC,88185,CPT,,,,Inpatient,,,130.66,130.66,HUMANA CHOICE PLUS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,AETNA,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,CIGNA,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,TRICARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,UNITED HEALTHCARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,UNITED HEALTHCARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,VA,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,VA TRICARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,WELLMED,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,HUMANA,MGD,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
PAP SMEAR THIN PREP           ,38000930,CDM,311,RC,88142,CPT,G0123,HCPCS,,Inpatient,,,167.08,167.08,HUMANA CHOICE PLUS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,AETNA,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,BCBS,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,CIGNA,COM,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,TRICARE,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,UNITED HEALTHCARE,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,UNITED HEALTHCARE,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,VA,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,VA TRICARE,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,WELLMED,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,HUMANA,MGD,118.61,,,,,,,per diem,118.61,118.61,"Per diem rate, code is bundled with other services"
PERIPH SMEAR REPT & INTERP    ,38001900,CDM,305,RC,85060,CPT,,,,Inpatient,,,118.61,118.61,HUMANA CHOICE PLUS,MGD,118.61,,,,,,,case rate,118.61,118.61,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,AETNA,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,CIGNA,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,TRICARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,UNITED HEALTHCARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,UNITED HEALTHCARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,VA,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,VA TRICARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,WELLMED,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,HUMANA,MGD,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
S/O FNA CYTO 1ST EVAL         ,38010000,CDM,311,RC,,,,,,Inpatient,,,711.14,711.14,HUMANA CHOICE PLUS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,AETNA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,CIGNA,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,VA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,VA TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,WELLMED,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,HUMANA,MGD,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ALK1 IMMUNOHIST           ,38010001,CDM,312,RC,,,,,,Inpatient,,,198.14,198.14,HUMANA CHOICE PLUS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO 1ST STAIN     ,38010002,CDM,312,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,AETNA,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,CIGNA,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,TRICARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,UNITED HEALTHCARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,UNITED HEALTHCARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,VA,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,VA TRICARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,WELLMED,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,HUMANA,MGD,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
S/O PD1 IMMUNOHIST W/INTR     ,38010003,CDM,312,RC,,,,,,Inpatient,,,244.19,244.19,HUMANA CHOICE PLUS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,AETNA,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,CIGNA,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,TRICARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,UNITED HEALTHCARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,UNITED HEALTHCARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,VA,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,VA TRICARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,WELLMED,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,HUMANA,MGD,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O PD-L1 22C3 KEYTRUDA       ,38010004,CDM,312,RC,,,,,,Inpatient,,,1311.98,1311.98,HUMANA CHOICE PLUS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,AETNA,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,BCBS,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,CIGNA,COM,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,TRICARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,UNITED HEALTHCARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,UNITED HEALTHCARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,VA,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,VA TRICARE,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,WELLMED,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,HUMANA,MGD,2912.05,,,,,,,per diem,2912.05,2912.05,"Per diem rate, code is bundled with other services"
S/O ELECTR MICROSCPY DXCP     ,38010005,CDM,312,RC,,,,,,Inpatient,,,2912.05,2912.05,HUMANA CHOICE PLUS,MGD,2912.05,,,,,,,case rate,2912.05,2912.05,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010006,CDM,311,RC,88271,CPT,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010007,CDM,311,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUOR STUDY AB      ,38010008,CDM,312,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,AETNA,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,BCBS,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,CIGNA,COM,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,TRICARE,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,UNITED HEALTHCARE,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,UNITED HEALTHCARE,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,VA,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,VA TRICARE,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,WELLMED,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,HUMANA,MGD,339.51,,,,,,,per diem,339.51,339.51,"Per diem rate, code is bundled with other services"
S/O FNA INTERP/REPORT         ,38010009,CDM,311,RC,,,,,,Inpatient,,,339.51,339.51,HUMANA CHOICE PLUS,MGD,339.51,,,,,,,case rate,339.51,339.51,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,AETNA,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,CIGNA,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,TRICARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,UNITED HEALTHCARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,UNITED HEALTHCARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,VA,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,VA TRICARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,WELLMED,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,HUMANA,MGD,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUKEMIA         ,38010010,CDM,311,RC,,,,,,Inpatient,,,265.61,265.61,HUMANA CHOICE PLUS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,AETNA,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,CIGNA,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,TRICARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,UNITED HEALTHCARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,UNITED HEALTHCARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,VA,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,VA TRICARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,WELLMED,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,HUMANA,MGD,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O LYMPHOMA/LEUK EA ADD      ,38010011,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,HUMANA CHOICE PLUS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O AMYLASE                   ,38010012,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,AETNA,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,BCBS,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,CIGNA,COM,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,TRICARE,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,UNITED HEALTHCARE,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,UNITED HEALTHCARE,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,VA,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,VA TRICARE,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,WELLMED,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,HUMANA,MGD,724,,,,,,,per diem,724,724,"Per diem rate, code is bundled with other services"
S/O IRON LIVER                ,38010013,CDM,301,RC,,,,,,Inpatient,,,724,724,HUMANA CHOICE PLUS,MGD,724,,,,,,,case rate,724,724,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,AETNA,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,BCBS,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,CIGNA,COM,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,TRICARE,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,UNITED HEALTHCARE,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,UNITED HEALTHCARE,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,VA,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,VA TRICARE,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,WELLMED,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,HUMANA,MGD,13136.89,,,,,,,per diem,13136.89,13136.89,"Per diem rate, code is bundled with other services"
S/O PATHFINDERTG ANALYSIS     ,38010014,CDM,301,RC,,,,,,Inpatient,,,13136.89,13136.89,HUMANA CHOICE PLUS,MGD,13136.89,,,,,,,case rate,13136.89,13136.89,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,AETNA,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,BCBS,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,CIGNA,COM,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,TRICARE,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,UNITED HEALTHCARE,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,UNITED HEALTHCARE,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,VA,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,VA TRICARE,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,WELLMED,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,HUMANA,MGD,345.93,,,,,,,per diem,345.93,345.93,"Per diem rate, code is bundled with other services"
S/O SYT-SSX TRN RTPCR         ,38010015,CDM,301,RC,,,,,,Inpatient,,,345.93,345.93,HUMANA CHOICE PLUS,MGD,345.93,,,,,,,case rate,345.93,345.93,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV LOW RISK PARAFFIN     ,38010016,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O HPV HIGH RISK PARAFF      ,38010017,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
S/O EBV IN SITU PARAFFIN      ,38010018,CDM,312,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010019,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,AETNA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,CIGNA,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,WELLMED,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA,MGD,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010020,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA CHOICE PLUS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,AETNA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,CIGNA,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,WELLMED,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA,MGD,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O GASTRO STROM TUMR         ,38010021,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA CHOICE PLUS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010022,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,AETNA,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,CIGNA,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,TRICARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,UNITED HEALTHCARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,UNITED HEALTHCARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,VA,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,VA TRICARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,WELLMED,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,HUMANA,MGD,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
S/O EGFR MUT DET PYRO         ,38010023,CDM,301,RC,,,,,,Inpatient,,,900.71,900.71,HUMANA CHOICE PLUS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,AETNA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,CIGNA,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,VA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,VA TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,WELLMED,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA,MGD,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010024,CDM,311,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA CHOICE PLUS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,AETNA,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,CIGNA,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,TRICARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,UNITED HEALTHCARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,UNITED HEALTHCARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,VA,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,VA TRICARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,WELLMED,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,HUMANA,MGD,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ALK GENE FISH             ,38010025,CDM,311,RC,,,,,,Inpatient,,,539.78,539.78,HUMANA CHOICE PLUS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,AETNA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,CIGNA,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,VA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,VA TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,WELLMED,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA,MGD,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010026,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA CHOICE PLUS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,AETNA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,CIGNA,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,VA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,VA TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,WELLMED,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA,MGD,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010027,CDM,301,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA CHOICE PLUS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,AETNA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,CIGNA,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,VA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,VA TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,WELLMED,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,HUMANA,MGD,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
S/O 5-FU 7 MUTATIONS          ,38010028,CDM,301,RC,81479,CPT,,,,Inpatient,,,371.64,371.64,HUMANA CHOICE PLUS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,AETNA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,CIGNA,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,VA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,VA TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,WELLMED,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,HUMANA,MGD,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
S/O PFTG GNAS                 ,38010029,CDM,301,RC,,,,,,Inpatient,,,187.43,187.43,HUMANA CHOICE PLUS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,AETNA,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,BCBS,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,CIGNA,COM,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,TRICARE,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,UNITED HEALTHCARE,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,UNITED HEALTHCARE,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,VA,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,VA TRICARE,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,WELLMED,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,HUMANA,MGD,309.52,,,,,,,per diem,309.52,309.52,"Per diem rate, code is bundled with other services"
S/O HER-2/NEU TISSUE ASSY     ,38010030,CDM,312,RC,,,,,,Inpatient,,,309.52,309.52,HUMANA CHOICE PLUS,MGD,309.52,,,,,,,case rate,309.52,309.52,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,AETNA,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,CIGNA,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,TRICARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,UNITED HEALTHCARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,UNITED HEALTHCARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,VA,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,VA TRICARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,WELLMED,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,HUMANA,MGD,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O INSITU HYBRID AUTO        ,38010031,CDM,312,RC,,,,,,Inpatient,,,508.73,508.73,HUMANA CHOICE PLUS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,AETNA,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,CIGNA,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,TRICARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,UNITED HEALTHCARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,UNITED HEALTHCARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,VA,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,VA TRICARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,WELLMED,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,HUMANA,MGD,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O FNA CYTO EA ADD EVAL      ,38010032,CDM,311,RC,,,,,,Inpatient,,,112.46,112.46,HUMANA CHOICE PLUS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O INTRAOP CYTO CNSLT1       ,38010033,CDM,312,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,AETNA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,BCBS,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,CIGNA,COM,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,UNITED HEALTHCARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,VA,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,VA TRICARE,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,WELLMED,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA,MGD,400.55,,,,,,,per diem,400.55,400.55,"Per diem rate, code is bundled with other services"
S/O CYTO SMEAR EXTENDED       ,38010034,CDM,311,RC,,,,,,Inpatient,,,400.55,400.55,HUMANA CHOICE PLUS,MGD,400.55,,,,,,,case rate,400.55,400.55,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,AETNA,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,BCBS,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,CIGNA,COM,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,TRICARE,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,UNITED HEALTHCARE,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,UNITED HEALTHCARE,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,VA,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,VA TRICARE,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,WELLMED,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,HUMANA,MGD,169.22,,,,,,,per diem,169.22,169.22,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO ADD STAIN     ,38010035,CDM,312,RC,,,,,,Inpatient,,,169.22,169.22,HUMANA CHOICE PLUS,MGD,169.22,,,,,,,case rate,169.22,169.22,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,AETNA,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,BCBS,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,CIGNA,COM,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,TRICARE,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,UNITED HEALTHCARE,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,UNITED HEALTHCARE,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,VA,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,VA TRICARE,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,WELLMED,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,HUMANA,MGD,1466.2,,,,,,,per diem,1466.2,1466.2,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 10-20     ,38010036,CDM,312,RC,,,,,,Inpatient,,,1466.2,1466.2,HUMANA CHOICE PLUS,MGD,1466.2,,,,,,,case rate,1466.2,1466.2,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,AETNA,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,BCBS,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,CIGNA,COM,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,TRICARE,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,UNITED HEALTHCARE,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,UNITED HEALTHCARE,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,VA,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,VA TRICARE,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,WELLMED,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,HUMANA,MGD,2939.9,,,,,,,per diem,2939.9,2939.9,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 21-40     ,38010037,CDM,312,RC,,,,,,Inpatient,,,2939.9,2939.9,HUMANA CHOICE PLUS,MGD,2939.9,,,,,,,case rate,2939.9,2939.9,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,AETNA,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,BCBS,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,CIGNA,COM,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,TRICARE,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,UNITED HEALTHCARE,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,UNITED HEALTHCARE,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,VA,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,VA TRICARE,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,WELLMED,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,HUMANA,MGD,4911.61,,,,,,,per diem,4911.61,4911.61,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX 41-60     ,38010038,CDM,312,RC,,,,,,Inpatient,,,4911.61,4911.61,HUMANA CHOICE PLUS,MGD,4911.61,,,,,,,case rate,4911.61,4911.61,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,AETNA,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,BCBS,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,CIGNA,COM,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,TRICARE,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,UNITED HEALTHCARE,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,UNITED HEALTHCARE,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,VA,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,VA TRICARE,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,WELLMED,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,HUMANA,MGD,5730.92,,,,,,,per diem,5730.92,5730.92,"Per diem rate, code is bundled with other services"
S/O PROS NDL SAT BX >60       ,38010039,CDM,312,RC,,,,,,Inpatient,,,5730.92,5730.92,HUMANA CHOICE PLUS,MGD,5730.92,,,,,,,case rate,5730.92,5730.92,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,AETNA,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,BCBS,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,CIGNA,COM,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,TRICARE,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,UNITED HEALTHCARE,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,UNITED HEALTHCARE,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,VA,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,VA TRICARE,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,WELLMED,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,HUMANA,MGD,217.41,,,,,,,per diem,217.41,217.41,"Per diem rate, code is bundled with other services"
S/O IMMUNO/CYTO MULTIPLEX     ,38010040,CDM,312,RC,,,,,,Inpatient,,,217.41,217.41,HUMANA CHOICE PLUS,MGD,217.41,,,,,,,case rate,217.41,217.41,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR 1ST PROBE     ,38010041,CDM,312,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,AETNA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,CIGNA,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,VA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,VA TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,WELLMED,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA,MGD,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR ADD PROBE     ,38010042,CDM,312,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA CHOICE PLUS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,AETNA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,CIGNA,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,VA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,VA TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,WELLMED,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,HUMANA,MGD,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR MULTIPLEX     ,38010043,CDM,312,RC,88366,CPT,,,,Inpatient,,,141.37,141.37,HUMANA CHOICE PLUS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,AETNA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,CIGNA,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,VA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,VA TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,WELLMED,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA,MGD,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO ADD      ,38010044,CDM,312,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA CHOICE PLUS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,AETNA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,CIGNA,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,VA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,VA TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,WELLMED,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA,MGD,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR AUTO MULT     ,38010045,CDM,312,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA CHOICE PLUS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,AETNA,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,BCBS,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,CIGNA,COM,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,TRICARE,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,UNITED HEALTHCARE,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,UNITED HEALTHCARE,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,VA,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,VA TRICARE,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,WELLMED,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,HUMANA,MGD,936.05,,,,,,,per diem,936.05,936.05,"Per diem rate, code is bundled with other services"
S/O INSITU HYBR HER2 MULT     ,38010046,CDM,312,RC,,,,,,Inpatient,,,936.05,936.05,HUMANA CHOICE PLUS,MGD,936.05,,,,,,,case rate,936.05,936.05,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O IMMUNOFLUORESCENE         ,38010047,CDM,312,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,AETNA,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,BCBS,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,CIGNA,COM,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,TRICARE,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,UNITED HEALTHCARE,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,UNITED HEALTHCARE,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,VA,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,VA TRICARE,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,WELLMED,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,HUMANA,MGD,154.35,,,,,,,per diem,154.35,154.35,"Per diem rate, code is bundled with other services"
CHG CYTOPATH CELLULAR ENH     ,38010052,CDM,311,RC,,,,,,Inpatient,,,154.35,154.35,HUMANA CHOICE PLUS,MGD,154.35,,,,,,,case rate,154.35,154.35,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,AETNA,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,BCBS,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,CIGNA,COM,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,TRICARE,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,UNITED HEALTHCARE,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,UNITED HEALTHCARE,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,VA,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,VA TRICARE,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,WELLMED,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,HUMANA,MGD,74.74,,,,,,,per diem,74.74,74.74,"Per diem rate, code is bundled with other services"
PHYS SER DIFFICULT CROSS      ,38010057,CDM,310,RC,86077,CPT,,,,Inpatient,,,74.74,74.74,HUMANA CHOICE PLUS,MGD,74.74,,,,,,,case rate,74.74,74.74,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,AETNA,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,BCBS,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,CIGNA,COM,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,TRICARE,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,UNITED HEALTHCARE,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,UNITED HEALTHCARE,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,VA,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,VA TRICARE,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,WELLMED,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,HUMANA,MGD,418.77,,,,,,,per diem,418.77,418.77,"Per diem rate, code is bundled with other services"
ADDTNL KARTYPE CSOME ANAL     ,38010058,CDM,311,RC,88280,CPT,,,,Inpatient,,,418.77,418.77,HUMANA CHOICE PLUS,MGD,418.77,,,,,,,case rate,418.77,418.77,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,AETNA,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,BCBS,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,CIGNA,COM,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,TRICARE,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,UNITED HEALTHCARE,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,UNITED HEALTHCARE,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,VA,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,VA TRICARE,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,WELLMED,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,HUMANA,MGD,158.28,,,,,,,per diem,158.28,158.28,"Per diem rate, code is bundled with other services"
ADDTNL CELL CSMONE ANAL       ,38010059,CDM,311,RC,88285,CPT,,,,Inpatient,,,158.28,158.28,HUMANA CHOICE PLUS,MGD,158.28,,,,,,,case rate,158.28,158.28,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,AETNA,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,BCBS,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,CIGNA,COM,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,TRICARE,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,UNITED HEALTHCARE,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,UNITED HEALTHCARE,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,VA,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,VA TRICARE,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,WELLMED,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,HUMANA,MGD,304.5,,,,,,,per diem,304.5,304.5,"Per diem rate, code is bundled with other services"
RENTAL WOUND VACUUM           ,38149994,CDM,270,RC,,,,,,Inpatient,,,304.5,304.5,HUMANA CHOICE PLUS,MGD,304.5,,,,,,,case rate,304.5,304.5,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,AETNA,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,BCBS,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,CIGNA,COM,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,TRICARE,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,UNITED HEALTHCARE,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,UNITED HEALTHCARE,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,VA,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,VA TRICARE,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,WELLMED,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,HUMANA,MGD,217.35,,,,,,,per diem,217.35,217.35,"Per diem rate, code is bundled with other services"
RENTAL NPWT SIMPLICITY        ,38163207,CDM,270,RC,,,,,,Inpatient,,,217.35,217.35,HUMANA CHOICE PLUS,MGD,217.35,,,,,,,case rate,217.35,217.35,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,AETNA,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,BCBS,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,CIGNA,COM,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,TRICARE,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,UNITED HEALTHCARE,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,UNITED HEALTHCARE,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,VA,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,VA TRICARE,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,WELLMED,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,HUMANA,MGD,330.75,,,,,,,per diem,330.75,330.75,"Per diem rate, code is bundled with other services"
RENTAL VAC KCI INFOVAC        ,38197185,CDM,270,RC,,,,,,Inpatient,,,330.75,330.75,HUMANA CHOICE PLUS,MGD,330.75,,,,,,,case rate,330.75,330.75,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,AETNA,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,BCBS,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,CIGNA,COM,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,TRICARE,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,UNITED HEALTHCARE,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,UNITED HEALTHCARE,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,VA,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,VA TRICARE,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,WELLMED,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,HUMANA,MGD,344.3,,,,,,,per diem,344.3,344.3,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38200004,CDM,301,RC,84145,CPT,,,,Inpatient,,,344.3,344.3,HUMANA CHOICE PLUS,MGD,344.3,,,,,,,case rate,344.3,344.3,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,AETNA,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,BCBS,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,CIGNA,COM,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,TRICARE,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,UNITED HEALTHCARE,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,UNITED HEALTHCARE,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,VA,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,VA TRICARE,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,WELLMED,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,HUMANA,MGD,279.53,,,,,,,per diem,279.53,279.53,"Per diem rate, code is bundled with other services"
17 OH PROGESTERONE 17-D       ,38200006,CDM,301,RC,83498,CPT,,,,Inpatient,,,279.53,279.53,HUMANA CHOICE PLUS,MGD,279.53,,,,,,,case rate,279.53,279.53,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,AETNA,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,BCBS,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,CIGNA,COM,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,TRICARE,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,UNITED HEALTHCARE,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,UNITED HEALTHCARE,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,VA,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,VA TRICARE,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,WELLMED,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,HUMANA,MGD,129.43,,,,,,,per diem,129.43,129.43,"Per diem rate, code is bundled with other services"
IGG SUBCLASSES (EACH)         ,38200007,CDM,301,RC,82787,CPT,,,,Inpatient,,,129.43,129.43,HUMANA CHOICE PLUS,MGD,129.43,,,,,,,case rate,129.43,129.43,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP A STREP SCR    ",38200008,CDM,306,RC,87081,CPT,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,AETNA,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,BCBS,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,CIGNA,COM,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,TRICARE,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,UNITED HEALTHCARE,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,UNITED HEALTHCARE,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,VA,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,VA TRICARE,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,WELLMED,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,HUMANA,MGD,71.23,,,,,,,per diem,71.23,71.23,"Per diem rate, code is bundled with other services"
"ALLERGEN, IGE                 ",38200009,CDM,302,RC,86003,CPT,,,,Inpatient,,,71.23,71.23,HUMANA CHOICE PLUS,MGD,71.23,,,,,,,case rate,71.23,71.23,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,AETNA,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,BCBS,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,CIGNA,COM,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,TRICARE,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,UNITED HEALTHCARE,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,UNITED HEALTHCARE,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,VA,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,VA TRICARE,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,WELLMED,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,HUMANA,MGD,359.61,,,,,,,per diem,359.61,359.61,"Per diem rate, code is bundled with other services"
ACETYCHOLINE RECEPTOR AB      ,38200010,CDM,301,RC,84238,CPT,,,,Inpatient,,,359.61,359.61,HUMANA CHOICE PLUS,MGD,359.61,,,,,,,case rate,359.61,359.61,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,AETNA,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,BCBS,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,CIGNA,COM,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,TRICARE,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,UNITED HEALTHCARE,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,UNITED HEALTHCARE,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,VA,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,VA TRICARE,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,WELLMED,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,HUMANA,MGD,181.1,,,,,,,per diem,181.1,181.1,"Per diem rate, code is bundled with other services"
BETA 2 MICROGLOBULIN          ,38200013,CDM,301,RC,82232,CPT,,,,Inpatient,,,181.1,181.1,HUMANA CHOICE PLUS,MGD,181.1,,,,,,,case rate,181.1,181.1,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,AETNA,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,BCBS,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,CIGNA,COM,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,TRICARE,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,UNITED HEALTHCARE,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,UNITED HEALTHCARE,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,VA,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,VA TRICARE,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,WELLMED,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,HUMANA,MGD,104.99,,,,,,,per diem,104.99,104.99,"Per diem rate, code is bundled with other services"
VARICELLA ZOSTER ANTIBODY     ,38200014,CDM,302,RC,86787,CPT,,,,Inpatient,,,104.99,104.99,HUMANA CHOICE PLUS,MGD,104.99,,,,,,,case rate,104.99,104.99,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,AETNA,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,BCBS,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,CIGNA,COM,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,TRICARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,UNITED HEALTHCARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,UNITED HEALTHCARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,VA,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,VA TRICARE,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,WELLMED,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,HUMANA,MGD,45.42,,,,,,,per diem,45.42,45.42,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGM             ,38200016,CDM,301,RC,82784,CPT,,,,Inpatient,,,45.42,45.42,HUMANA CHOICE PLUS,MGD,45.42,,,,,,,case rate,45.42,45.42,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,AETNA,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,BCBS,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,CIGNA,COM,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,TRICARE,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,UNITED HEALTHCARE,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,UNITED HEALTHCARE,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,VA,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,VA TRICARE,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,WELLMED,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,HUMANA,MGD,219.66,,,,,,,per diem,219.66,219.66,"Per diem rate, code is bundled with other services"
"AEROBIC CULTURE, QUANT        ",38200017,CDM,306,RC,87071,CPT,,,,Inpatient,,,219.66,219.66,HUMANA CHOICE PLUS,MGD,219.66,,,,,,,case rate,219.66,219.66,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,AETNA,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,CIGNA,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,TRICARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,UNITED HEALTHCARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,UNITED HEALTHCARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,VA,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,VA TRICARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,WELLMED,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,HUMANA,MGD,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO BLOOD TYPING              ,38200018,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,HUMANA CHOICE PLUS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,AETNA,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,BCBS,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,CIGNA,COM,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,TRICARE,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,UNITED HEALTHCARE,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,UNITED HEALTHCARE,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,VA,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,VA TRICARE,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,WELLMED,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,HUMANA,MGD,157.9,,,,,,,per diem,157.9,157.9,"Per diem rate, code is bundled with other services"
RH BLOOD TYPING               ,38200019,CDM,302,RC,86901,CPT,,,,Inpatient,,,157.9,157.9,HUMANA CHOICE PLUS,MGD,157.9,,,,,,,case rate,157.9,157.9,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,AETNA,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,BCBS,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,CIGNA,COM,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,TRICARE,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,UNITED HEALTHCARE,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,UNITED HEALTHCARE,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,VA,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,VA TRICARE,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,WELLMED,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,HUMANA,MGD,705.13,,,,,,,per diem,705.13,705.13,"Per diem rate, code is bundled with other services"
PURKINJE CELL CYTOPLASMA      ,38200020,CDM,302,RC,86255,CPT,,,,Inpatient,,,705.13,705.13,HUMANA CHOICE PLUS,MGD,705.13,,,,,,,case rate,705.13,705.13,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,AETNA,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,BCBS,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,CIGNA,COM,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,TRICARE,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,UNITED HEALTHCARE,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,UNITED HEALTHCARE,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,VA,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,VA TRICARE,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,WELLMED,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,HUMANA,MGD,224.73,,,,,,,per diem,224.73,224.73,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUALITATIVE        ",38200021,CDM,301,RC,84703,CPT,,,,Inpatient,,,224.73,224.73,HUMANA CHOICE PLUS,MGD,224.73,,,,,,,case rate,224.73,224.73,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,AETNA,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,BCBS,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,CIGNA,COM,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,TRICARE,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,UNITED HEALTHCARE,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,UNITED HEALTHCARE,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,VA,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,VA TRICARE,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,WELLMED,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,HUMANA,MGD,514.86,,,,,,,per diem,514.86,514.86,"Per diem rate, code is bundled with other services"
"HCG SERUM, QUANTITATIVE       ",38200022,CDM,301,RC,84702,CPT,,,,Inpatient,,,514.86,514.86,HUMANA CHOICE PLUS,MGD,514.86,,,,,,,case rate,514.86,514.86,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,AETNA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,CIGNA,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,VA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,VA TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,WELLMED,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,HUMANA,MGD,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PANEL                   ,38200024,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,HUMANA CHOICE PLUS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,AETNA,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,BCBS,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,CIGNA,COM,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,TRICARE,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,UNITED HEALTHCARE,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,UNITED HEALTHCARE,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,VA,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,VA TRICARE,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,WELLMED,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,HUMANA,MGD,135.98,,,,,,,per diem,135.98,135.98,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN                 ,38200032,CDM,301,RC,82003,CPT,,,,Inpatient,,,135.98,135.98,HUMANA CHOICE PLUS,MGD,135.98,,,,,,,case rate,135.98,135.98,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,AETNA,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,BCBS,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,CIGNA,COM,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,TRICARE,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,UNITED HEALTHCARE,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,UNITED HEALTHCARE,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,VA,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,VA TRICARE,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,WELLMED,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,HUMANA,MGD,411.36,,,,,,,per diem,411.36,411.36,"Per diem rate, code is bundled with other services"
ANTIDIURETIC HORMONE          ,38200035,CDM,301,RC,84588,CPT,,,,Inpatient,,,411.36,411.36,HUMANA CHOICE PLUS,MGD,411.36,,,,,,,case rate,411.36,411.36,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
SPECTROPHOTOMETRY ANALYTE NOS ,38200036,CDM,301,RC,84311,CPT,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,AETNA,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,BCBS,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,CIGNA,COM,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,TRICARE,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,UNITED HEALTHCARE,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,UNITED HEALTHCARE,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,VA,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,VA TRICARE,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,WELLMED,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,HUMANA,MGD,78.63,,,,,,,per diem,78.63,78.63,"Per diem rate, code is bundled with other services"
CITRATE                       ,38200037,CDM,301,RC,82507,CPT,,,,Inpatient,,,78.63,78.63,HUMANA CHOICE PLUS,MGD,78.63,,,,,,,case rate,78.63,78.63,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,AETNA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,CIGNA,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,VA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,VA TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,WELLMED,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,HUMANA,MGD,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
ACETONE SERUM QUAL.           ,38200040,CDM,301,RC,82009,CPT,,,,Inpatient,,,128.52,128.52,HUMANA CHOICE PLUS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,AETNA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,CIGNA,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,VA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,VA TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,WELLMED,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,HUMANA,MGD,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"ACID PHOS, PROSTATIC          ",38200055,CDM,301,RC,84066,CPT,,,,Inpatient,,,47.12,47.12,HUMANA CHOICE PLUS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,AETNA,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,BCBS,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,CIGNA,COM,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,TRICARE,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,UNITED HEALTHCARE,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,UNITED HEALTHCARE,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,VA,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,VA TRICARE,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,WELLMED,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,HUMANA,MGD,254.35,,,,,,,per diem,254.35,254.35,"Per diem rate, code is bundled with other services"
ACID PHOS SERUM TOTAL         ,38200056,CDM,301,RC,84060,CPT,,,,Inpatient,,,254.35,254.35,HUMANA CHOICE PLUS,MGD,254.35,,,,,,,case rate,254.35,254.35,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,AETNA,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,BCBS,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,CIGNA,COM,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,TRICARE,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,UNITED HEALTHCARE,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,UNITED HEALTHCARE,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,VA,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,VA TRICARE,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,WELLMED,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,HUMANA,MGD,211.52,,,,,,,per diem,211.52,211.52,"Per diem rate, code is bundled with other services"
ACTIVATED PROTEIN C RESISTANCE,38200057,CDM,305,RC,85307,CPT,,,,Inpatient,,,211.52,211.52,HUMANA CHOICE PLUS,MGD,211.52,,,,,,,case rate,211.52,211.52,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,AETNA,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,BCBS,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,CIGNA,COM,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,TRICARE,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,UNITED HEALTHCARE,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,UNITED HEALTHCARE,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,VA,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,VA TRICARE,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,WELLMED,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,HUMANA,MGD,312.56,,,,,,,per diem,312.56,312.56,"Per diem rate, code is bundled with other services"
ACTH                          ,38200060,CDM,301,RC,82024,CPT,,,,Inpatient,,,312.56,312.56,HUMANA CHOICE PLUS,MGD,312.56,,,,,,,case rate,312.56,312.56,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,AETNA,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,BCBS,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,CIGNA,COM,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,TRICARE,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,UNITED HEALTHCARE,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,UNITED HEALTHCARE,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,VA,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,VA TRICARE,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,WELLMED,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,HUMANA,MGD,393.67,,,,,,,per diem,393.67,393.67,"Per diem rate, code is bundled with other services"
GM1 ANTIBODIES                ,38200063,CDM,301,RC,83520,CPT,,,,Inpatient,,,393.67,393.67,HUMANA CHOICE PLUS,MGD,393.67,,,,,,,case rate,393.67,393.67,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,AETNA,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,BCBS,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,CIGNA,COM,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,TRICARE,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,UNITED HEALTHCARE,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,UNITED HEALTHCARE,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,VA,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,VA TRICARE,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,WELLMED,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,HUMANA,MGD,170.04,,,,,,,per diem,170.04,170.04,"Per diem rate, code is bundled with other services"
ALDOLASE                      ,38200070,CDM,301,RC,82085,CPT,,,,Inpatient,,,170.04,170.04,HUMANA CHOICE PLUS,MGD,170.04,,,,,,,case rate,170.04,170.04,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,AETNA,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,CIGNA,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,TRICARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,UNITED HEALTHCARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,UNITED HEALTHCARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,VA,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,VA TRICARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,WELLMED,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,HUMANA,MGD,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
NIACIN LEVEL                  ,38200071,CDM,301,RC,84591,CPT,,,,Inpatient,,,293.45,293.45,HUMANA CHOICE PLUS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,AETNA,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,CIGNA,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,TRICARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,UNITED HEALTHCARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,UNITED HEALTHCARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,VA,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,VA TRICARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,WELLMED,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,HUMANA,MGD,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
PORPHYRINS STOOL              ,38200072,CDM,301,RC,84126,CPT,,,,Inpatient,,,242.05,242.05,HUMANA CHOICE PLUS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,AETNA,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,BCBS,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,CIGNA,COM,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,TRICARE,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,UNITED HEALTHCARE,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,UNITED HEALTHCARE,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,VA,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,VA TRICARE,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,WELLMED,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,HUMANA,MGD,94.59,,,,,,,per diem,94.59,94.59,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI SMEAR       ,38200073,CDM,306,RC,87206,CPT,,,,Inpatient,,,94.59,94.59,HUMANA CHOICE PLUS,MGD,94.59,,,,,,,case rate,94.59,94.59,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,AETNA,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,BCBS,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,CIGNA,COM,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,TRICARE,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,UNITED HEALTHCARE,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,UNITED HEALTHCARE,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,VA,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,VA TRICARE,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,WELLMED,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,HUMANA,MGD,76.4,,,,,,,per diem,76.4,76.4,"Per diem rate, code is bundled with other services"
ACHR BINDING AB SERUM         ,38200076,CDM,300,RC,83519,CPT,,,,Inpatient,,,76.4,76.4,HUMANA CHOICE PLUS,MGD,76.4,,,,,,,case rate,76.4,76.4,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,AETNA,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,BCBS,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,CIGNA,COM,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,TRICARE,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,UNITED HEALTHCARE,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,UNITED HEALTHCARE,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,VA,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,VA TRICARE,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,WELLMED,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,HUMANA,MGD,11.36,,,,,,,per diem,11.36,11.36,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38200080,CDM,301,RC,82040,CPT,,,,Inpatient,,,11.36,11.36,HUMANA CHOICE PLUS,MGD,11.36,,,,,,,case rate,11.36,11.36,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,AETNA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,CIGNA,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,VA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,VA TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,WELLMED,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,HUMANA,MGD,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
ALCOHOL BIOMARKERS 1 OR 2     ,38200082,CDM,301,RC,80321,CPT,,,,Inpatient,,,47.12,47.12,HUMANA CHOICE PLUS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,AETNA,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,BCBS,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,CIGNA,COM,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,TRICARE,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,UNITED HEALTHCARE,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,UNITED HEALTHCARE,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,VA,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,VA TRICARE,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,WELLMED,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,HUMANA,MGD,172.7,,,,,,,per diem,172.7,172.7,"Per diem rate, code is bundled with other services"
ALCOHOL (ETOH)BLOOD LEVEL     ,38200090,CDM,301,RC,82055,CPT,,,,Inpatient,,,172.7,172.7,HUMANA CHOICE PLUS,MGD,172.7,,,,,,,case rate,172.7,172.7,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,AETNA,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,BCBS,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,CIGNA,COM,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,TRICARE,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,UNITED HEALTHCARE,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,UNITED HEALTHCARE,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,VA,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,VA TRICARE,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,WELLMED,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,HUMANA,MGD,422.73,,,,,,,per diem,422.73,422.73,"Per diem rate, code is bundled with other services"
"ALPHA-FETOPROTEIN, SERUM      ",38200091,CDM,301,RC,82105,CPT,,,,Inpatient,,,422.73,422.73,HUMANA CHOICE PLUS,MGD,422.73,,,,,,,case rate,422.73,422.73,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,AETNA,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,BCBS,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,CIGNA,COM,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,TRICARE,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,UNITED HEALTHCARE,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,UNITED HEALTHCARE,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,VA,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,VA TRICARE,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,WELLMED,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,HUMANA,MGD,66.52,,,,,,,per diem,66.52,66.52,"Per diem rate, code is bundled with other services"
ALDOSTERONE SERUM             ,38200092,CDM,301,RC,82088,CPT,,,,Inpatient,,,66.52,66.52,HUMANA CHOICE PLUS,MGD,66.52,,,,,,,case rate,66.52,66.52,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,AETNA,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,CIGNA,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,TRICARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,UNITED HEALTHCARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,UNITED HEALTHCARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,VA,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,VA TRICARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,WELLMED,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,HUMANA,MGD,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN LEVEL     ,38200093,CDM,301,RC,82103,CPT,,,,Inpatient,,,349.27,349.27,HUMANA CHOICE PLUS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,AETNA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,CIGNA,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,VA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,VA TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,WELLMED,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,HUMANA,MGD,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
ALPHA I ANTITRYPSIN PHENO     ,38200094,CDM,301,RC,82104,CPT,,,,Inpatient,,,122.09,122.09,HUMANA CHOICE PLUS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,AETNA,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,BCBS,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,CIGNA,COM,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,TRICARE,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,UNITED HEALTHCARE,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,UNITED HEALTHCARE,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,VA,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,VA TRICARE,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,WELLMED,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,HUMANA,MGD,28.34,,,,,,,per diem,28.34,28.34,"Per diem rate, code is bundled with other services"
"ALKALINE PHOSPHATASE, TOTAL   ",38200095,CDM,301,RC,84075,CPT,,,,Inpatient,,,28.34,28.34,HUMANA CHOICE PLUS,MGD,28.34,,,,,,,case rate,28.34,28.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
ALPHA 2 ANTIPLASMIN           ,38200096,CDM,305,RC,85410,CPT,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CLOTEST                       ,38200099,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,AETNA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,CIGNA,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,VA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,VA TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,WELLMED,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,HUMANA,MGD,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 1-2    ,38200104,CDM,301,RC,80335,CPT,,,,Inpatient,,,371.64,371.64,HUMANA CHOICE PLUS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,AETNA,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,BCBS,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,CIGNA,COM,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,TRICARE,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,UNITED HEALTHCARE,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,UNITED HEALTHCARE,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,VA,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,VA TRICARE,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,WELLMED,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,HUMANA,MGD,530.15,,,,,,,per diem,530.15,530.15,"Per diem rate, code is bundled with other services"
ANTIDEPRESSANTS TRICYC 6+     ,38200106,CDM,301,RC,80337,CPT,,,,Inpatient,,,530.15,530.15,HUMANA CHOICE PLUS,MGD,530.15,,,,,,,case rate,530.15,530.15,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,AETNA,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,BCBS,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,CIGNA,COM,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,TRICARE,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,UNITED HEALTHCARE,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,UNITED HEALTHCARE,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,VA,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,VA TRICARE,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,WELLMED,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,HUMANA,MGD,273.08,,,,,,,per diem,273.08,273.08,"Per diem rate, code is bundled with other services"
AMIKACIN                      ,38200110,CDM,301,RC,80150,CPT,,,,Inpatient,,,273.08,273.08,HUMANA CHOICE PLUS,MGD,273.08,,,,,,,case rate,273.08,273.08,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,AETNA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,CIGNA,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,VA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,VA TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,WELLMED,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,HUMANA,MGD,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/O MICROSC,38200111,CDM,307,RC,81002,CPT,,,,Inpatient,,,92.11,92.11,HUMANA CHOICE PLUS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,AETNA,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,BCBS,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,CIGNA,COM,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,TRICARE,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,UNITED HEALTHCARE,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,UNITED HEALTHCARE,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,VA,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,VA TRICARE,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,WELLMED,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,HUMANA,MGD,177.51,,,,,,,per diem,177.51,177.51,"Per diem rate, code is bundled with other services"
AMIODARONE                    ,38200112,CDM,301,RC,80299,CPT,,,,Inpatient,,,177.51,177.51,HUMANA CHOICE PLUS,MGD,177.51,,,,,,,case rate,177.51,177.51,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,AETNA,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,BCBS,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,CIGNA,COM,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,TRICARE,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,UNITED HEALTHCARE,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,UNITED HEALTHCARE,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,VA,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,VA TRICARE,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,WELLMED,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,HUMANA,MGD,191.58,,,,,,,per diem,191.58,191.58,"Per diem rate, code is bundled with other services"
BETA HYDROXYBUTYRATE          ,38200116,CDM,301,RC,82010,CPT,,,,Inpatient,,,191.58,191.58,HUMANA CHOICE PLUS,MGD,191.58,,,,,,,case rate,191.58,191.58,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,AETNA,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,CIGNA,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,TRICARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,UNITED HEALTHCARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,UNITED HEALTHCARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,VA,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,VA TRICARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,WELLMED,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,HUMANA,MGD,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
CA 27.29                      ,38200117,CDM,302,RC,86300,CPT,,,,Inpatient,,,131.91,131.91,HUMANA CHOICE PLUS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,AETNA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,CIGNA,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,VA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,VA TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,WELLMED,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,HUMANA,MGD,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
RISTOCETIN CO FACTOR          ,38200118,CDM,305,RC,85245,CPT,,,,Inpatient,,,269.89,269.89,HUMANA CHOICE PLUS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
VON WILLEBRAND ANTIGEN        ,38200119,CDM,305,RC,85246,CPT,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,AETNA,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,CIGNA,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,TRICARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,UNITED HEALTHCARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,UNITED HEALTHCARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,VA,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,VA TRICARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,WELLMED,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,HUMANA,MGD,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
AMMONIA                       ,38200120,CDM,301,RC,82140,CPT,,,,Inpatient,,,45.9,45.9,HUMANA CHOICE PLUS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,AETNA,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,BCBS,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,CIGNA,COM,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,TRICARE,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,UNITED HEALTHCARE,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,UNITED HEALTHCARE,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,VA,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,VA TRICARE,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,WELLMED,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,HUMANA,MGD,96.27,,,,,,,per diem,96.27,96.27,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR MULTIMET,38200122,CDM,305,RC,85247,CPT,,,,Inpatient,,,96.27,96.27,HUMANA CHOICE PLUS,MGD,96.27,,,,,,,case rate,96.27,96.27,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,AETNA,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,BCBS,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,CIGNA,COM,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,TRICARE,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,UNITED HEALTHCARE,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,UNITED HEALTHCARE,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,VA,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,VA TRICARE,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,WELLMED,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,HUMANA,MGD,165.97,,,,,,,per diem,165.97,165.97,"Per diem rate, code is bundled with other services"
ABG ANALYSIS                  ,38200125,CDM,301,RC,82803,CPT,,,,Inpatient,,,165.97,165.97,HUMANA CHOICE PLUS,MGD,165.97,,,,,,,case rate,165.97,165.97,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38200130,CDM,301,RC,82150,CPT,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,AETNA,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,BCBS,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,CIGNA,COM,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,TRICARE,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,UNITED HEALTHCARE,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,UNITED HEALTHCARE,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,VA,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,VA TRICARE,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,WELLMED,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,HUMANA,MGD,370.87,,,,,,,per diem,370.87,370.87,"Per diem rate, code is bundled with other services"
DNA SINGLE STRAND ANTIBODY    ,38200131,CDM,302,RC,86226,CPT,,,,Inpatient,,,370.87,370.87,HUMANA CHOICE PLUS,MGD,370.87,,,,,,,case rate,370.87,370.87,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,AETNA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,CIGNA,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,WELLMED,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA,MGD,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE URINE                 ,38200135,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA CHOICE PLUS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,AETNA,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,BCBS,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,CIGNA,COM,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,TRICARE,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,UNITED HEALTHCARE,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,UNITED HEALTHCARE,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,VA,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,VA TRICARE,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,WELLMED,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,HUMANA,MGD,165.83,,,,,,,per diem,165.83,165.83,"Per diem rate, code is bundled with other services"
HDL (DIRECT)                  ,38200138,CDM,301,RC,83718,CPT,,,,Inpatient,,,165.83,165.83,HUMANA CHOICE PLUS,MGD,165.83,,,,,,,case rate,165.83,165.83,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,AETNA,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,BCBS,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,CIGNA,COM,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,TRICARE,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,UNITED HEALTHCARE,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,UNITED HEALTHCARE,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,VA,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,VA TRICARE,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,WELLMED,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,HUMANA,MGD,196.3,,,,,,,per diem,196.3,196.3,"Per diem rate, code is bundled with other services"
ANA SCREEN                    ,38200140,CDM,302,RC,86038,CPT,,,,Inpatient,,,196.3,196.3,HUMANA CHOICE PLUS,MGD,196.3,,,,,,,case rate,196.3,196.3,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,AETNA,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,BCBS,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,CIGNA,COM,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,TRICARE,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,UNITED HEALTHCARE,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,UNITED HEALTHCARE,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,VA,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,VA TRICARE,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,WELLMED,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,HUMANA,MGD,143.8,,,,,,,per diem,143.8,143.8,"Per diem rate, code is bundled with other services"
ANA TITER                     ,38200150,CDM,302,RC,86039,CPT,,,,Inpatient,,,143.8,143.8,HUMANA CHOICE PLUS,MGD,143.8,,,,,,,case rate,143.8,143.8,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,AETNA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,CIGNA,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,VA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,VA TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,WELLMED,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,HUMANA,MGD,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
ANDROSTENEDIONE LEVEL         ,38200155,CDM,301,RC,82157,CPT,,,,Inpatient,,,136.02,136.02,HUMANA CHOICE PLUS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,AETNA,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,BCBS,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,CIGNA,COM,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,TRICARE,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,UNITED HEALTHCARE,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,UNITED HEALTHCARE,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,VA,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,VA TRICARE,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,WELLMED,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,HUMANA,MGD,201.47,,,,,,,per diem,201.47,201.47,"Per diem rate, code is bundled with other services"
ANGIOTENSIN CONVERT ENZYME    ,38200157,CDM,301,RC,82164,CPT,,,,Inpatient,,,201.47,201.47,HUMANA CHOICE PLUS,MGD,201.47,,,,,,,case rate,201.47,201.47,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,AETNA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,CIGNA,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,WELLMED,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA,MGD,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38200161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA CHOICE PLUS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,AETNA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,CIGNA,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,WELLMED,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA,MGD,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38200166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA CHOICE PLUS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
ANTIBODY CYSTICERCOSIS        ,38200175,CDM,302,RC,86682,CPT,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,AETNA,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,BCBS,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,CIGNA,COM,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,TRICARE,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,UNITED HEALTHCARE,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,UNITED HEALTHCARE,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,VA,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,VA TRICARE,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,WELLMED,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,HUMANA,MGD,377.44,,,,,,,per diem,377.44,377.44,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EA PANEL       ,38200180,CDM,300,RC,86870,CPT,,,,Inpatient,,,377.44,377.44,HUMANA CHOICE PLUS,MGD,377.44,,,,,,,case rate,377.44,377.44,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,AETNA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,CIGNA,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,VA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,VA TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,WELLMED,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,HUMANA,MGD,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,38200190,CDM,300,RC,86850,CPT,,,,Inpatient,,,32.07,32.07,HUMANA CHOICE PLUS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,AETNA,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,BCBS,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,CIGNA,COM,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,TRICARE,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,UNITED HEALTHCARE,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,UNITED HEALTHCARE,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,VA,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,VA TRICARE,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,WELLMED,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,HUMANA,MGD,99.15,,,,,,,per diem,99.15,99.15,"Per diem rate, code is bundled with other services"
ANTI-DNA ANTIBODY             ,38200197,CDM,302,RC,86225,CPT,,,,Inpatient,,,99.15,99.15,HUMANA CHOICE PLUS,MGD,99.15,,,,,,,case rate,99.15,99.15,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
ANTI-MITOCHONDRIAL ANTIB      ,38200198,CDM,302,RC,86255,CPT,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,AETNA,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,BCBS,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,CIGNA,COM,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,TRICARE,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,UNITED HEALTHCARE,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,UNITED HEALTHCARE,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,VA,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,VA TRICARE,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,WELLMED,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,HUMANA,MGD,493.5,,,,,,,per diem,493.5,493.5,"Per diem rate, code is bundled with other services"
ANTI-SMOOTH MUSCLE ANTIBODY   ,38200199,CDM,302,RC,86255,CPT,,,,Inpatient,,,493.5,493.5,HUMANA CHOICE PLUS,MGD,493.5,,,,,,,case rate,493.5,493.5,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,AETNA,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,BCBS,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,CIGNA,COM,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,TRICARE,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,UNITED HEALTHCARE,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,UNITED HEALTHCARE,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,VA,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,VA TRICARE,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,WELLMED,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,HUMANA,MGD,238.41,,,,,,,per diem,238.41,238.41,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIB           ,38200200,CDM,302,RC,86022,CPT,,,,Inpatient,,,238.41,238.41,HUMANA CHOICE PLUS,MGD,238.41,,,,,,,case rate,238.41,238.41,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,AETNA,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,BCBS,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,CIGNA,COM,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,TRICARE,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,UNITED HEALTHCARE,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,UNITED HEALTHCARE,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,VA,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,VA TRICARE,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,WELLMED,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,HUMANA,MGD,356.45,,,,,,,per diem,356.45,356.45,"Per diem rate, code is bundled with other services"
ANTI-THYROGLOBIN              ,38200205,CDM,302,RC,86800,CPT,,,,Inpatient,,,356.45,356.45,HUMANA CHOICE PLUS,MGD,356.45,,,,,,,case rate,356.45,356.45,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,AETNA,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,CIGNA,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,TRICARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,UNITED HEALTHCARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,UNITED HEALTHCARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,VA,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,VA TRICARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,WELLMED,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,HUMANA,MGD,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
ANTITHROMBIN III              ,38200210,CDM,305,RC,85300,CPT,,,,Inpatient,,,30.83,30.83,HUMANA CHOICE PLUS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,AETNA,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,BCBS,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,CIGNA,COM,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,TRICARE,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,UNITED HEALTHCARE,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,UNITED HEALTHCARE,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,VA,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,VA TRICARE,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,WELLMED,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,HUMANA,MGD,486.23,,,,,,,per diem,486.23,486.23,"Per diem rate, code is bundled with other services"
PLASMINOGEN ACTIVATOR         ,38200211,CDM,305,RC,85415,CPT,,,,Inpatient,,,486.23,486.23,HUMANA CHOICE PLUS,MGD,486.23,,,,,,,case rate,486.23,486.23,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,AETNA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,CIGNA,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,VA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,VA TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,WELLMED,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,HUMANA,MGD,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
PROTEIN C ACTIVITY            ,38200212,CDM,305,RC,85303,CPT,,,,Inpatient,,,38.4,38.4,HUMANA CHOICE PLUS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,AETNA,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,BCBS,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,CIGNA,COM,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,TRICARE,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,UNITED HEALTHCARE,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,UNITED HEALTHCARE,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,VA,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,VA TRICARE,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,WELLMED,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,HUMANA,MGD,474.9,,,,,,,per diem,474.9,474.9,"Per diem rate, code is bundled with other services"
PROTEIN S ANTIGEN (TOTAL)     ,38200213,CDM,305,RC,85305,CPT,,,,Inpatient,,,474.9,474.9,HUMANA CHOICE PLUS,MGD,474.9,,,,,,,case rate,474.9,474.9,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,AETNA,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,BCBS,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,CIGNA,COM,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,TRICARE,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,UNITED HEALTHCARE,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,UNITED HEALTHCARE,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,VA,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,VA TRICARE,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,WELLMED,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,HUMANA,MGD,1059.45,,,,,,,per diem,1059.45,1059.45,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN INHIBITION     ,38200214,CDM,305,RC,85705,CPT,,,,Inpatient,,,1059.45,1059.45,HUMANA CHOICE PLUS,MGD,1059.45,,,,,,,case rate,1059.45,1059.45,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,AETNA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,CIGNA,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,VA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,VA TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,WELLMED,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,HUMANA,MGD,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
PROTEIN C ANTIGEN             ,38200215,CDM,305,RC,85302,CPT,,,,Inpatient,,,88.68,88.68,HUMANA CHOICE PLUS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,AETNA,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,BCBS,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,CIGNA,COM,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,TRICARE,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,UNITED HEALTHCARE,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,UNITED HEALTHCARE,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,VA,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,VA TRICARE,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,WELLMED,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,HUMANA,MGD,170.53,,,,,,,per diem,170.53,170.53,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN SERUM    ,38200216,CDM,306,RC,87899,CPT,,,,Inpatient,,,170.53,170.53,HUMANA CHOICE PLUS,MGD,170.53,,,,,,,case rate,170.53,170.53,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,AETNA,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,BCBS,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,CIGNA,COM,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,TRICARE,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,UNITED HEALTHCARE,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,UNITED HEALTHCARE,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,VA,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,VA TRICARE,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,WELLMED,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,HUMANA,MGD,100.57,,,,,,,per diem,100.57,100.57,"Per diem rate, code is bundled with other services"
C DIFFICILE ANTIGEN           ,38200218,CDM,306,RC,87449,CPT,,,,Inpatient,,,100.57,100.57,HUMANA CHOICE PLUS,MGD,100.57,,,,,,,case rate,100.57,100.57,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,AETNA,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,BCBS,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,CIGNA,COM,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,TRICARE,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,UNITED HEALTHCARE,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,UNITED HEALTHCARE,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,VA,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,VA TRICARE,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,WELLMED,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,HUMANA,MGD,840.26,,,,,,,per diem,840.26,840.26,"Per diem rate, code is bundled with other services"
HEP C GENOTYPE DNA/RNA        ,38200220,CDM,306,RC,87902,CPT,,,,Inpatient,,,840.26,840.26,HUMANA CHOICE PLUS,MGD,840.26,,,,,,,case rate,840.26,840.26,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,AETNA,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,CIGNA,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,TRICARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,UNITED HEALTHCARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,UNITED HEALTHCARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,VA,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,VA TRICARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,WELLMED,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,HUMANA,MGD,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZA A&B                 ,38200221,CDM,306,RC,86710,CPT,,,,Inpatient,,,81.62,81.62,HUMANA CHOICE PLUS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,AETNA,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,BCBS,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,CIGNA,COM,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,TRICARE,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,UNITED HEALTHCARE,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,UNITED HEALTHCARE,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,VA,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,VA TRICARE,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,WELLMED,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,HUMANA,MGD,123.67,,,,,,,per diem,123.67,123.67,"Per diem rate, code is bundled with other services"
BNP (B NATRIURETIC PEPTIDE)   ,38200222,CDM,301,RC,83880,CPT,,,,Inpatient,,,123.67,123.67,HUMANA CHOICE PLUS,MGD,123.67,,,,,,,case rate,123.67,123.67,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,AETNA,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,BCBS,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,CIGNA,COM,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,TRICARE,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,UNITED HEALTHCARE,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,UNITED HEALTHCARE,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,VA,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,VA TRICARE,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,WELLMED,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,HUMANA,MGD,152.61,,,,,,,per diem,152.61,152.61,"Per diem rate, code is bundled with other services"
NT-PRO BNP                    ,38200223,CDM,301,RC,83880,CPT,,,,Inpatient,,,152.61,152.61,HUMANA CHOICE PLUS,MGD,152.61,,,,,,,case rate,152.61,152.61,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,AETNA,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,BCBS,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,CIGNA,COM,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,TRICARE,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,UNITED HEALTHCARE,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,UNITED HEALTHCARE,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,VA,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,VA TRICARE,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,WELLMED,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,HUMANA,MGD,170.18,,,,,,,per diem,170.18,170.18,"Per diem rate, code is bundled with other services"
ANTI STREP O TITER            ,38200230,CDM,302,RC,86060,CPT,,,,Inpatient,,,170.18,170.18,HUMANA CHOICE PLUS,MGD,170.18,,,,,,,case rate,170.18,170.18,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYP ADD HIV1,38200241,CDM,306,RC,87904,CPT,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,AETNA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,CIGNA,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,VA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,VA TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,WELLMED,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,HUMANA,MGD,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
INFECT AGENT PHENOTYPE HIV1   ,38200242,CDM,306,RC,87903,CPT,,,,Inpatient,,,327.73,327.73,HUMANA CHOICE PLUS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,AETNA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,CIGNA,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,VA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,VA TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,WELLMED,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,HUMANA,MGD,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
HIV GENOTYPE DNA/RNA          ,38200243,CDM,306,RC,87901,CPT,,,,Inpatient,,,327.73,327.73,HUMANA CHOICE PLUS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,AETNA,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,CIGNA,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,TRICARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,UNITED HEALTHCARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,UNITED HEALTHCARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,VA,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,VA TRICARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,WELLMED,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,HUMANA,MGD,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
BILIRUBIN DIRECT              ,38200250,CDM,301,RC,82248,CPT,,,,Inpatient,,,61.65,61.65,HUMANA CHOICE PLUS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,AETNA,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,BCBS,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,CIGNA,COM,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,TRICARE,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,UNITED HEALTHCARE,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,UNITED HEALTHCARE,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,VA,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,VA TRICARE,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,WELLMED,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,HUMANA,MGD,78.41,,,,,,,per diem,78.41,78.41,"Per diem rate, code is bundled with other services"
BILIRUBIN TOTAL               ,38200260,CDM,301,RC,82247,CPT,,,,Inpatient,,,78.41,78.41,HUMANA CHOICE PLUS,MGD,78.41,,,,,,,case rate,78.41,78.41,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,AETNA,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,BCBS,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,CIGNA,COM,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,TRICARE,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,UNITED HEALTHCARE,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,UNITED HEALTHCARE,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,VA,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,VA TRICARE,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,WELLMED,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,HUMANA,MGD,108.22,,,,,,,per diem,108.22,108.22,"Per diem rate, code is bundled with other services"
BLEEDING TIME                 ,38200290,CDM,305,RC,85002,CPT,,,,Inpatient,,,108.22,108.22,HUMANA CHOICE PLUS,MGD,108.22,,,,,,,case rate,108.22,108.22,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
RETICULATED PLT ASSAY         ,38200293,CDM,305,RC,85055,CPT,,,,Inpatient,,,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,AETNA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,CIGNA,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,VA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,VA TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,WELLMED,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,HUMANA,MGD,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (FREE)  ,38200302,CDM,301,RC,84154,CPT,,,,Inpatient,,,30.28,30.28,HUMANA CHOICE PLUS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,AETNA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,CIGNA,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,VA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,VA TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,WELLMED,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,HUMANA,MGD,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
BUN (UREANITROGEN)            ,38200310,CDM,301,RC,84520,CPT,,,,Inpatient,,,68.68,68.68,HUMANA CHOICE PLUS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,AETNA,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,BCBS,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,CIGNA,COM,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,TRICARE,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,UNITED HEALTHCARE,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,UNITED HEALTHCARE,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,VA,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,VA TRICARE,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,WELLMED,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,HUMANA,MGD,22.18,,,,,,,per diem,22.18,22.18,"Per diem rate, code is bundled with other services"
NEPHELOMETRY                  ,38200315,CDM,301,RC,83883,CPT,,,,Inpatient,,,22.18,22.18,HUMANA CHOICE PLUS,MGD,22.18,,,,,,,case rate,22.18,22.18,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,AETNA,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,BCBS,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,CIGNA,COM,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,TRICARE,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,UNITED HEALTHCARE,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,UNITED HEALTHCARE,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,VA,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,VA TRICARE,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,WELLMED,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,HUMANA,MGD,95.92,,,,,,,per diem,95.92,95.92,"Per diem rate, code is bundled with other services"
INF AG DET BY IA INFLUENZA    ,38200326,CDM,306,RC,87804,CPT,,,,Inpatient,,,95.92,95.92,HUMANA CHOICE PLUS,MGD,95.92,,,,,,,case rate,95.92,95.92,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,AETNA,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,BCBS,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,CIGNA,COM,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,TRICARE,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,UNITED HEALTHCARE,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,UNITED HEALTHCARE,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,VA,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,VA TRICARE,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,WELLMED,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,HUMANA,MGD,107.71,,,,,,,per diem,107.71,107.71,"Per diem rate, code is bundled with other services"
CRP (HIGH SENSITIVITY)        ,38200346,CDM,302,RC,86141,CPT,,,,Inpatient,,,107.71,107.71,HUMANA CHOICE PLUS,MGD,107.71,,,,,,,case rate,107.71,107.71,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,AETNA,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,BCBS,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,CIGNA,COM,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,TRICARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,UNITED HEALTHCARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,UNITED HEALTHCARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,VA,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,VA TRICARE,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,WELLMED,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,HUMANA,MGD,133.35,,,,,,,per diem,133.35,133.35,"Per diem rate, code is bundled with other services"
CA 15-3                       ,38200350,CDM,302,RC,86300,CPT,,,,Inpatient,,,133.35,133.35,HUMANA CHOICE PLUS,MGD,133.35,,,,,,,case rate,133.35,133.35,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,AETNA,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,BCBS,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,CIGNA,COM,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,TRICARE,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,UNITED HEALTHCARE,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,UNITED HEALTHCARE,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,VA,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,VA TRICARE,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,WELLMED,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,HUMANA,MGD,388.11,,,,,,,per diem,388.11,388.11,"Per diem rate, code is bundled with other services"
CA 125 ANTIBODY               ,38200360,CDM,302,RC,86304,CPT,,,,Inpatient,,,388.11,388.11,HUMANA CHOICE PLUS,MGD,388.11,,,,,,,case rate,388.11,388.11,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,AETNA,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,BCBS,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,CIGNA,COM,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,TRICARE,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,UNITED HEALTHCARE,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,UNITED HEALTHCARE,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,VA,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,VA TRICARE,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,WELLMED,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,HUMANA,MGD,287.91,,,,,,,per diem,287.91,287.91,"Per diem rate, code is bundled with other services"
CALCITONIN                    ,38200361,CDM,301,RC,82308,CPT,,,,Inpatient,,,287.91,287.91,HUMANA CHOICE PLUS,MGD,287.91,,,,,,,case rate,287.91,287.91,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,AETNA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,CIGNA,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,VA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,VA TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,WELLMED,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,HUMANA,MGD,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38200370,CDM,301,RC,82310,CPT,,,,Inpatient,,,68.68,68.68,HUMANA CHOICE PLUS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,AETNA,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,BCBS,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,CIGNA,COM,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,TRICARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,UNITED HEALTHCARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,UNITED HEALTHCARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,VA,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,VA TRICARE,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,WELLMED,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,HUMANA,MGD,163.31,,,,,,,per diem,163.31,163.31,"Per diem rate, code is bundled with other services"
CALCIUM (IONIZED)             ,38200380,CDM,301,RC,82330,CPT,,,,Inpatient,,,163.31,163.31,HUMANA CHOICE PLUS,MGD,163.31,,,,,,,case rate,163.31,163.31,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,AETNA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,CIGNA,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,VA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,VA TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,WELLMED,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,HUMANA,MGD,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
CARBOXYHEMOGLOBIN             ,38200403,CDM,301,RC,82375,CPT,,,,Inpatient,,,32.07,32.07,HUMANA CHOICE PLUS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,AETNA,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,BCBS,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,CIGNA,COM,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,TRICARE,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,UNITED HEALTHCARE,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,UNITED HEALTHCARE,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,VA,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,VA TRICARE,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,WELLMED,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,HUMANA,MGD,238.85,,,,,,,per diem,238.85,238.85,"Per diem rate, code is bundled with other services"
CARCINOEMBRYONIC-(CEA)        ,38200405,CDM,301,RC,82378,CPT,,,,Inpatient,,,238.85,238.85,HUMANA CHOICE PLUS,MGD,238.85,,,,,,,case rate,238.85,238.85,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,AETNA,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,BCBS,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,CIGNA,COM,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,TRICARE,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,UNITED HEALTHCARE,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,UNITED HEALTHCARE,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,VA,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,VA TRICARE,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,WELLMED,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,HUMANA,MGD,284.04,,,,,,,per diem,284.04,284.04,"Per diem rate, code is bundled with other services"
CAROTENE BLOOD LEVEL          ,38200420,CDM,301,RC,82380,CPT,,,,Inpatient,,,284.04,284.04,HUMANA CHOICE PLUS,MGD,284.04,,,,,,,case rate,284.04,284.04,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,AETNA,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,BCBS,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,CIGNA,COM,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,TRICARE,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,UNITED HEALTHCARE,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,UNITED HEALTHCARE,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,VA,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,VA TRICARE,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,WELLMED,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,HUMANA,MGD,473.6,,,,,,,per diem,473.6,473.6,"Per diem rate, code is bundled with other services"
CATECHOLAMINES BLOOD FRACT    ,38200436,CDM,301,RC,82384,CPT,,,,Inpatient,,,473.6,473.6,HUMANA CHOICE PLUS,MGD,473.6,,,,,,,case rate,473.6,473.6,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,AETNA,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,BCBS,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,CIGNA,COM,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,TRICARE,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,UNITED HEALTHCARE,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,UNITED HEALTHCARE,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,VA,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,VA TRICARE,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,WELLMED,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,HUMANA,MGD,31.09,,,,,,,per diem,31.09,31.09,"Per diem rate, code is bundled with other services"
DIFF MANUAL                   ,38200451,CDM,305,RC,85007,CPT,,,,Inpatient,,,31.09,31.09,HUMANA CHOICE PLUS,MGD,31.09,,,,,,,case rate,31.09,31.09,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,AETNA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,CIGNA,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,VA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,VA TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,WELLMED,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,HUMANA,MGD,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGAL SENSITIVITY            ,38200452,CDM,306,RC,87186,CPT,,,,Inpatient,,,113.02,113.02,HUMANA CHOICE PLUS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,AETNA,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,BCBS,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,CIGNA,COM,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,TRICARE,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,UNITED HEALTHCARE,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,UNITED HEALTHCARE,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,VA,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,VA TRICARE,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,WELLMED,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,HUMANA,MGD,430.5,,,,,,,per diem,430.5,430.5,"Per diem rate, code is bundled with other services"
ACTH STIMULATION PANEL        ,38200456,CDM,301,RC,80400,CPT,,,,Inpatient,,,430.5,430.5,HUMANA CHOICE PLUS,MGD,430.5,,,,,,,case rate,430.5,430.5,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,AETNA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,CIGNA,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,VA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,VA TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,WELLMED,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,HUMANA,MGD,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, W/ AUTO DIFF             ",38200470,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,HUMANA CHOICE PLUS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,AETNA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,CIGNA,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,VA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,VA TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,WELLMED,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,HUMANA,MGD,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
BETA 2 GLYCOPROTEIN AB        ,38200471,CDM,302,RC,86146,CPT,,,,Inpatient,,,38.4,38.4,HUMANA CHOICE PLUS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,AETNA,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,BCBS,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,CIGNA,COM,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,TRICARE,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,UNITED HEALTHCARE,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,UNITED HEALTHCARE,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,VA,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,VA TRICARE,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,WELLMED,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,HUMANA,MGD,210.89,,,,,,,per diem,210.89,210.89,"Per diem rate, code is bundled with other services"
LEVITIRACETAM                 ,38200472,CDM,301,RC,80177,CPT,,,,Inpatient,,,210.89,210.89,HUMANA CHOICE PLUS,MGD,210.89,,,,,,,case rate,210.89,210.89,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,AETNA,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,BCBS,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,CIGNA,COM,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,TRICARE,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,UNITED HEALTHCARE,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,UNITED HEALTHCARE,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,VA,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,VA TRICARE,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,WELLMED,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,HUMANA,MGD,246.83,,,,,,,per diem,246.83,246.83,"Per diem rate, code is bundled with other services"
TRYPSIN                       ,38200474,CDM,301,RC,83519,CPT,,,,Inpatient,,,246.83,246.83,HUMANA CHOICE PLUS,MGD,246.83,,,,,,,case rate,246.83,246.83,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
E HISTOLYTICA-EIA             ,38200475,CDM,306,RC,87337,CPT,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,AETNA,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,BCBS,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,CIGNA,COM,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,TRICARE,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,UNITED HEALTHCARE,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,UNITED HEALTHCARE,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,VA,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,VA TRICARE,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,WELLMED,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,HUMANA,MGD,120.78,,,,,,,per diem,120.78,120.78,"Per diem rate, code is bundled with other services"
DRUG QUANT CHROM SGL ANALYTE  ,38200477,CDM,301,RC,82491,CPT,,,,Inpatient,,,120.78,120.78,HUMANA CHOICE PLUS,MGD,120.78,,,,,,,case rate,120.78,120.78,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,AETNA,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,BCBS,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,CIGNA,COM,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,TRICARE,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,UNITED HEALTHCARE,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,UNITED HEALTHCARE,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,VA,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,VA TRICARE,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,WELLMED,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,HUMANA,MGD,113.87,,,,,,,per diem,113.87,113.87,"Per diem rate, code is bundled with other services"
CEA                           ,38200480,CDM,300,RC,82378,CPT,,,,Inpatient,,,113.87,113.87,HUMANA CHOICE PLUS,MGD,113.87,,,,,,,case rate,113.87,113.87,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,AETNA,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,CIGNA,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,TRICARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,UNITED HEALTHCARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,UNITED HEALTHCARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,VA,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,VA TRICARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,WELLMED,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,HUMANA,MGD,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/O DIFF    ,38200490,CDM,300,RC,89050,CPT,,,,Inpatient,,,40.75,40.75,HUMANA CHOICE PLUS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,AETNA,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,CIGNA,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,TRICARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,UNITED HEALTHCARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,UNITED HEALTHCARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,VA,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,VA TRICARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,WELLMED,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,HUMANA,MGD,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
CELL COUNT FLUIDS W/ DIFF     ,38200491,CDM,300,RC,89051,CPT,,,,Inpatient,,,47.59,47.59,HUMANA CHOICE PLUS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,AETNA,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,BCBS,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,CIGNA,COM,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,TRICARE,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,UNITED HEALTHCARE,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,UNITED HEALTHCARE,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,VA,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,VA TRICARE,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,WELLMED,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,HUMANA,MGD,216.33,,,,,,,per diem,216.33,216.33,"Per diem rate, code is bundled with other services"
CERULOPLASMIN                 ,38200495,CDM,301,RC,82390,CPT,,,,Inpatient,,,216.33,216.33,HUMANA CHOICE PLUS,MGD,216.33,,,,,,,case rate,216.33,216.33,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,AETNA,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,BCBS,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,CIGNA,COM,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,TRICARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,UNITED HEALTHCARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,UNITED HEALTHCARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,VA,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,VA TRICARE,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,WELLMED,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,HUMANA,MGD,30.83,,,,,,,per diem,30.83,30.83,"Per diem rate, code is bundled with other services"
CH50 TOTAL COMPLEMENT         ,38200498,CDM,302,RC,86162,CPT,,,,Inpatient,,,30.83,30.83,HUMANA CHOICE PLUS,MGD,30.83,,,,,,,case rate,30.83,30.83,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,AETNA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,CIGNA,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,VA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,VA TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,WELLMED,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,HUMANA,MGD,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
"GAMMAGLOBULIN IGD, FLUID      ",38200500,CDM,301,RC,82784,CPT,,,,Inpatient,,,153.15,153.15,HUMANA CHOICE PLUS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
M TUBERCULOSIS DNA AMP PROBE  ,38200504,CDM,306,RC,87556,CPT,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
SEX HORMONE BINDING GLOBULIN  ,38200505,CDM,301,RC,84270,CPT,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,AETNA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,CIGNA,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,VA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,VA TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,WELLMED,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,HUMANA,MGD,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN 24 HOUR URINE    ,38200513,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,HUMANA CHOICE PLUS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,AETNA,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,BCBS,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,CIGNA,COM,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,TRICARE,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,UNITED HEALTHCARE,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,UNITED HEALTHCARE,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,VA,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,VA TRICARE,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,WELLMED,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,HUMANA,MGD,122.65,,,,,,,per diem,122.65,122.65,"Per diem rate, code is bundled with other services"
CHLAMYDIA TRACHOMATIS(AMP)    ,38200517,CDM,306,RC,87491,CPT,,,,Inpatient,,,122.65,122.65,HUMANA CHOICE PLUS,MGD,122.65,,,,,,,case rate,122.65,122.65,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,AETNA,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,CIGNA,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,TRICARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,UNITED HEALTHCARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,UNITED HEALTHCARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,VA,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,VA TRICARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,WELLMED,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,HUMANA,MGD,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
LIPOPROTEINS FRACTION         ,38200521,CDM,301,RC,83701,CPT,,,,Inpatient,,,332.01,332.01,HUMANA CHOICE PLUS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,AETNA,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,BCBS,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,CIGNA,COM,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,TRICARE,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,UNITED HEALTHCARE,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,UNITED HEALTHCARE,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,VA,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,VA TRICARE,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,WELLMED,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,HUMANA,MGD,260.25,,,,,,,per diem,260.25,260.25,"Per diem rate, code is bundled with other services"
LIPOPROTEIN PARTICLE QUANT    ,38200522,CDM,301,RC,83704,CPT,,,,Inpatient,,,260.25,260.25,HUMANA CHOICE PLUS,MGD,260.25,,,,,,,case rate,260.25,260.25,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,AETNA,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,BCBS,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,CIGNA,COM,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,TRICARE,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,UNITED HEALTHCARE,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,UNITED HEALTHCARE,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,VA,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,VA TRICARE,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,WELLMED,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,HUMANA,MGD,83.98,,,,,,,per diem,83.98,83.98,"Per diem rate, code is bundled with other services"
CHLORIDE BLOOD                ,38200530,CDM,301,RC,82435,CPT,,,,Inpatient,,,83.98,83.98,HUMANA CHOICE PLUS,MGD,83.98,,,,,,,case rate,83.98,83.98,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,AETNA,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,BCBS,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,CIGNA,COM,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,TRICARE,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,UNITED HEALTHCARE,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,UNITED HEALTHCARE,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,VA,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,VA TRICARE,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,WELLMED,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,HUMANA,MGD,96.26,,,,,,,per diem,96.26,96.26,"Per diem rate, code is bundled with other services"
CHOLESTEROL (TOTAL)           ,38200540,CDM,301,RC,82465,CPT,,,,Inpatient,,,96.26,96.26,HUMANA CHOICE PLUS,MGD,96.26,,,,,,,case rate,96.26,96.26,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,AETNA,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,BCBS,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,CIGNA,COM,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,TRICARE,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,UNITED HEALTHCARE,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,UNITED HEALTHCARE,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,VA,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,VA TRICARE,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,WELLMED,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,HUMANA,MGD,104.63,,,,,,,per diem,104.63,104.63,"Per diem rate, code is bundled with other services"
CHOLESTEROL - DIRECT LDL CHOOL,38200555,CDM,301,RC,83721,CPT,,,,Inpatient,,,104.63,104.63,HUMANA CHOICE PLUS,MGD,104.63,,,,,,,case rate,104.63,104.63,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
CHOLINESTERASE                ,38200560,CDM,301,RC,82480,CPT,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,AETNA,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,BCBS,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,CIGNA,COM,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,TRICARE,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,UNITED HEALTHCARE,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,UNITED HEALTHCARE,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,VA,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,VA TRICARE,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,WELLMED,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,HUMANA,MGD,130.43,,,,,,,per diem,130.43,130.43,"Per diem rate, code is bundled with other services"
CLOZAPINE/CLOZARIL            ,38200569,CDM,301,RC,80159,CPT,,,,Inpatient,,,130.43,130.43,HUMANA CHOICE PLUS,MGD,130.43,,,,,,,case rate,130.43,130.43,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,AETNA,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,BCBS,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,CIGNA,COM,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,TRICARE,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,UNITED HEALTHCARE,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,UNITED HEALTHCARE,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,VA,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,VA TRICARE,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,WELLMED,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,HUMANA,MGD,270.9,,,,,,,per diem,270.9,270.9,"Per diem rate, code is bundled with other services"
CMV TITER                     ,38200570,CDM,306,RC,86644,CPT,,,,Inpatient,,,270.9,270.9,HUMANA CHOICE PLUS,MGD,270.9,,,,,,,case rate,270.9,270.9,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,AETNA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,CIGNA,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,VA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,VA TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,WELLMED,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,HUMANA,MGD,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
CMV IGM ANTIBODY              ,38200571,CDM,302,RC,86645,CPT,,,,Inpatient,,,74.62,74.62,HUMANA CHOICE PLUS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,AETNA,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,BCBS,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,CIGNA,COM,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,TRICARE,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,UNITED HEALTHCARE,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,UNITED HEALTHCARE,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,VA,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,VA TRICARE,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,WELLMED,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,HUMANA,MGD,409.01,,,,,,,per diem,409.01,409.01,"Per diem rate, code is bundled with other services"
CMV IGG ANTIBODY              ,38200572,CDM,302,RC,86644,CPT,,,,Inpatient,,,409.01,409.01,HUMANA CHOICE PLUS,MGD,409.01,,,,,,,case rate,409.01,409.01,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,AETNA,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,BCBS,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,CIGNA,COM,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,TRICARE,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,UNITED HEALTHCARE,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,UNITED HEALTHCARE,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,VA,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,VA TRICARE,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,WELLMED,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,HUMANA,MGD,61.12,,,,,,,per diem,61.12,61.12,"Per diem rate, code is bundled with other services"
C02 CONTENT                   ,38200580,CDM,301,RC,82374,CPT,,,,Inpatient,,,61.12,61.12,HUMANA CHOICE PLUS,MGD,61.12,,,,,,,case rate,61.12,61.12,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,AETNA,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,CIGNA,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,TRICARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,UNITED HEALTHCARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,UNITED HEALTHCARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,VA,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,VA TRICARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,WELLMED,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,HUMANA,MGD,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VIII          ,38200590,CDM,305,RC,85240,CPT,,,,Inpatient,,,529.07,529.07,HUMANA CHOICE PLUS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,AETNA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,CIGNA,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,VA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,VA TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,WELLMED,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,HUMANA,MGD,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
COLD AGGLUTININ               ,38200600,CDM,302,RC,86156,CPT,,,,Inpatient,,,104.91,104.91,HUMANA CHOICE PLUS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,AETNA,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,BCBS,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,CIGNA,COM,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,TRICARE,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,UNITED HEALTHCARE,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,UNITED HEALTHCARE,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,VA,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,VA TRICARE,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,WELLMED,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,HUMANA,MGD,56.78,,,,,,,per diem,56.78,56.78,"Per diem rate, code is bundled with other services"
COMPLEMENT C-3                ,38200630,CDM,302,RC,86160,CPT,,,,Inpatient,,,56.78,56.78,HUMANA CHOICE PLUS,MGD,56.78,,,,,,,case rate,56.78,56.78,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,AETNA,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,BCBS,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,CIGNA,COM,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,TRICARE,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,UNITED HEALTHCARE,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,UNITED HEALTHCARE,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,VA,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,VA TRICARE,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,WELLMED,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,HUMANA,MGD,194.21,,,,,,,per diem,194.21,194.21,"Per diem rate, code is bundled with other services"
COMPLEMENT C-4                ,38200640,CDM,302,RC,86160,CPT,,,,Inpatient,,,194.21,194.21,HUMANA CHOICE PLUS,MGD,194.21,,,,,,,case rate,194.21,194.21,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,AETNA,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,CIGNA,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,TRICARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,UNITED HEALTHCARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,UNITED HEALTHCARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,VA,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,VA TRICARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,WELLMED,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,HUMANA,MGD,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TEGRETOL-FREE                 ,38200671,CDM,301,RC,80157,CPT,,,,Inpatient,,,148.05,148.05,HUMANA CHOICE PLUS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,AETNA,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,BCBS,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,CIGNA,COM,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,TRICARE,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,UNITED HEALTHCARE,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,UNITED HEALTHCARE,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,VA,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,VA TRICARE,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,WELLMED,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,HUMANA,MGD,49.89,,,,,,,per diem,49.89,49.89,"Per diem rate, code is bundled with other services"
COPPER                        ,38200675,CDM,301,RC,82525,CPT,,,,Inpatient,,,49.89,49.89,HUMANA CHOICE PLUS,MGD,49.89,,,,,,,case rate,49.89,49.89,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,AETNA,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,BCBS,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,CIGNA,COM,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,TRICARE,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,UNITED HEALTHCARE,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,UNITED HEALTHCARE,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,VA,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,VA TRICARE,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,WELLMED,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,HUMANA,MGD,97.34,,,,,,,per diem,97.34,97.34,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38200680,CDM,301,RC,82533,CPT,,,,Inpatient,,,97.34,97.34,HUMANA CHOICE PLUS,MGD,97.34,,,,,,,case rate,97.34,97.34,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,AETNA,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,BCBS,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,CIGNA,COM,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,TRICARE,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,UNITED HEALTHCARE,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,UNITED HEALTHCARE,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,VA,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,VA TRICARE,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,WELLMED,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,HUMANA,MGD,359.73,,,,,,,per diem,359.73,359.73,"Per diem rate, code is bundled with other services"
T CELLS CD4 & CD8 W/RATIO     ,38200685,CDM,302,RC,86360,CPT,,,,Inpatient,,,359.73,359.73,HUMANA CHOICE PLUS,MGD,359.73,,,,,,,case rate,359.73,359.73,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
SACCHAROMYCES CEREVISIAE AB   ,38200686,CDM,302,RC,86671,CPT,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,AETNA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,CIGNA,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,VA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,VA TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,WELLMED,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,HUMANA,MGD,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
"ANTIBODY ID, LEUKOCYTE        ",38200687,CDM,302,RC,86021,CPT,,,,Inpatient,,,32.07,32.07,HUMANA CHOICE PLUS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
BORDETELLA PERTUSSIS AB       ,38200688,CDM,302,RC,86615,CPT,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,AETNA,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,BCBS,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,CIGNA,COM,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,TRICARE,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,UNITED HEALTHCARE,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,UNITED HEALTHCARE,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,VA,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,VA TRICARE,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,WELLMED,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,HUMANA,MGD,197.83,,,,,,,per diem,197.83,197.83,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE (TRILEPTAL)     ,38200689,CDM,301,RC,80183,CPT,,,,Inpatient,,,197.83,197.83,HUMANA CHOICE PLUS,MGD,197.83,,,,,,,case rate,197.83,197.83,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,AETNA,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,BCBS,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,CIGNA,COM,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,TRICARE,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,UNITED HEALTHCARE,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,UNITED HEALTHCARE,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,VA,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,VA TRICARE,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,WELLMED,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,HUMANA,MGD,69.47,,,,,,,per diem,69.47,69.47,"Per diem rate, code is bundled with other services"
SED RATE (AUTO)               ,38200690,CDM,305,RC,85652,CPT,,,,Inpatient,,,69.47,69.47,HUMANA CHOICE PLUS,MGD,69.47,,,,,,,case rate,69.47,69.47,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,AETNA,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,BCBS,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,CIGNA,COM,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,TRICARE,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,UNITED HEALTHCARE,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,UNITED HEALTHCARE,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,VA,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,VA TRICARE,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,WELLMED,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,HUMANA,MGD,217.01,,,,,,,per diem,217.01,217.01,"Per diem rate, code is bundled with other services"
TISSUE TRANSGLUTAMINASE AB    ,38200691,CDM,301,RC,83516,CPT,,,,Inpatient,,,217.01,217.01,HUMANA CHOICE PLUS,MGD,217.01,,,,,,,case rate,217.01,217.01,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,AETNA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,CIGNA,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,VA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,VA TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,WELLMED,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,HUMANA,MGD,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
TISSUE HOMOGENIZATION         ,38200692,CDM,306,RC,87176,CPT,,,,Inpatient,,,100.67,100.67,HUMANA CHOICE PLUS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
HISTAMINE URINE 24HR          ,38200693,CDM,301,RC,83088,CPT,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,AETNA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,CIGNA,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,VA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,VA TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,WELLMED,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,HUMANA,MGD,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
CREATININE URINE 24HR         ,38200694,CDM,301,RC,82570,CPT,,,,Inpatient,,,68.68,68.68,HUMANA CHOICE PLUS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,AETNA,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,CIGNA,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,TRICARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,UNITED HEALTHCARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,UNITED HEALTHCARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,VA,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,VA TRICARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,WELLMED,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,HUMANA,MGD,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
VASOACTIVE INTESTINAL PEPTIDE ,38200696,CDM,301,RC,84586,CPT,,,,Inpatient,,,531.22,531.22,HUMANA CHOICE PLUS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,AETNA,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,BCBS,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,CIGNA,COM,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,TRICARE,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,UNITED HEALTHCARE,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,UNITED HEALTHCARE,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,VA,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,VA TRICARE,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,WELLMED,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,HUMANA,MGD,200.16,,,,,,,per diem,200.16,200.16,"Per diem rate, code is bundled with other services"
C-PEPTIDE                     ,38200700,CDM,301,RC,84681,CPT,,,,Inpatient,,,200.16,200.16,HUMANA CHOICE PLUS,MGD,200.16,,,,,,,case rate,200.16,200.16,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,AETNA,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,BCBS,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,CIGNA,COM,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,TRICARE,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,UNITED HEALTHCARE,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,UNITED HEALTHCARE,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,VA,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,VA TRICARE,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,WELLMED,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,HUMANA,MGD,20.51,,,,,,,per diem,20.51,20.51,"Per diem rate, code is bundled with other services"
CPK-TOTAL                     ,38200710,CDM,301,RC,82550,CPT,,,,Inpatient,,,20.51,20.51,HUMANA CHOICE PLUS,MGD,20.51,,,,,,,case rate,20.51,20.51,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,AETNA,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,BCBS,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,CIGNA,COM,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,TRICARE,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,UNITED HEALTHCARE,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,UNITED HEALTHCARE,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,VA,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,VA TRICARE,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,WELLMED,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,HUMANA,MGD,107.88,,,,,,,per diem,107.88,107.88,"Per diem rate, code is bundled with other services"
CPK ISOENZYMES                ,38200720,CDM,301,RC,82552,CPT,,,,Inpatient,,,107.88,107.88,HUMANA CHOICE PLUS,MGD,107.88,,,,,,,case rate,107.88,107.88,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,AETNA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,CIGNA,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,VA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,VA TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,WELLMED,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,HUMANA,MGD,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
"CPK-MB,COLORIMETRIC           ",38200730,CDM,300,RC,82553,CPT,,,,Inpatient,,,88.68,88.68,HUMANA CHOICE PLUS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,AETNA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,BCBS,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,CIGNA,COM,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,UNITED HEALTHCARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,VA,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,VA TRICARE,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,WELLMED,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,HUMANA,MGD,68.68,,,,,,,per diem,68.68,68.68,"Per diem rate, code is bundled with other services"
"CREATININE, BLOOD             ",38200740,CDM,301,RC,82565,CPT,,,,Inpatient,,,68.68,68.68,HUMANA CHOICE PLUS,MGD,68.68,,,,,,,case rate,68.68,68.68,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,AETNA,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,BCBS,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,CIGNA,COM,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,TRICARE,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,UNITED HEALTHCARE,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,UNITED HEALTHCARE,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,VA,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,VA TRICARE,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,WELLMED,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,HUMANA,MGD,240.57,,,,,,,per diem,240.57,240.57,"Per diem rate, code is bundled with other services"
CREATININE CLEARANCE          ,38200750,CDM,301,RC,82575,CPT,,,,Inpatient,,,240.57,240.57,HUMANA CHOICE PLUS,MGD,240.57,,,,,,,case rate,240.57,240.57,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CREATINE                      ,38200760,CDM,301,RC,82540,CPT,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,AETNA,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,CIGNA,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,TRICARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,UNITED HEALTHCARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,UNITED HEALTHCARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,VA,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,VA TRICARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,WELLMED,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,HUMANA,MGD,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
IMMEDIATE SPIN CROSSMATCH     ,38200770,CDM,302,RC,86920,CPT,,,,Inpatient,,,206.03,206.03,HUMANA CHOICE PLUS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,AETNA,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,BCBS,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,CIGNA,COM,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,TRICARE,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,UNITED HEALTHCARE,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,UNITED HEALTHCARE,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,VA,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,VA TRICARE,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,WELLMED,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,HUMANA,MGD,16.32,,,,,,,per diem,16.32,16.32,"Per diem rate, code is bundled with other services"
C-REACTIVE PROTEIN            ,38200780,CDM,302,RC,86140,CPT,,,,Inpatient,,,16.32,16.32,HUMANA CHOICE PLUS,MGD,16.32,,,,,,,case rate,16.32,16.32,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
REPTILASE TIME TEST           ,38200790,CDM,305,RC,85635,CPT,,,,Inpatient,,,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,AETNA,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,BCBS,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,CIGNA,COM,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,TRICARE,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,UNITED HEALTHCARE,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,UNITED HEALTHCARE,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,VA,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,VA TRICARE,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,WELLMED,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,HUMANA,MGD,265.07,,,,,,,per diem,265.07,265.07,"Per diem rate, code is bundled with other services"
QUANTIFERON TB GOLD           ,38200795,CDM,302,RC,86480,CPT,,,,Inpatient,,,265.07,265.07,HUMANA CHOICE PLUS,MGD,265.07,,,,,,,case rate,265.07,265.07,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,AETNA,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,BCBS,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,CIGNA,COM,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,TRICARE,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,UNITED HEALTHCARE,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,UNITED HEALTHCARE,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,VA,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,VA TRICARE,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,WELLMED,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,HUMANA,MGD,270.38,,,,,,,per diem,270.38,270.38,"Per diem rate, code is bundled with other services"
TB AG RESPONSE T-CELL SUSP    ,38200796,CDM,302,RC,86481,CPT,,,,Inpatient,,,270.38,270.38,HUMANA CHOICE PLUS,MGD,270.38,,,,,,,case rate,270.38,270.38,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,AETNA,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,BCBS,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,CIGNA,COM,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,TRICARE,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,UNITED HEALTHCARE,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,UNITED HEALTHCARE,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,VA,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,VA TRICARE,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,WELLMED,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,HUMANA,MGD,113.45,,,,,,,per diem,113.45,113.45,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AB               ,38200800,CDM,302,RC,86641,CPT,,,,Inpatient,,,113.45,113.45,HUMANA CHOICE PLUS,MGD,113.45,,,,,,,case rate,113.45,113.45,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS ANTIGEN (CSF)    ,38200801,CDM,306,RC,87327,CPT,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,AETNA,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,BCBS,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,CIGNA,COM,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,TRICARE,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,UNITED HEALTHCARE,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,UNITED HEALTHCARE,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,VA,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,VA TRICARE,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,WELLMED,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,HUMANA,MGD,118.08,,,,,,,per diem,118.08,118.08,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM ANTIGEN       ,38200805,CDM,306,RC,87328,CPT,,,,Inpatient,,,118.08,118.08,HUMANA CHOICE PLUS,MGD,118.08,,,,,,,case rate,118.08,118.08,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,AETNA,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,BCBS,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,CIGNA,COM,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,TRICARE,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,UNITED HEALTHCARE,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,UNITED HEALTHCARE,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,VA,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,VA TRICARE,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,WELLMED,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,HUMANA,MGD,29.31,,,,,,,per diem,29.31,29.31,"Per diem rate, code is bundled with other services"
"GLUCOSE, BODY FLUID           ",38200810,CDM,301,RC,82945,CPT,,,,Inpatient,,,29.31,29.31,HUMANA CHOICE PLUS,MGD,29.31,,,,,,,case rate,29.31,29.31,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,AETNA,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,BCBS,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,CIGNA,COM,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,TRICARE,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,UNITED HEALTHCARE,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,UNITED HEALTHCARE,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,VA,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,VA TRICARE,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,WELLMED,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,HUMANA,MGD,117.35,,,,,,,per diem,117.35,117.35,"Per diem rate, code is bundled with other services"
CULTURE-FUNGUS-OTHER SOURCE   ,38200830,CDM,306,RC,87102,CPT,,,,Inpatient,,,117.35,117.35,HUMANA CHOICE PLUS,MGD,117.35,,,,,,,case rate,117.35,117.35,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,AETNA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,CIGNA,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,VA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,VA TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,WELLMED,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,HUMANA,MGD,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE-ROUTINE               ,38200840,CDM,306,RC,87070,CPT,,,,Inpatient,,,25.42,25.42,HUMANA CHOICE PLUS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,AETNA,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,BCBS,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,CIGNA,COM,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,TRICARE,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,UNITED HEALTHCARE,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,UNITED HEALTHCARE,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,VA,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,VA TRICARE,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,WELLMED,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,HUMANA,MGD,114.86,,,,,,,per diem,114.86,114.86,"Per diem rate, code is bundled with other services"
AEROBIC ORGANISM ID           ,38200845,CDM,306,RC,87077,CPT,,,,Inpatient,,,114.86,114.86,HUMANA CHOICE PLUS,MGD,114.86,,,,,,,case rate,114.86,114.86,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,AETNA,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,BCBS,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,CIGNA,COM,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,TRICARE,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,UNITED HEALTHCARE,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,UNITED HEALTHCARE,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,VA,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,VA TRICARE,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,WELLMED,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,HUMANA,MGD,25.45,,,,,,,per diem,25.45,25.45,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38200850,CDM,306,RC,87075,CPT,,,,Inpatient,,,25.45,25.45,HUMANA CHOICE PLUS,MGD,25.45,,,,,,,case rate,25.45,25.45,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,AETNA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,CIGNA,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,VA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,VA TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,WELLMED,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,HUMANA,MGD,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE BACTERIA              ,38200860,CDM,306,RC,87040,CPT,,,,Inpatient,,,25.42,25.42,HUMANA CHOICE PLUS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,AETNA,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,BCBS,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,CIGNA,COM,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,TRICARE,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,UNITED HEALTHCARE,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,UNITED HEALTHCARE,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,VA,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,VA TRICARE,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,WELLMED,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,HUMANA,MGD,62.62,,,,,,,per diem,62.62,62.62,"Per diem rate, code is bundled with other services"
CULTURE BLOOD                 ,38200880,CDM,306,RC,87040,CPT,,,,Inpatient,,,62.62,62.62,HUMANA CHOICE PLUS,MGD,62.62,,,,,,,case rate,62.62,62.62,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,AETNA,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,BCBS,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,CIGNA,COM,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,TRICARE,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,UNITED HEALTHCARE,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,UNITED HEALTHCARE,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,VA,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,VA TRICARE,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,WELLMED,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,HUMANA,MGD,120.89,,,,,,,per diem,120.89,120.89,"Per diem rate, code is bundled with other services"
C. DIFF. CULTURE (STOOL)      ,38200885,CDM,306,RC,87075,CPT,,,,Inpatient,,,120.89,120.89,HUMANA CHOICE PLUS,MGD,120.89,,,,,,,case rate,120.89,120.89,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE CAMPY                 ,38200890,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
TIAGABINE (GABITRIL)          ,38200894,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,AETNA,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,BCBS,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,CIGNA,COM,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,TRICARE,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,UNITED HEALTHCARE,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,UNITED HEALTHCARE,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,VA,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,VA TRICARE,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,WELLMED,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,HUMANA,MGD,82.24,,,,,,,per diem,82.24,82.24,"Per diem rate, code is bundled with other services"
"CULTURE, CATH-TIP             ",38200895,CDM,306,RC,87070,CPT,,,,Inpatient,,,82.24,82.24,HUMANA CHOICE PLUS,MGD,82.24,,,,,,,case rate,82.24,82.24,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,AETNA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,CIGNA,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,VA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,VA TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,WELLMED,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,HUMANA,MGD,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CULTURE CHLAMYDIA             ,38200900,CDM,306,RC,87110,CPT,,,,Inpatient,,,442.32,442.32,HUMANA CHOICE PLUS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,AETNA,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,BCBS,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,CIGNA,COM,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,TRICARE,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,UNITED HEALTHCARE,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,UNITED HEALTHCARE,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,VA,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,VA TRICARE,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,WELLMED,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,HUMANA,MGD,111,,,,,,,per diem,111,111,"Per diem rate, code is bundled with other services"
CULTURE VIRAL                 ,38200901,CDM,306,RC,87252,CPT,,,,Inpatient,,,111,111,HUMANA CHOICE PLUS,MGD,111,,,,,,,case rate,111,111,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,AETNA,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,CIGNA,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,TRICARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UNITED HEALTHCARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UNITED HEALTHCARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA TRICARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,WELLMED,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,HUMANA,MGD,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE CSF                   ,38200910,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,HUMANA CHOICE PLUS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,AETNA,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,BCBS,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,CIGNA,COM,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,TRICARE,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,UNITED HEALTHCARE,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,UNITED HEALTHCARE,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,VA,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,VA TRICARE,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,WELLMED,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,HUMANA,MGD,85.79,,,,,,,per diem,85.79,85.79,"Per diem rate, code is bundled with other services"
CULTURE GC                    ,38200920,CDM,306,RC,87081,CPT,,,,Inpatient,,,85.79,85.79,HUMANA CHOICE PLUS,MGD,85.79,,,,,,,case rate,85.79,85.79,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,AETNA,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,CIGNA,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,TRICARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,UNITED HEALTHCARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,UNITED HEALTHCARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,VA,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,VA TRICARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,WELLMED,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,HUMANA,MGD,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
CULTURE GRP & TYP AGGL        ,38200921,CDM,306,RC,87147,CPT,,,,Inpatient,,,58.4,58.4,HUMANA CHOICE PLUS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,AETNA,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,BCBS,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,CIGNA,COM,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,TRICARE,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,UNITED HEALTHCARE,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,UNITED HEALTHCARE,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,VA,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,VA TRICARE,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,WELLMED,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,HUMANA,MGD,133.42,,,,,,,per diem,133.42,133.42,"Per diem rate, code is bundled with other services"
CULTURE NARES                 ,38200923,CDM,306,RC,87070,CPT,,,,Inpatient,,,133.42,133.42,HUMANA CHOICE PLUS,MGD,133.42,,,,,,,case rate,133.42,133.42,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE KPC SCREEN            ,38200924,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,AETNA,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,BCBS,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,CIGNA,COM,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,TRICARE,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,UNITED HEALTHCARE,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,UNITED HEALTHCARE,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,VA,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,VA TRICARE,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,WELLMED,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,HUMANA,MGD,88.49,,,,,,,per diem,88.49,88.49,"Per diem rate, code is bundled with other services"
CULTURE SCREEN MRSA           ,38200930,CDM,306,RC,87081,CPT,,,,Inpatient,,,88.49,88.49,HUMANA CHOICE PLUS,MGD,88.49,,,,,,,case rate,88.49,88.49,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE SCREEN ACINETOBACTER  ,38200935,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,AETNA,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,BCBS,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,CIGNA,COM,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,TRICARE,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,UNITED HEALTHCARE,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,UNITED HEALTHCARE,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,VA,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,VA TRICARE,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,WELLMED,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,HUMANA,MGD,29.74,,,,,,,per diem,29.74,29.74,"Per diem rate, code is bundled with other services"
CULTURE STOOL                 ,38200950,CDM,306,RC,87045,CPT,,,,Inpatient,,,29.74,29.74,HUMANA CHOICE PLUS,MGD,29.74,,,,,,,case rate,29.74,29.74,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
CULTURE THROAT                ,38200970,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,AETNA,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,CIGNA,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,TRICARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,UNITED HEALTHCARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,UNITED HEALTHCARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,VA,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,VA TRICARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,WELLMED,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,HUMANA,MGD,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE WOUND                 ,38200975,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,HUMANA CHOICE PLUS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,AETNA,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,BCBS,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,CIGNA,COM,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,TRICARE,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,UNITED HEALTHCARE,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,UNITED HEALTHCARE,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,VA,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,VA TRICARE,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,WELLMED,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,HUMANA,MGD,60.34,,,,,,,per diem,60.34,60.34,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38200980,CDM,306,RC,87088,CPT,,,,Inpatient,,,60.34,60.34,HUMANA CHOICE PLUS,MGD,60.34,,,,,,,case rate,60.34,60.34,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,AETNA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,BCBS,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,CIGNA,COM,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,UNITED HEALTHCARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,VA,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,VA TRICARE,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,WELLMED,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,HUMANA,MGD,25.42,,,,,,,per diem,25.42,25.42,"Per diem rate, code is bundled with other services"
CULTURE URINE W/COLONY COUNT  ,38200981,CDM,306,RC,87086,CPT,,,,Inpatient,,,25.42,25.42,HUMANA CHOICE PLUS,MGD,25.42,,,,,,,case rate,25.42,25.42,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
ANTI-PLATELET ANTIBODY-DIRECT ,38200982,CDM,300,RC,86023,CPT,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,AETNA,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,BCBS,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,CIGNA,COM,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,TRICARE,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,UNITED HEALTHCARE,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,UNITED HEALTHCARE,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,VA,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,VA TRICARE,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,WELLMED,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,HUMANA,MGD,500.73,,,,,,,per diem,500.73,500.73,"Per diem rate, code is bundled with other services"
CYCLOSPORINE                  ,38200985,CDM,301,RC,80158,CPT,,,,Inpatient,,,500.73,500.73,HUMANA CHOICE PLUS,MGD,500.73,,,,,,,case rate,500.73,500.73,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,AETNA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,CIGNA,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,VA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,VA TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,WELLMED,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,HUMANA,MGD,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
FIBRIN-D-DIMER QUANT          ,38201010,CDM,305,RC,85379,CPT,,,,Inpatient,,,32.07,32.07,HUMANA CHOICE PLUS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,AETNA,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,BCBS,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,CIGNA,COM,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,TRICARE,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,UNITED HEALTHCARE,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,UNITED HEALTHCARE,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,VA,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,VA TRICARE,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,WELLMED,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,HUMANA,MGD,83.25,,,,,,,per diem,83.25,83.25,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGG)    ,38201011,CDM,302,RC,86631,CPT,,,,Inpatient,,,83.25,83.25,HUMANA CHOICE PLUS,MGD,83.25,,,,,,,case rate,83.25,83.25,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
CHLAMYDIA. PNEUMONIA (IGM)    ,38201012,CDM,302,RC,86632,CPT,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,AETNA,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,BCBS,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,CIGNA,COM,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,TRICARE,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,UNITED HEALTHCARE,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,UNITED HEALTHCARE,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,VA,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,VA TRICARE,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,WELLMED,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,HUMANA,MGD,363.63,,,,,,,per diem,363.63,363.63,"Per diem rate, code is bundled with other services"
DHEA-S                        ,38201015,CDM,301,RC,82627,CPT,,,,Inpatient,,,363.63,363.63,HUMANA CHOICE PLUS,MGD,363.63,,,,,,,case rate,363.63,363.63,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,AETNA,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,BCBS,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,CIGNA,COM,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,TRICARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,UNITED HEALTHCARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,UNITED HEALTHCARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,VA,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,VA TRICARE,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,WELLMED,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,HUMANA,MGD,47.59,,,,,,,per diem,47.59,47.59,"Per diem rate, code is bundled with other services"
BLOOD SMR W/ MAN DIFF WBC CNT ,38201020,CDM,305,RC,85007,CPT,,,,Inpatient,,,47.59,47.59,HUMANA CHOICE PLUS,MGD,47.59,,,,,,,case rate,47.59,47.59,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
DIGITOXIN                     ,38201030,CDM,301,RC,80299,CPT,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38201040,CDM,301,RC,80162,CPT,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,AETNA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,BCBS,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,CIGNA,COM,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,UNITED HEALTHCARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,VA,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,VA TRICARE,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,WELLMED,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,HUMANA,MGD,75.6,,,,,,,per diem,75.6,75.6,"Per diem rate, code is bundled with other services"
DILANTIN (PHENYTOIN-TOTAL)    ,38201050,CDM,301,RC,80185,CPT,,,,Inpatient,,,75.6,75.6,HUMANA CHOICE PLUS,MGD,75.6,,,,,,,case rate,75.6,75.6,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,AETNA,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,BCBS,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,CIGNA,COM,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,TRICARE,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,UNITED HEALTHCARE,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,UNITED HEALTHCARE,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,VA,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,VA TRICARE,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,WELLMED,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,HUMANA,MGD,211.4,,,,,,,per diem,211.4,211.4,"Per diem rate, code is bundled with other services"
FREE DILANTIN                 ,38201051,CDM,301,RC,80186,CPT,,,,Inpatient,,,211.4,211.4,HUMANA CHOICE PLUS,MGD,211.4,,,,,,,case rate,211.4,211.4,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,AETNA,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,BCBS,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,CIGNA,COM,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,TRICARE,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,UNITED HEALTHCARE,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,UNITED HEALTHCARE,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,VA,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,VA TRICARE,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,WELLMED,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,HUMANA,MGD,351.75,,,,,,,per diem,351.75,351.75,"Per diem rate, code is bundled with other services"
DRUG SCREEN-COMPL QUAL        ,38201080,CDM,301,RC,80100,CPT,G0431,HCPCS,,Inpatient,,,351.75,351.75,HUMANA CHOICE PLUS,MGD,351.75,,,,,,,case rate,351.75,351.75,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,AETNA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,BCBS,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,CIGNA,COM,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,UNITED HEALTHCARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,VA,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,VA TRICARE,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,WELLMED,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,HUMANA,MGD,77.33,,,,,,,per diem,77.33,77.33,"Per diem rate, code is bundled with other services"
DRUG SCREEN W/URINE ALCOHOL   ,38201081,CDM,301,RC,80101,CPT,,,,Inpatient,,,77.33,77.33,HUMANA CHOICE PLUS,MGD,77.33,,,,,,,case rate,77.33,77.33,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
DRUG SCREEN-SERUM             ,38201090,CDM,301,RC,80100,CPT,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
DRUG SCRN A NON TLC DVC/DOS   ,38201095,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,AETNA,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,BCBS,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,CIGNA,COM,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,TRICARE,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,UNITED HEALTHCARE,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,UNITED HEALTHCARE,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,VA,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,VA TRICARE,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,WELLMED,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,HUMANA,MGD,738.44,,,,,,,per diem,738.44,738.44,"Per diem rate, code is bundled with other services"
DRUG SCRN CLASS A /DOS        ,38201096,CDM,301,RC,G0479,HCPCS,,,,Inpatient,,,738.44,738.44,HUMANA CHOICE PLUS,MGD,738.44,,,,,,,case rate,738.44,738.44,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,AETNA,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,BCBS,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,CIGNA,COM,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,TRICARE,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,UNITED HEALTHCARE,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,UNITED HEALTHCARE,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,VA,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,VA TRICARE,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,WELLMED,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,HUMANA,MGD,655.29,,,,,,,per diem,655.29,655.29,"Per diem rate, code is bundled with other services"
DRUG SCRN PRESUMP CLASS B     ,38201097,CDM,301,RC,80307,CPT,,,,Inpatient,,,655.29,655.29,HUMANA CHOICE PLUS,MGD,655.29,,,,,,,case rate,655.29,655.29,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,AETNA,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,CIGNA,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,TRICARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UNITED HEALTHCARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UNITED HEALTHCARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,VA,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,VA TRICARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,WELLMED,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,HUMANA,MGD,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
DRUG SCRN ALL CLASS NOS EA    ,38201099,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,HUMANA CHOICE PLUS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,AETNA,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,BCBS,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,CIGNA,COM,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,TRICARE,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,UNITED HEALTHCARE,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,UNITED HEALTHCARE,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,VA,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,VA TRICARE,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,WELLMED,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,HUMANA,MGD,135.92,,,,,,,per diem,135.92,135.92,"Per diem rate, code is bundled with other services"
ALCOHOLS SCREENING            ,38201100,CDM,301,RC,80320,CPT,,,,Inpatient,,,135.92,135.92,HUMANA CHOICE PLUS,MGD,135.92,,,,,,,case rate,135.92,135.92,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,AETNA,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,BCBS,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,CIGNA,COM,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,TRICARE,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,UNITED HEALTHCARE,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,UNITED HEALTHCARE,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,VA,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,VA TRICARE,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,WELLMED,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,HUMANA,MGD,264.31,,,,,,,per diem,264.31,264.31,"Per diem rate, code is bundled with other services"
ELECTROLYTE PANEL             ,38201120,CDM,301,RC,80051,CPT,,,,Inpatient,,,264.31,264.31,HUMANA CHOICE PLUS,MGD,264.31,,,,,,,case rate,264.31,264.31,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,AETNA,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,BCBS,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,CIGNA,COM,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,TRICARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,UNITED HEALTHCARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,UNITED HEALTHCARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,VA,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,VA TRICARE,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,WELLMED,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,HUMANA,MGD,89.76,,,,,,,per diem,89.76,89.76,"Per diem rate, code is bundled with other services"
ELECTROPHORESIS HEMOGLOBLIN   ,38201130,CDM,301,RC,83020,CPT,,,,Inpatient,,,89.76,89.76,HUMANA CHOICE PLUS,MGD,89.76,,,,,,,case rate,89.76,89.76,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,AETNA,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,BCBS,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,CIGNA,COM,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,TRICARE,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,UNITED HEALTHCARE,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,UNITED HEALTHCARE,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,VA,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,VA TRICARE,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,WELLMED,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,HUMANA,MGD,293.07,,,,,,,per diem,293.07,293.07,"Per diem rate, code is bundled with other services"
ERYTHROPOIETIN                ,38201155,CDM,301,RC,82668,CPT,,,,Inpatient,,,293.07,293.07,HUMANA CHOICE PLUS,MGD,293.07,,,,,,,case rate,293.07,293.07,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,AETNA,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,BCBS,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,CIGNA,COM,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,TRICARE,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,UNITED HEALTHCARE,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,UNITED HEALTHCARE,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,VA,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,VA TRICARE,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,WELLMED,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,HUMANA,MGD,190.4,,,,,,,per diem,190.4,190.4,"Per diem rate, code is bundled with other services"
ESTRADIOL                     ,38201170,CDM,301,RC,82670,CPT,,,,Inpatient,,,190.4,190.4,HUMANA CHOICE PLUS,MGD,190.4,,,,,,,case rate,190.4,190.4,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
ESTRIOL                       ,38201171,CDM,301,RC,82677,CPT,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,AETNA,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,BCBS,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,CIGNA,COM,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,TRICARE,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,UNITED HEALTHCARE,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,UNITED HEALTHCARE,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,VA,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,VA TRICARE,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,WELLMED,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,HUMANA,MGD,325.74,,,,,,,per diem,325.74,325.74,"Per diem rate, code is bundled with other services"
"FECAL FAT, QUALITATIVE        ",38201180,CDM,301,RC,82705,CPT,,,,Inpatient,,,325.74,325.74,HUMANA CHOICE PLUS,MGD,325.74,,,,,,,case rate,325.74,325.74,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,AETNA,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,BCBS,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,CIGNA,COM,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,TRICARE,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,UNITED HEALTHCARE,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,UNITED HEALTHCARE,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,VA,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,VA TRICARE,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,WELLMED,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,HUMANA,MGD,80.89,,,,,,,per diem,80.89,80.89,"Per diem rate, code is bundled with other services"
FECAL HGB IMMUNOASSAY         ,38201181,CDM,301,RC,82274,CPT,,,,Inpatient,,,80.89,80.89,HUMANA CHOICE PLUS,MGD,80.89,,,,,,,case rate,80.89,80.89,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,AETNA,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,BCBS,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,CIGNA,COM,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,TRICARE,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,UNITED HEALTHCARE,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,UNITED HEALTHCARE,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,VA,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,VA TRICARE,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,WELLMED,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,HUMANA,MGD,260.49,,,,,,,per diem,260.49,260.49,"Per diem rate, code is bundled with other services"
FDP (FSP)                     ,38201190,CDM,305,RC,85362,CPT,,,,Inpatient,,,260.49,260.49,HUMANA CHOICE PLUS,MGD,260.49,,,,,,,case rate,260.49,260.49,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38201200,CDM,301,RC,82728,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,AETNA,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,BCBS,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,CIGNA,COM,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,TRICARE,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,UNITED HEALTHCARE,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,UNITED HEALTHCARE,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,VA,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,VA TRICARE,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,WELLMED,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,HUMANA,MGD,214.4,,,,,,,per diem,214.4,214.4,"Per diem rate, code is bundled with other services"
FIBRINOGEN                    ,38201220,CDM,305,RC,85384,CPT,,,,Inpatient,,,214.4,214.4,HUMANA CHOICE PLUS,MGD,214.4,,,,,,,case rate,214.4,214.4,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,AETNA,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,BCBS,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,CIGNA,COM,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,TRICARE,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,UNITED HEALTHCARE,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,UNITED HEALTHCARE,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,VA,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,VA TRICARE,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,WELLMED,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,HUMANA,MGD,46.31,,,,,,,per diem,46.31,46.31,"Per diem rate, code is bundled with other services"
FOLIC ACID                    ,38201240,CDM,301,RC,82746,CPT,,,,Inpatient,,,46.31,46.31,HUMANA CHOICE PLUS,MGD,46.31,,,,,,,case rate,46.31,46.31,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,AETNA,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,BCBS,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,CIGNA,COM,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,TRICARE,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,UNITED HEALTHCARE,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,UNITED HEALTHCARE,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,VA,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,VA TRICARE,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,WELLMED,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,HUMANA,MGD,126.54,,,,,,,per diem,126.54,126.54,"Per diem rate, code is bundled with other services"
TREPONEMA PALLIDUM            ,38201256,CDM,302,RC,86780,CPT,,,,Inpatient,,,126.54,126.54,HUMANA CHOICE PLUS,MGD,126.54,,,,,,,case rate,126.54,126.54,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,AETNA,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,BCBS,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,CIGNA,COM,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,TRICARE,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,UNITED HEALTHCARE,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,UNITED HEALTHCARE,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,VA,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,VA TRICARE,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,WELLMED,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,HUMANA,MGD,228.36,,,,,,,per diem,228.36,228.36,"Per diem rate, code is bundled with other services"
WET MOUNT SMEAR               ,38201260,CDM,306,RC,87210,CPT,,,,Inpatient,,,228.36,228.36,HUMANA CHOICE PLUS,MGD,228.36,,,,,,,case rate,228.36,228.36,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,AETNA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,CIGNA,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,VA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,VA TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,WELLMED,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,HUMANA,MGD,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
GAMMA GT (GGT)                ,38201270,CDM,301,RC,82977,CPT,,,,Inpatient,,,110.31,110.31,HUMANA CHOICE PLUS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,AETNA,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,BCBS,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,CIGNA,COM,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,TRICARE,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,UNITED HEALTHCARE,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,UNITED HEALTHCARE,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,VA,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,VA TRICARE,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,WELLMED,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,HUMANA,MGD,346.24,,,,,,,per diem,346.24,346.24,"Per diem rate, code is bundled with other services"
GASTRIN                       ,38201280,CDM,301,RC,82941,CPT,,,,Inpatient,,,346.24,346.24,HUMANA CHOICE PLUS,MGD,346.24,,,,,,,case rate,346.24,346.24,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,AETNA,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,BCBS,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,CIGNA,COM,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,TRICARE,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,UNITED HEALTHCARE,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,UNITED HEALTHCARE,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,VA,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,VA TRICARE,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,WELLMED,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,HUMANA,MGD,97.88,,,,,,,per diem,97.88,97.88,"Per diem rate, code is bundled with other services"
GENTAMICIN                    ,38201290,CDM,301,RC,80170,CPT,,,,Inpatient,,,97.88,97.88,HUMANA CHOICE PLUS,MGD,97.88,,,,,,,case rate,97.88,97.88,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
GLUCAGON                      ,38201315,CDM,301,RC,82943,CPT,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,AETNA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,CIGNA,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,VA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,VA TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,WELLMED,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,HUMANA,MGD,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38201320,CDM,301,RC,82948,CPT,,,,Inpatient,,,19.95,19.95,HUMANA CHOICE PLUS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,AETNA,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,BCBS,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,CIGNA,COM,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,TRICARE,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,UNITED HEALTHCARE,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,UNITED HEALTHCARE,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,VA,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,VA TRICARE,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,WELLMED,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,HUMANA,MGD,51.92,,,,,,,per diem,51.92,51.92,"Per diem rate, code is bundled with other services"
"GLUCOSE,EXCEPT URINE          ",38201330,CDM,301,RC,82947,CPT,,,,Inpatient,,,51.92,51.92,HUMANA CHOICE PLUS,MGD,51.92,,,,,,,case rate,51.92,51.92,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,AETNA,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,BCBS,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,CIGNA,COM,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,TRICARE,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,UNITED HEALTHCARE,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,UNITED HEALTHCARE,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,VA,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,VA TRICARE,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,WELLMED,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,HUMANA,MGD,164.86,,,,,,,per diem,164.86,164.86,"Per diem rate, code is bundled with other services"
GLUCOSE TOL - 3 SPECIMENS     ,38201350,CDM,301,RC,82951,CPT,,,,Inpatient,,,164.86,164.86,HUMANA CHOICE PLUS,MGD,164.86,,,,,,,case rate,164.86,164.86,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,AETNA,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,BCBS,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,CIGNA,COM,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,TRICARE,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,UNITED HEALTHCARE,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,UNITED HEALTHCARE,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,VA,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,VA TRICARE,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,WELLMED,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,HUMANA,MGD,72.04,,,,,,,per diem,72.04,72.04,"Per diem rate, code is bundled with other services"
"GLUCOSE TOL, EACH ADD SPEC    ",38201360,CDM,301,RC,82952,CPT,,,,Inpatient,,,72.04,72.04,HUMANA CHOICE PLUS,MGD,72.04,,,,,,,case rate,72.04,72.04,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,AETNA,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,BCBS,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,CIGNA,COM,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,TRICARE,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,UNITED HEALTHCARE,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,UNITED HEALTHCARE,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,VA,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,VA TRICARE,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,WELLMED,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,HUMANA,MGD,30.59,,,,,,,per diem,30.59,30.59,"Per diem rate, code is bundled with other services"
GLYCOHEMOGLOBIN  (HGB A1)     ,38201380,CDM,301,RC,83036,CPT,,,,Inpatient,,,30.59,30.59,HUMANA CHOICE PLUS,MGD,30.59,,,,,,,case rate,30.59,30.59,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,AETNA,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,BCBS,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,CIGNA,COM,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,TRICARE,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,UNITED HEALTHCARE,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,UNITED HEALTHCARE,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,VA,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,VA TRICARE,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,WELLMED,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,HUMANA,MGD,274.98,,,,,,,per diem,274.98,274.98,"Per diem rate, code is bundled with other services"
GONORRHEA DNA PROBE           ,38201385,CDM,306,RC,87800,CPT,,,,Inpatient,,,274.98,274.98,HUMANA CHOICE PLUS,MGD,274.98,,,,,,,case rate,274.98,274.98,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,AETNA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,CIGNA,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,VA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,VA TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,WELLMED,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,HUMANA,MGD,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM/GIESMA SMEAR             ,38201390,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,HUMANA CHOICE PLUS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,AETNA,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,BCBS,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,CIGNA,COM,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,TRICARE,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,UNITED HEALTHCARE,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,UNITED HEALTHCARE,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,VA,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,VA TRICARE,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,WELLMED,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,HUMANA,MGD,277.41,,,,,,,per diem,277.41,277.41,"Per diem rate, code is bundled with other services"
POST GLUCOSE DOSE (GTT)       ,38201399,CDM,301,RC,82950,CPT,,,,Inpatient,,,277.41,277.41,HUMANA CHOICE PLUS,MGD,277.41,,,,,,,case rate,277.41,277.41,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,AETNA,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,BCBS,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,CIGNA,COM,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,TRICARE,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,UNITED HEALTHCARE,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,UNITED HEALTHCARE,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,VA,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,VA TRICARE,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,WELLMED,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,HUMANA,MGD,112.48,,,,,,,per diem,112.48,112.48,"Per diem rate, code is bundled with other services"
HAPTOGLOBIN                   ,38201400,CDM,301,RC,83010,CPT,,,,Inpatient,,,112.48,112.48,HUMANA CHOICE PLUS,MGD,112.48,,,,,,,case rate,112.48,112.48,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,AETNA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,BCBS,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,CIGNA,COM,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,UNITED HEALTHCARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,VA,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,VA TRICARE,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,WELLMED,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,HUMANA,MGD,110.25,,,,,,,per diem,110.25,110.25,"Per diem rate, code is bundled with other services"
HCG QUAL URINE                ,38201410,CDM,307,RC,84703,CPT,,,,Inpatient,,,110.25,110.25,HUMANA CHOICE PLUS,MGD,110.25,,,,,,,case rate,110.25,110.25,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,AETNA,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,BCBS,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,CIGNA,COM,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,TRICARE,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,UNITED HEALTHCARE,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,UNITED HEALTHCARE,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,VA,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,VA TRICARE,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,WELLMED,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,HUMANA,MGD,81.01,,,,,,,per diem,81.01,81.01,"Per diem rate, code is bundled with other services"
HELICOBACTER PYLORI AB        ,38201415,CDM,302,RC,86677,CPT,,,,Inpatient,,,81.01,81.01,HUMANA CHOICE PLUS,MGD,81.01,,,,,,,case rate,81.01,81.01,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
HEMATOCRIT                    ,38201420,CDM,305,RC,85014,CPT,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,AETNA,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,CIGNA,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,TRICARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,UNITED HEALTHCARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,UNITED HEALTHCARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,VA,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,VA TRICARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,WELLMED,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,HUMANA,MGD,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
HCT                           ,38201425,CDM,300,RC,85014,CPT,,,,Inpatient,,,64.8,64.8,HUMANA CHOICE PLUS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,AETNA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,CIGNA,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,VA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,VA TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,WELLMED,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,HUMANA,MGD,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
"CBC, AUTO W/O DIFF            ",38201439,CDM,305,RC,85027,CPT,,,,Inpatient,,,24.48,24.48,HUMANA CHOICE PLUS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,AETNA,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,BCBS,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,CIGNA,COM,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,TRICARE,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,UNITED HEALTHCARE,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,UNITED HEALTHCARE,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,VA,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,VA TRICARE,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,WELLMED,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,HUMANA,MGD,39.45,,,,,,,per diem,39.45,39.45,"Per diem rate, code is bundled with other services"
HEMOSIDERIN                   ,38201441,CDM,301,RC,83070,CPT,,,,Inpatient,,,39.45,39.45,HUMANA CHOICE PLUS,MGD,39.45,,,,,,,case rate,39.45,39.45,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,AETNA,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,BCBS,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,CIGNA,COM,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,TRICARE,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,UNITED HEALTHCARE,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,UNITED HEALTHCARE,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,VA,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,VA TRICARE,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,WELLMED,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,HUMANA,MGD,20.55,,,,,,,per diem,20.55,20.55,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY          ,38201450,CDM,302,RC,86708,CPT,,,,Inpatient,,,20.55,20.55,HUMANA CHOICE PLUS,MGD,20.55,,,,,,,case rate,20.55,20.55,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,AETNA,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,BCBS,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,CIGNA,COM,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,TRICARE,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,UNITED HEALTHCARE,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,UNITED HEALTHCARE,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,VA,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,VA TRICARE,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,WELLMED,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,HUMANA,MGD,143.4,,,,,,,per diem,143.4,143.4,"Per diem rate, code is bundled with other services"
HEPATITIS A ANTIBODY IGM      ,38201455,CDM,302,RC,86709,CPT,,,,Inpatient,,,143.4,143.4,HUMANA CHOICE PLUS,MGD,143.4,,,,,,,case rate,143.4,143.4,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,AETNA,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,CIGNA,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,TRICARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,UNITED HEALTHCARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,UNITED HEALTHCARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,VA,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,VA TRICARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,WELLMED,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,HUMANA,MGD,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38201460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,HUMANA CHOICE PLUS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,AETNA,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,BCBS,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,CIGNA,COM,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,TRICARE,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,UNITED HEALTHCARE,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,UNITED HEALTHCARE,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,VA,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,VA TRICARE,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,WELLMED,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,HUMANA,MGD,25.11,,,,,,,per diem,25.11,25.11,"Per diem rate, code is bundled with other services"
HEPATITIS BE ANTIBODY         ,38201465,CDM,302,RC,86707,CPT,,,,Inpatient,,,25.11,25.11,HUMANA CHOICE PLUS,MGD,25.11,,,,,,,case rate,25.11,25.11,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,AETNA,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,BCBS,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,CIGNA,COM,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,TRICARE,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,UNITED HEALTHCARE,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,UNITED HEALTHCARE,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,VA,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,VA TRICARE,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,WELLMED,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,HUMANA,MGD,32.54,,,,,,,per diem,32.54,32.54,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38201470,CDM,306,RC,87340,CPT,,,,Inpatient,,,32.54,32.54,HUMANA CHOICE PLUS,MGD,32.54,,,,,,,case rate,32.54,32.54,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,AETNA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,BCBS,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,CIGNA,COM,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,UNITED HEALTHCARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,VA,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,VA TRICARE,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,WELLMED,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,HUMANA,MGD,78.75,,,,,,,per diem,78.75,78.75,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38201472,CDM,302,RC,86704,CPT,,,,Inpatient,,,78.75,78.75,HUMANA CHOICE PLUS,MGD,78.75,,,,,,,case rate,78.75,78.75,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,AETNA,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,CIGNA,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,TRICARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,UNITED HEALTHCARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,UNITED HEALTHCARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,VA,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,VA TRICARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,WELLMED,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,HUMANA,MGD,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
"HEPATITIS BE ANTIGEN, EIA     ",38201475,CDM,306,RC,87350,CPT,,,,Inpatient,,,240.19,240.19,HUMANA CHOICE PLUS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,AETNA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,CIGNA,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,VA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,VA TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,WELLMED,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,HUMANA,MGD,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38201480,CDM,302,RC,86803,CPT,,,,Inpatient,,,23.26,23.26,HUMANA CHOICE PLUS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,AETNA,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,BCBS,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,CIGNA,COM,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,TRICARE,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,UNITED HEALTHCARE,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,UNITED HEALTHCARE,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,VA,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,VA TRICARE,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,WELLMED,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,HUMANA,MGD,153.65,,,,,,,per diem,153.65,153.65,"Per diem rate, code is bundled with other services"
HEPATITIS C AMP. PROBE TECH   ,38201481,CDM,306,RC,87521,CPT,,,,Inpatient,,,153.65,153.65,HUMANA CHOICE PLUS,MGD,153.65,,,,,,,case rate,153.65,153.65,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,AETNA,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,BCBS,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,CIGNA,COM,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,TRICARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,UNITED HEALTHCARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,UNITED HEALTHCARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,VA,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,VA TRICARE,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,WELLMED,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,HUMANA,MGD,40.75,,,,,,,per diem,40.75,40.75,"Per diem rate, code is bundled with other services"
"HEPATITIS C AB, CONFIRM       ",38201482,CDM,302,RC,86804,CPT,,,,Inpatient,,,40.75,40.75,HUMANA CHOICE PLUS,MGD,40.75,,,,,,,case rate,40.75,40.75,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,AETNA,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,BCBS,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,CIGNA,COM,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,TRICARE,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,UNITED HEALTHCARE,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,UNITED HEALTHCARE,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,VA,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,VA TRICARE,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,WELLMED,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,HUMANA,MGD,408.81,,,,,,,per diem,408.81,408.81,"Per diem rate, code is bundled with other services"
HEPATITIS PANEL (ACUTE)       ,38201498,CDM,301,RC,80074,CPT,,,,Inpatient,,,408.81,408.81,HUMANA CHOICE PLUS,MGD,408.81,,,,,,,case rate,408.81,408.81,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,AETNA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,BCBS,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,CIGNA,COM,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,UNITED HEALTHCARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,VA,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,VA TRICARE,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,WELLMED,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,HUMANA,MGD,42,,,,,,,per diem,42,42,"Per diem rate, code is bundled with other services"
HEPATITIS DELTA VIRUS AB      ,38201499,CDM,302,RC,86692,CPT,,,,Inpatient,,,42,42,HUMANA CHOICE PLUS,MGD,42,,,,,,,case rate,42,42,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,AETNA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,BCBS,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,CIGNA,COM,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,UNITED HEALTHCARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,VA,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,VA TRICARE,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,WELLMED,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,HUMANA,MGD,104.91,,,,,,,per diem,104.91,104.91,"Per diem rate, code is bundled with other services"
RUSSELL VIPER VNM TIME-DIL    ,38201501,CDM,305,RC,85613,CPT,,,,Inpatient,,,104.91,104.91,HUMANA CHOICE PLUS,MGD,104.91,,,,,,,case rate,104.91,104.91,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CULTURE HERPES                ,38201505,CDM,306,RC,87254,CPT,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,AETNA,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,BCBS,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,CIGNA,COM,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,TRICARE,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,UNITED HEALTHCARE,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,UNITED HEALTHCARE,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,VA,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,VA TRICARE,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,WELLMED,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,HUMANA,MGD,359.82,,,,,,,per diem,359.82,359.82,"Per diem rate, code is bundled with other services"
HIV-1 ANTIBODY                ,38201540,CDM,302,RC,86701,CPT,,,,Inpatient,,,359.82,359.82,HUMANA CHOICE PLUS,MGD,359.82,,,,,,,case rate,359.82,359.82,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,AETNA,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,BCBS,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,CIGNA,COM,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,TRICARE,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,UNITED HEALTHCARE,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,UNITED HEALTHCARE,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,VA,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,VA TRICARE,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,WELLMED,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,HUMANA,MGD,70.07,,,,,,,per diem,70.07,70.07,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 2 ABY     ,38201541,CDM,302,RC,86696,CPT,,,,Inpatient,,,70.07,70.07,HUMANA CHOICE PLUS,MGD,70.07,,,,,,,case rate,70.07,70.07,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,AETNA,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,BCBS,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,CIGNA,COM,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,TRICARE,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,UNITED HEALTHCARE,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,UNITED HEALTHCARE,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,VA,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,VA TRICARE,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,WELLMED,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,HUMANA,MGD,188.18,,,,,,,per diem,188.18,188.18,"Per diem rate, code is bundled with other services"
T-CELLS-CD4COUNT              ,38201545,CDM,302,RC,86361,CPT,,,,Inpatient,,,188.18,188.18,HUMANA CHOICE PLUS,MGD,188.18,,,,,,,case rate,188.18,188.18,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
PROTOZOA AB                   ,38201547,CDM,302,RC,86753,CPT,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,AETNA,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,BCBS,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,CIGNA,COM,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,TRICARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,UNITED HEALTHCARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,UNITED HEALTHCARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,VA,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,VA TRICARE,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,WELLMED,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,HUMANA,MGD,326.08,,,,,,,per diem,326.08,326.08,"Per diem rate, code is bundled with other services"
"HIV VIRAL LOAD, QUANT (DNA)   ",38201555,CDM,306,RC,87536,CPT,,,,Inpatient,,,326.08,326.08,HUMANA CHOICE PLUS,MGD,326.08,,,,,,,case rate,326.08,326.08,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,AETNA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,BCBS,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,CIGNA,COM,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,UNITED HEALTHCARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,VA,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,VA TRICARE,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,WELLMED,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,HUMANA,MGD,131.25,,,,,,,per diem,131.25,131.25,"Per diem rate, code is bundled with other services"
IMMUNOELEC SERUM              ,38201570,CDM,302,RC,86320,CPT,,,,Inpatient,,,131.25,131.25,HUMANA CHOICE PLUS,MGD,131.25,,,,,,,case rate,131.25,131.25,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,AETNA,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,BCBS,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,CIGNA,COM,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,TRICARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,UNITED HEALTHCARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,UNITED HEALTHCARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,VA,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,VA TRICARE,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,WELLMED,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,HUMANA,MGD,81.66,,,,,,,per diem,81.66,81.66,"Per diem rate, code is bundled with other services"
INSULIN                       ,38201580,CDM,301,RC,83525,CPT,,,,Inpatient,,,81.66,81.66,HUMANA CHOICE PLUS,MGD,81.66,,,,,,,case rate,81.66,81.66,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
ASPERGILLUS                   ,38201590,CDM,306,RC,87305,CPT,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,AETNA,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,BCBS,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,CIGNA,COM,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,TRICARE,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,UNITED HEALTHCARE,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,UNITED HEALTHCARE,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,VA,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,VA TRICARE,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,WELLMED,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,HUMANA,MGD,117.4,,,,,,,per diem,117.4,117.4,"Per diem rate, code is bundled with other services"
"IRON,SERUM,CHEMICAL           ",38201600,CDM,301,RC,83540,CPT,,,,Inpatient,,,117.4,117.4,HUMANA CHOICE PLUS,MGD,117.4,,,,,,,case rate,117.4,117.4,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,AETNA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,CIGNA,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,VA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,VA TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,WELLMED,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,HUMANA,MGD,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38201610,CDM,301,RC,83550,CPT,,,,Inpatient,,,103.29,103.29,HUMANA CHOICE PLUS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
"KETONES (ACETONE),QUAL        ",38201620,CDM,301,RC,82009,CPT,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,AETNA,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,BCBS,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,CIGNA,COM,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,TRICARE,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,UNITED HEALTHCARE,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,UNITED HEALTHCARE,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,VA,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,VA TRICARE,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,WELLMED,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,HUMANA,MGD,191.02,,,,,,,per diem,191.02,191.02,"Per diem rate, code is bundled with other services"
"KETOSTEROIDS 17, TOTAL        ",38201625,CDM,301,RC,83586,CPT,,,,Inpatient,,,191.02,191.02,HUMANA CHOICE PLUS,MGD,191.02,,,,,,,case rate,191.02,191.02,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,AETNA,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,BCBS,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,CIGNA,COM,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,TRICARE,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,UNITED HEALTHCARE,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,UNITED HEALTHCARE,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,VA,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,VA TRICARE,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,WELLMED,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,HUMANA,MGD,36.45,,,,,,,per diem,36.45,36.45,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38201630,CDM,301,RC,83605,CPT,,,,Inpatient,,,36.45,36.45,HUMANA CHOICE PLUS,MGD,36.45,,,,,,,case rate,36.45,36.45,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,AETNA,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,BCBS,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,CIGNA,COM,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,TRICARE,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,UNITED HEALTHCARE,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,UNITED HEALTHCARE,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,VA,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,VA TRICARE,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,WELLMED,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,HUMANA,MGD,81.85,,,,,,,per diem,81.85,81.85,"Per diem rate, code is bundled with other services"
LAMICTAL/LAMOTRIGINE          ,38201639,CDM,301,RC,80175,CPT,,,,Inpatient,,,81.85,81.85,HUMANA CHOICE PLUS,MGD,81.85,,,,,,,case rate,81.85,81.85,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,AETNA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,CIGNA,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,VA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,VA TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,WELLMED,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,HUMANA,MGD,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
LDH                           ,38201650,CDM,301,RC,83615,CPT,,,,Inpatient,,,103.29,103.29,HUMANA CHOICE PLUS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,AETNA,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,BCBS,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,CIGNA,COM,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,TRICARE,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,UNITED HEALTHCARE,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,UNITED HEALTHCARE,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,VA,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,VA TRICARE,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,WELLMED,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,HUMANA,MGD,184.05,,,,,,,per diem,184.05,184.05,"Per diem rate, code is bundled with other services"
LDH ISOENZYMES                ,38201660,CDM,301,RC,83625,CPT,,,,Inpatient,,,184.05,184.05,HUMANA CHOICE PLUS,MGD,184.05,,,,,,,case rate,184.05,184.05,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,AETNA,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,CIGNA,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,TRICARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UNITED HEALTHCARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UNITED HEALTHCARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA TRICARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,WELLMED,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,HUMANA,MGD,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
CULTURE LEGIONELLA            ,38201680,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,HUMANA CHOICE PLUS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,AETNA,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,CIGNA,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,TRICARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,UNITED HEALTHCARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,UNITED HEALTHCARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,VA,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,VA TRICARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,WELLMED,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,HUMANA,MGD,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
LEGIONELLA AG-DFA             ,38201685,CDM,306,RC,87278,CPT,,,,Inpatient,,,532.29,532.29,HUMANA CHOICE PLUS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,AETNA,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,BCBS,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,CIGNA,COM,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,TRICARE,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,UNITED HEALTHCARE,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,UNITED HEALTHCARE,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,VA,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,VA TRICARE,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,WELLMED,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,HUMANA,MGD,338.23,,,,,,,per diem,338.23,338.23,"Per diem rate, code is bundled with other services"
LEGIONELLA TITER              ,38201690,CDM,302,RC,86713,CPT,,,,Inpatient,,,338.23,338.23,HUMANA CHOICE PLUS,MGD,338.23,,,,,,,case rate,338.23,338.23,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,AETNA,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,BCBS,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,CIGNA,COM,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,TRICARE,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,UNITED HEALTHCARE,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,UNITED HEALTHCARE,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,VA,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,VA TRICARE,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,WELLMED,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,HUMANA,MGD,284.46,,,,,,,per diem,284.46,284.46,"Per diem rate, code is bundled with other services"
LEUKOCYTE ALK.PHOS            ,38201695,CDM,305,RC,85540,CPT,,,,Inpatient,,,284.46,284.46,HUMANA CHOICE PLUS,MGD,284.46,,,,,,,case rate,284.46,284.46,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,AETNA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,CIGNA,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,VA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,VA TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,WELLMED,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,HUMANA,MGD,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
LUTEINIZING HORMONE           ,38201700,CDM,301,RC,83002,CPT,,,,Inpatient,,,30.28,30.28,HUMANA CHOICE PLUS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,AETNA,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,BCBS,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,CIGNA,COM,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,TRICARE,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,UNITED HEALTHCARE,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,UNITED HEALTHCARE,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,VA,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,VA TRICARE,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,WELLMED,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,HUMANA,MGD,165.05,,,,,,,per diem,165.05,165.05,"Per diem rate, code is bundled with other services"
LIDOCAINE                     ,38201710,CDM,301,RC,80176,CPT,,,,Inpatient,,,165.05,165.05,HUMANA CHOICE PLUS,MGD,165.05,,,,,,,case rate,165.05,165.05,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,AETNA,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,BCBS,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,CIGNA,COM,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,TRICARE,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,UNITED HEALTHCARE,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,UNITED HEALTHCARE,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,VA,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,VA TRICARE,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,WELLMED,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,HUMANA,MGD,93.01,,,,,,,per diem,93.01,93.01,"Per diem rate, code is bundled with other services"
LIPASE                        ,38201720,CDM,301,RC,83690,CPT,,,,Inpatient,,,93.01,93.01,HUMANA CHOICE PLUS,MGD,93.01,,,,,,,case rate,93.01,93.01,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,AETNA,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,BCBS,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,CIGNA,COM,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,TRICARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,UNITED HEALTHCARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,UNITED HEALTHCARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,VA,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,VA TRICARE,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,WELLMED,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,HUMANA,MGD,102.74,,,,,,,per diem,102.74,102.74,"Per diem rate, code is bundled with other services"
PROGRAF LEVEL (TACROLIMUS)    ,38201722,CDM,301,RC,80197,CPT,,,,Inpatient,,,102.74,102.74,HUMANA CHOICE PLUS,MGD,102.74,,,,,,,case rate,102.74,102.74,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,AETNA,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,CIGNA,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,TRICARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,UNITED HEALTHCARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,UNITED HEALTHCARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,VA,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,VA TRICARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,WELLMED,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,HUMANA,MGD,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
LITHIUM                       ,38201730,CDM,301,RC,80178,CPT,,,,Inpatient,,,193.59,193.59,HUMANA CHOICE PLUS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,AETNA,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,BCBS,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,CIGNA,COM,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,TRICARE,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,UNITED HEALTHCARE,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,UNITED HEALTHCARE,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,VA,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,VA TRICARE,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,WELLMED,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,HUMANA,MGD,25.74,,,,,,,per diem,25.74,25.74,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38201740,CDM,301,RC,80076,CPT,,,,Inpatient,,,25.74,25.74,HUMANA CHOICE PLUS,MGD,25.74,,,,,,,case rate,25.74,25.74,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,AETNA,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,BCBS,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,CIGNA,COM,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,TRICARE,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,UNITED HEALTHCARE,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,UNITED HEALTHCARE,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,VA,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,VA TRICARE,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,WELLMED,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,HUMANA,MGD,279.29,,,,,,,per diem,279.29,279.29,"Per diem rate, code is bundled with other services"
LYME DISEASE TITER            ,38201750,CDM,302,RC,86618,CPT,,,,Inpatient,,,279.29,279.29,HUMANA CHOICE PLUS,MGD,279.29,,,,,,,case rate,279.29,279.29,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,AETNA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,CIGNA,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,VA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,VA TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,WELLMED,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,HUMANA,MGD,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38201760,CDM,301,RC,83735,CPT,,,,Inpatient,,,21.11,21.11,HUMANA CHOICE PLUS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,AETNA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,CIGNA,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,VA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,VA TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,WELLMED,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,HUMANA,MGD,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
MICROALBUMIN URINE QUANT      ,38201770,CDM,301,RC,82043,CPT,,,,Inpatient,,,74.62,74.62,HUMANA CHOICE PLUS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,AETNA,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,BCBS,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,CIGNA,COM,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,TRICARE,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,UNITED HEALTHCARE,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,UNITED HEALTHCARE,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,VA,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,VA TRICARE,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,WELLMED,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,HUMANA,MGD,130.71,,,,,,,per diem,130.71,130.71,"Per diem rate, code is bundled with other services"
HETEROPHILE ANTIBODY SCREEN   ,38201780,CDM,302,RC,86308,CPT,,,,Inpatient,,,130.71,130.71,HUMANA CHOICE PLUS,MGD,130.71,,,,,,,case rate,130.71,130.71,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,AETNA,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,BCBS,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,CIGNA,COM,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,TRICARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,UNITED HEALTHCARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,UNITED HEALTHCARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,VA,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,VA TRICARE,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,WELLMED,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,HUMANA,MGD,74.55,,,,,,,per diem,74.55,74.55,"Per diem rate, code is bundled with other services"
FLUORESCENT AB SCREEN         ,38201790,CDM,302,RC,86255,CPT,,,,Inpatient,,,74.55,74.55,HUMANA CHOICE PLUS,MGD,74.55,,,,,,,case rate,74.55,74.55,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,AETNA,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,BCBS,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,CIGNA,COM,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,TRICARE,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,UNITED HEALTHCARE,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,UNITED HEALTHCARE,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,VA,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,VA TRICARE,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,WELLMED,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,HUMANA,MGD,10.28,,,,,,,per diem,10.28,10.28,"Per diem rate, code is bundled with other services"
"OCCULT BLOOD, FECAL           ",38201800,CDM,301,RC,82270,CPT,,,,Inpatient,,,10.28,10.28,HUMANA CHOICE PLUS,MGD,10.28,,,,,,,case rate,10.28,10.28,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
"OUCHTERLONY GEL DIFFUSION, EA ",38201805,CDM,302,RC,86331,CPT,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,AETNA,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,BCBS,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,CIGNA,COM,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,TRICARE,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,UNITED HEALTHCARE,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,UNITED HEALTHCARE,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,VA,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,VA TRICARE,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,WELLMED,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,HUMANA,MGD,107.61,,,,,,,per diem,107.61,107.61,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38201810,CDM,301,RC,83930,CPT,,,,Inpatient,,,107.61,107.61,HUMANA CHOICE PLUS,MGD,107.61,,,,,,,case rate,107.61,107.61,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,AETNA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,CIGNA,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,VA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,VA TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,WELLMED,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,HUMANA,MGD,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
OSMOLALITY URINE              ,38201820,CDM,301,RC,83935,CPT,,,,Inpatient,,,40.95,40.95,HUMANA CHOICE PLUS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,AETNA,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,BCBS,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,CIGNA,COM,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,TRICARE,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,UNITED HEALTHCARE,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,UNITED HEALTHCARE,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,VA,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,VA TRICARE,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,WELLMED,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,HUMANA,MGD,93.29,,,,,,,per diem,93.29,93.29,"Per diem rate, code is bundled with other services"
OVA AND PARASITES             ,38201830,CDM,306,RC,87177,CPT,,,,Inpatient,,,93.29,93.29,HUMANA CHOICE PLUS,MGD,93.29,,,,,,,case rate,93.29,93.29,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,AETNA,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,BCBS,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,CIGNA,COM,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,TRICARE,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,UNITED HEALTHCARE,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,UNITED HEALTHCARE,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,VA,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,VA TRICARE,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,WELLMED,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,HUMANA,MGD,32.99,,,,,,,per diem,32.99,32.99,"Per diem rate, code is bundled with other services"
"PHENOBARBITAL, QUANT          ",38201880,CDM,301,RC,80184,CPT,,,,Inpatient,,,32.99,32.99,HUMANA CHOICE PLUS,MGD,32.99,,,,,,,case rate,32.99,32.99,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,AETNA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,CIGNA,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,VA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,VA TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,WELLMED,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,HUMANA,MGD,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
"SODIUM, URINE                 ",38201882,CDM,301,RC,84300,CPT,,,,Inpatient,,,77.87,77.87,HUMANA CHOICE PLUS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,AETNA,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,BCBS,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,CIGNA,COM,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,TRICARE,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,UNITED HEALTHCARE,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,UNITED HEALTHCARE,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,VA,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,VA TRICARE,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,WELLMED,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,HUMANA,MGD,47.9,,,,,,,per diem,47.9,47.9,"Per diem rate, code is bundled with other services"
"CHLORIDE, URINE               ",38201883,CDM,301,RC,82436,CPT,,,,Inpatient,,,47.9,47.9,HUMANA CHOICE PLUS,MGD,47.9,,,,,,,case rate,47.9,47.9,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,AETNA,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,BCBS,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,CIGNA,COM,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,TRICARE,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,UNITED HEALTHCARE,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,UNITED HEALTHCARE,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,VA,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,VA TRICARE,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,WELLMED,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,HUMANA,MGD,62.42,,,,,,,per diem,62.42,62.42,"Per diem rate, code is bundled with other services"
"PH,OTHER BODY FLUIDS          ",38201890,CDM,301,RC,83986,CPT,,,,Inpatient,,,62.42,62.42,HUMANA CHOICE PLUS,MGD,62.42,,,,,,,case rate,62.42,62.42,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,AETNA,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,CIGNA,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,TRICARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,UNITED HEALTHCARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,UNITED HEALTHCARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,VA,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,VA TRICARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,WELLMED,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,HUMANA,MGD,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHOROUS SERUM             ,38201910,CDM,301,RC,84100,CPT,,,,Inpatient,,,14.93,14.93,HUMANA CHOICE PLUS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,AETNA,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,BCBS,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,CIGNA,COM,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,TRICARE,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,UNITED HEALTHCARE,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,UNITED HEALTHCARE,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,VA,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,VA TRICARE,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,WELLMED,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,HUMANA,MGD,123.17,,,,,,,per diem,123.17,123.17,"Per diem rate, code is bundled with other services"
TOPUMAX-TOPIRAMATE            ,38201928,CDM,301,RC,80201,CPT,,,,Inpatient,,,123.17,123.17,HUMANA CHOICE PLUS,MGD,123.17,,,,,,,case rate,123.17,123.17,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM               ,38201930,CDM,301,RC,84132,CPT,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,AETNA,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,BCBS,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,CIGNA,COM,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,TRICARE,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,UNITED HEALTHCARE,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,UNITED HEALTHCARE,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,VA,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,VA TRICARE,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,WELLMED,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,HUMANA,MGD,49.06,,,,,,,per diem,49.06,49.06,"Per diem rate, code is bundled with other services"
POTASSIUM URINE               ,38201940,CDM,301,RC,84133,CPT,,,,Inpatient,,,49.06,49.06,HUMANA CHOICE PLUS,MGD,49.06,,,,,,,case rate,49.06,49.06,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,AETNA,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,CIGNA,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,TRICARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,UNITED HEALTHCARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,UNITED HEALTHCARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,VA,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,VA TRICARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,WELLMED,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,HUMANA,MGD,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
PREGNENOLONE LEVEL            ,38201977,CDM,301,RC,84140,CPT,,,,Inpatient,,,83.54,83.54,HUMANA CHOICE PLUS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,AETNA,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,BCBS,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,CIGNA,COM,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,TRICARE,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,UNITED HEALTHCARE,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,UNITED HEALTHCARE,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,VA,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,VA TRICARE,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,WELLMED,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,HUMANA,MGD,45.96,,,,,,,per diem,45.96,45.96,"Per diem rate, code is bundled with other services"
PREALBUMIN                    ,38201978,CDM,301,RC,84134,CPT,,,,Inpatient,,,45.96,45.96,HUMANA CHOICE PLUS,MGD,45.96,,,,,,,case rate,45.96,45.96,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,AETNA,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,BCBS,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,CIGNA,COM,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,TRICARE,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,UNITED HEALTHCARE,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,UNITED HEALTHCARE,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,VA,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,VA TRICARE,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,WELLMED,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,HUMANA,MGD,437.81,,,,,,,per diem,437.81,437.81,"Per diem rate, code is bundled with other services"
PROGESTERONE                  ,38201985,CDM,301,RC,84144,CPT,,,,Inpatient,,,437.81,437.81,HUMANA CHOICE PLUS,MGD,437.81,,,,,,,case rate,437.81,437.81,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,AETNA,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,BCBS,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,CIGNA,COM,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,TRICARE,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,UNITED HEALTHCARE,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,UNITED HEALTHCARE,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,VA,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,VA TRICARE,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,WELLMED,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,HUMANA,MGD,130.33,,,,,,,per diem,130.33,130.33,"Per diem rate, code is bundled with other services"
PROLACTIN                     ,38201990,CDM,301,RC,84146,CPT,,,,Inpatient,,,130.33,130.33,HUMANA CHOICE PLUS,MGD,130.33,,,,,,,case rate,130.33,130.33,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
PROLIXIN LEVEL                ,38201992,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,AETNA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,BCBS,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,CIGNA,COM,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,UNITED HEALTHCARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,VA,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,VA TRICARE,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,WELLMED,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,HUMANA,MGD,30.28,,,,,,,per diem,30.28,30.28,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ATG (TOTAL) ,38202000,CDM,301,RC,84153,CPT,,,,Inpatient,,,30.28,30.28,HUMANA CHOICE PLUS,MGD,30.28,,,,,,,case rate,30.28,30.28,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,AETNA,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,BCBS,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,CIGNA,COM,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,TRICARE,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,UNITED HEALTHCARE,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,UNITED HEALTHCARE,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,VA,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,VA TRICARE,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,WELLMED,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,HUMANA,MGD,34.88,,,,,,,per diem,34.88,34.88,"Per diem rate, code is bundled with other services"
PROTEIN TOTAL                 ,38202010,CDM,301,RC,84155,CPT,,,,Inpatient,,,34.88,34.88,HUMANA CHOICE PLUS,MGD,34.88,,,,,,,case rate,34.88,34.88,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,AETNA,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,BCBS,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,CIGNA,COM,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,TRICARE,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,UNITED HEALTHCARE,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,UNITED HEALTHCARE,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,VA,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,VA TRICARE,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,WELLMED,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,HUMANA,MGD,142.38,,,,,,,per diem,142.38,142.38,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL, OTHER SOURCE  ",38202011,CDM,301,RC,84157,CPT,,,,Inpatient,,,142.38,142.38,HUMANA CHOICE PLUS,MGD,142.38,,,,,,,case rate,142.38,142.38,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,AETNA,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,BCBS,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,CIGNA,COM,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,TRICARE,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,UNITED HEALTHCARE,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,UNITED HEALTHCARE,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,VA,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,VA TRICARE,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,WELLMED,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,HUMANA,MGD,136.27,,,,,,,per diem,136.27,136.27,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPHORESIS       ,38202015,CDM,301,RC,84165,CPT,,,,Inpatient,,,136.27,136.27,HUMANA CHOICE PLUS,MGD,136.27,,,,,,,case rate,136.27,136.27,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,AETNA,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,BCBS,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,CIGNA,COM,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,TRICARE,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,UNITED HEALTHCARE,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,UNITED HEALTHCARE,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,VA,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,VA TRICARE,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,WELLMED,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,HUMANA,MGD,13.51,,,,,,,per diem,13.51,13.51,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38202040,CDM,305,RC,85610,CPT,,,,Inpatient,,,13.51,13.51,HUMANA CHOICE PLUS,MGD,13.51,,,,,,,case rate,13.51,13.51,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,AETNA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,CIGNA,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,VA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,VA TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,WELLMED,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,HUMANA,MGD,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONES INTACT   ,38202045,CDM,300,RC,83970,CPT,,,,Inpatient,,,28.41,28.41,HUMANA CHOICE PLUS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,AETNA,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,BCBS,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,CIGNA,COM,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,TRICARE,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,UNITED HEALTHCARE,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,UNITED HEALTHCARE,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,VA,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,VA TRICARE,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,WELLMED,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,HUMANA,MGD,295.64,,,,,,,per diem,295.64,295.64,"Per diem rate, code is bundled with other services"
PARA THYROID INTACT C TERMINAL,38202048,CDM,300,RC,83970,CPT,,,,Inpatient,,,295.64,295.64,HUMANA CHOICE PLUS,MGD,295.64,,,,,,,case rate,295.64,295.64,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,AETNA,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,BCBS,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,CIGNA,COM,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,TRICARE,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,UNITED HEALTHCARE,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,UNITED HEALTHCARE,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,VA,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,VA TRICARE,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,WELLMED,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,HUMANA,MGD,204.03,,,,,,,per diem,204.03,204.03,"Per diem rate, code is bundled with other services"
PARATHYROID HORMONE           ,38202049,CDM,301,RC,83970,CPT,,,,Inpatient,,,204.03,204.03,HUMANA CHOICE PLUS,MGD,204.03,,,,,,,case rate,204.03,204.03,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,AETNA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,CIGNA,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,VA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,VA TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,WELLMED,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,HUMANA,MGD,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
PTT                           ,38202050,CDM,305,RC,85730,CPT,,,,Inpatient,,,28.41,28.41,HUMANA CHOICE PLUS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,AETNA,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,BCBS,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,CIGNA,COM,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,TRICARE,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,UNITED HEALTHCARE,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,UNITED HEALTHCARE,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,VA,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,VA TRICARE,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,WELLMED,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,HUMANA,MGD,101.6,,,,,,,per diem,101.6,101.6,"Per diem rate, code is bundled with other services"
IMMUNO OTHER INFECT AGENT AB  ,38202055,CDM,302,RC,86317,CPT,,,,Inpatient,,,101.6,101.6,HUMANA CHOICE PLUS,MGD,101.6,,,,,,,case rate,101.6,101.6,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,AETNA,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,BCBS,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,CIGNA,COM,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,TRICARE,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,UNITED HEALTHCARE,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,UNITED HEALTHCARE,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,VA,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,VA TRICARE,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,WELLMED,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,HUMANA,MGD,292.78,,,,,,,per diem,292.78,292.78,"Per diem rate, code is bundled with other services"
QUINIDINE                     ,38202070,CDM,301,RC,80194,CPT,,,,Inpatient,,,292.78,292.78,HUMANA CHOICE PLUS,MGD,292.78,,,,,,,case rate,292.78,292.78,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
CMV BY PCR                    ,38202073,CDM,306,RC,87496,CPT,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,AETNA,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,BCBS,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,CIGNA,COM,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,TRICARE,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,UNITED HEALTHCARE,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,UNITED HEALTHCARE,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,VA,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,VA TRICARE,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,WELLMED,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,HUMANA,MGD,121.68,,,,,,,per diem,121.68,121.68,"Per diem rate, code is bundled with other services"
RAPAMYCIN (SIROLIMUS)         ,38202080,CDM,301,RC,80195,CPT,,,,Inpatient,,,121.68,121.68,HUMANA CHOICE PLUS,MGD,121.68,,,,,,,case rate,121.68,121.68,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
"RBC COUNT, AUTO               ",38202090,CDM,305,RC,85041,CPT,,,,Inpatient,,,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,AETNA,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,BCBS,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,CIGNA,COM,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,TRICARE,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,UNITED HEALTHCARE,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,UNITED HEALTHCARE,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,VA,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,VA TRICARE,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,WELLMED,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,HUMANA,MGD,161.62,,,,,,,per diem,161.62,161.62,"Per diem rate, code is bundled with other services"
"FOLIC ACID, RBC               ",38202095,CDM,301,RC,82747,CPT,,,,Inpatient,,,161.62,161.62,HUMANA CHOICE PLUS,MGD,161.62,,,,,,,case rate,161.62,161.62,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,AETNA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,CIGNA,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,VA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,VA TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,WELLMED,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,HUMANA,MGD,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RENIN-PLASMA                  ,38202115,CDM,301,RC,84244,CPT,,,,Inpatient,,,35.69,35.69,HUMANA CHOICE PLUS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,AETNA,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,BCBS,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,CIGNA,COM,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,TRICARE,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,UNITED HEALTHCARE,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,UNITED HEALTHCARE,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,VA,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,VA TRICARE,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,WELLMED,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,HUMANA,MGD,65.35,,,,,,,per diem,65.35,65.35,"Per diem rate, code is bundled with other services"
RETICULOCYTE (MANUAL)         ,38202120,CDM,305,RC,85044,CPT,,,,Inpatient,,,65.35,65.35,HUMANA CHOICE PLUS,MGD,65.35,,,,,,,case rate,65.35,65.35,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,AETNA,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,BCBS,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,CIGNA,COM,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,TRICARE,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,UNITED HEALTHCARE,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,UNITED HEALTHCARE,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,VA,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,VA TRICARE,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,WELLMED,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,HUMANA,MGD,265.82,,,,,,,per diem,265.82,265.82,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUAL       ",38202130,CDM,302,RC,86430,CPT,,,,Inpatient,,,265.82,265.82,HUMANA CHOICE PLUS,MGD,265.82,,,,,,,case rate,265.82,265.82,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,AETNA,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,BCBS,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,CIGNA,COM,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,TRICARE,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,UNITED HEALTHCARE,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,UNITED HEALTHCARE,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,VA,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,VA TRICARE,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,WELLMED,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,HUMANA,MGD,91.38,,,,,,,per diem,91.38,91.38,"Per diem rate, code is bundled with other services"
CULTURE VRE SCREEN            ,38202138,CDM,306,RC,87081,CPT,,,,Inpatient,,,91.38,91.38,HUMANA CHOICE PLUS,MGD,91.38,,,,,,,case rate,91.38,91.38,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,AETNA,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,BCBS,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,CIGNA,COM,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,TRICARE,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,UNITED HEALTHCARE,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,UNITED HEALTHCARE,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,VA,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,VA TRICARE,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,WELLMED,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,HUMANA,MGD,52.07,,,,,,,per diem,52.07,52.07,"Per diem rate, code is bundled with other services"
RPR                           ,38202140,CDM,302,RC,86592,CPT,,,,Inpatient,,,52.07,52.07,HUMANA CHOICE PLUS,MGD,52.07,,,,,,,case rate,52.07,52.07,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,AETNA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,CIGNA,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,VA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,VA TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,WELLMED,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,HUMANA,MGD,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
RUBELLA ANTIBODY              ,38202145,CDM,302,RC,86762,CPT,,,,Inpatient,,,323.44,323.44,HUMANA CHOICE PLUS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
RUBEOLA ANTIBODY              ,38202146,CDM,302,RC,86765,CPT,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,AETNA,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,BCBS,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,CIGNA,COM,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,TRICARE,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,UNITED HEALTHCARE,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,UNITED HEALTHCARE,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,VA,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,VA TRICARE,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,WELLMED,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,HUMANA,MGD,81.54,,,,,,,per diem,81.54,81.54,"Per diem rate, code is bundled with other services"
PSA SCREENING                 ,38202151,CDM,300,RC,G0103,HCPCS,,,,Inpatient,,,81.54,81.54,HUMANA CHOICE PLUS,MGD,81.54,,,,,,,case rate,81.54,81.54,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
SENSITIVITY (MIC)             ,38202160,CDM,306,RC,87186,CPT,,,,Inpatient,,,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,AETNA,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,BCBS,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,CIGNA,COM,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,TRICARE,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,UNITED HEALTHCARE,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,UNITED HEALTHCARE,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,VA,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,VA TRICARE,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,WELLMED,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,HUMANA,MGD,102.23,,,,,,,per diem,102.23,102.23,"Per diem rate, code is bundled with other services"
"SENSITIVITY, ANTIBIOTIC-K     ",38202161,CDM,300,RC,87186,CPT,,,,Inpatient,,,102.23,102.23,HUMANA CHOICE PLUS,MGD,102.23,,,,,,,case rate,102.23,102.23,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,AETNA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,BCBS,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,CIGNA,COM,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,UNITED HEALTHCARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,VA,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,VA TRICARE,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,WELLMED,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,HUMANA,MGD,103.29,,,,,,,per diem,103.29,103.29,"Per diem rate, code is bundled with other services"
SGOT (AST)                    ,38202170,CDM,301,RC,84450,CPT,,,,Inpatient,,,103.29,103.29,HUMANA CHOICE PLUS,MGD,103.29,,,,,,,case rate,103.29,103.29,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,AETNA,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,BCBS,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,CIGNA,COM,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,TRICARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,UNITED HEALTHCARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,UNITED HEALTHCARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,VA,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,VA TRICARE,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,WELLMED,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,HUMANA,MGD,99.5,,,,,,,per diem,99.5,99.5,"Per diem rate, code is bundled with other services"
SGPT (ALT)                    ,38202180,CDM,301,RC,84460,CPT,,,,Inpatient,,,99.5,99.5,HUMANA CHOICE PLUS,MGD,99.5,,,,,,,case rate,99.5,99.5,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,AETNA,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,BCBS,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,CIGNA,COM,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,TRICARE,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,UNITED HEALTHCARE,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,UNITED HEALTHCARE,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,VA,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,VA TRICARE,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,WELLMED,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,HUMANA,MGD,22.3,,,,,,,per diem,22.3,22.3,"Per diem rate, code is bundled with other services"
SICKLE CELL SCREEN            ,38202190,CDM,305,RC,85660,CPT,,,,Inpatient,,,22.3,22.3,HUMANA CHOICE PLUS,MGD,22.3,,,,,,,case rate,22.3,22.3,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,AETNA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,CIGNA,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,VA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,VA TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,WELLMED,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,HUMANA,MGD,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
SODIUM SERUM                  ,38202200,CDM,301,RC,84295,CPT,,,,Inpatient,,,77.87,77.87,HUMANA CHOICE PLUS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,AETNA,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,BCBS,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,CIGNA,COM,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,TRICARE,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,UNITED HEALTHCARE,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,UNITED HEALTHCARE,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,VA,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,VA TRICARE,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,WELLMED,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,HUMANA,MGD,389.2,,,,,,,per diem,389.2,389.2,"Per diem rate, code is bundled with other services"
RSV PCR QUALITATIVE           ,38202208,CDM,300,RC,87798,CPT,,,,Inpatient,,,389.2,389.2,HUMANA CHOICE PLUS,MGD,389.2,,,,,,,case rate,389.2,389.2,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,AETNA,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,BCBS,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,CIGNA,COM,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,TRICARE,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,UNITED HEALTHCARE,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,UNITED HEALTHCARE,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,VA,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,VA TRICARE,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,WELLMED,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,HUMANA,MGD,35.85,,,,,,,per diem,35.85,35.85,"Per diem rate, code is bundled with other services"
SODIUM NON-URINE/NON-BLOOD    ,38202211,CDM,301,RC,84302,CPT,,,,Inpatient,,,35.85,35.85,HUMANA CHOICE PLUS,MGD,35.85,,,,,,,case rate,35.85,35.85,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,AETNA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,CIGNA,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,VA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,VA TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,WELLMED,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,HUMANA,MGD,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
"BLOOD COUNT-PLATELET, AUTO    ",38202212,CDM,305,RC,85049,CPT,,,,Inpatient,,,63.27,63.27,HUMANA CHOICE PLUS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,AETNA,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,BCBS,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,CIGNA,COM,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,TRICARE,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,UNITED HEALTHCARE,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,UNITED HEALTHCARE,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,VA,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,VA TRICARE,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,WELLMED,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,HUMANA,MGD,72.94,,,,,,,per diem,72.94,72.94,"Per diem rate, code is bundled with other services"
BLOOD SMR W/O MAN DIFF WBC CNT,38202213,CDM,305,RC,85008,CPT,,,,Inpatient,,,72.94,72.94,HUMANA CHOICE PLUS,MGD,72.94,,,,,,,case rate,72.94,72.94,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
MAN DIFF WBC CNT BUFFY COAT   ,38202214,CDM,305,RC,85009,CPT,,,,Inpatient,,,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,AETNA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,CIGNA,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,VA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,VA TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,WELLMED,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,HUMANA,MGD,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
RETICULOCYTE (AUTO)           ,38202215,CDM,305,RC,85045,CPT,,,,Inpatient,,,58.95,58.95,HUMANA CHOICE PLUS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,AETNA,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,BCBS,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,CIGNA,COM,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,TRICARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,UNITED HEALTHCARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,UNITED HEALTHCARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,VA,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,VA TRICARE,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,WELLMED,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,HUMANA,MGD,100.83,,,,,,,per diem,100.83,100.83,"Per diem rate, code is bundled with other services"
"LEUKOCYTE COUNT, FECAL        ",38202216,CDM,300,RC,89055,CPT,,,,Inpatient,,,100.83,100.83,HUMANA CHOICE PLUS,MGD,100.83,,,,,,,case rate,100.83,100.83,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,AETNA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,CIGNA,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,VA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,VA TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,WELLMED,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,HUMANA,MGD,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
SPECIFIC GRAVITY (NON-URINE)  ,38202229,CDM,301,RC,84315,CPT,,,,Inpatient,,,22.49,22.49,HUMANA CHOICE PLUS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,AETNA,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,BCBS,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,CIGNA,COM,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,TRICARE,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,UNITED HEALTHCARE,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,UNITED HEALTHCARE,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,VA,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,VA TRICARE,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,WELLMED,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,HUMANA,MGD,53.22,,,,,,,per diem,53.22,53.22,"Per diem rate, code is bundled with other services"
STREP A SCREEN (EIA)          ,38202270,CDM,306,RC,87430,CPT,,,,Inpatient,,,53.22,53.22,HUMANA CHOICE PLUS,MGD,53.22,,,,,,,case rate,53.22,53.22,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,AETNA,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,BCBS,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,CIGNA,COM,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,TRICARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UNITED HEALTHCARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,UNITED HEALTHCARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,VA TRICARE,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,WELLMED,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,HUMANA,MGD,56.73,,,,,,,per diem,56.73,56.73,"Per diem rate, code is bundled with other services"
"CULTURE, GROUP B STREP SC     ",38202271,CDM,306,RC,87081,CPT,,,,Inpatient,,,56.73,56.73,HUMANA CHOICE PLUS,MGD,56.73,,,,,,,case rate,56.73,56.73,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,AETNA,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,BCBS,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,CIGNA,COM,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,TRICARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,UNITED HEALTHCARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,UNITED HEALTHCARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,VA,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,VA TRICARE,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,WELLMED,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,HUMANA,MGD,206.03,,,,,,,per diem,206.03,206.03,"Per diem rate, code is bundled with other services"
T3 FREE                       ,38202290,CDM,301,RC,84481,CPT,,,,Inpatient,,,206.03,206.03,HUMANA CHOICE PLUS,MGD,206.03,,,,,,,case rate,206.03,206.03,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,AETNA,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,BCBS,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,CIGNA,COM,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,TRICARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,UNITED HEALTHCARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,UNITED HEALTHCARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,VA,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,VA TRICARE,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,WELLMED,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,HUMANA,MGD,244.19,,,,,,,per diem,244.19,244.19,"Per diem rate, code is bundled with other services"
T-3 UPTAKE                    ,38202300,CDM,301,RC,84479,CPT,,,,Inpatient,,,244.19,244.19,HUMANA CHOICE PLUS,MGD,244.19,,,,,,,case rate,244.19,244.19,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,AETNA,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,BCBS,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,CIGNA,COM,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,TRICARE,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,UNITED HEALTHCARE,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,UNITED HEALTHCARE,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,VA,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,VA TRICARE,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,WELLMED,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,HUMANA,MGD,158.4,,,,,,,per diem,158.4,158.4,"Per diem rate, code is bundled with other services"
T3 TOTAL                      ,38202303,CDM,301,RC,84480,CPT,,,,Inpatient,,,158.4,158.4,HUMANA CHOICE PLUS,MGD,158.4,,,,,,,case rate,158.4,158.4,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,AETNA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,CIGNA,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,VA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,VA TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,WELLMED,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,HUMANA,MGD,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
REVERSE T3                    ,38202304,CDM,301,RC,84482,CPT,,,,Inpatient,,,494.8,494.8,HUMANA CHOICE PLUS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,AETNA,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,BCBS,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,CIGNA,COM,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,TRICARE,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,UNITED HEALTHCARE,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,UNITED HEALTHCARE,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,VA,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,VA TRICARE,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,WELLMED,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,HUMANA,MGD,121.67,,,,,,,per diem,121.67,121.67,"Per diem rate, code is bundled with other services"
T-4 TOTAL (THYROXINE)         ,38202310,CDM,301,RC,84436,CPT,,,,Inpatient,,,121.67,121.67,HUMANA CHOICE PLUS,MGD,121.67,,,,,,,case rate,121.67,121.67,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,AETNA,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,BCBS,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,CIGNA,COM,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,TRICARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,UNITED HEALTHCARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,UNITED HEALTHCARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,VA,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,VA TRICARE,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,WELLMED,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,HUMANA,MGD,193.59,,,,,,,per diem,193.59,193.59,"Per diem rate, code is bundled with other services"
TEGRETOL-TOTAL                ,38202330,CDM,301,RC,80156,CPT,,,,Inpatient,,,193.59,193.59,HUMANA CHOICE PLUS,MGD,193.59,,,,,,,case rate,193.59,193.59,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,AETNA,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,BCBS,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,CIGNA,COM,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,TRICARE,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,UNITED HEALTHCARE,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,UNITED HEALTHCARE,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,VA,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,VA TRICARE,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,WELLMED,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,HUMANA,MGD,185.72,,,,,,,per diem,185.72,185.72,"Per diem rate, code is bundled with other services"
TESTOSTERONE TOTAL            ,38202340,CDM,301,RC,84403,CPT,,,,Inpatient,,,185.72,185.72,HUMANA CHOICE PLUS,MGD,185.72,,,,,,,case rate,185.72,185.72,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,AETNA,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,BCBS,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,CIGNA,COM,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,TRICARE,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,UNITED HEALTHCARE,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,UNITED HEALTHCARE,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,VA,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,VA TRICARE,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,WELLMED,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,HUMANA,MGD,217.93,,,,,,,per diem,217.93,217.93,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38202350,CDM,301,RC,80198,CPT,,,,Inpatient,,,217.93,217.93,HUMANA CHOICE PLUS,MGD,217.93,,,,,,,case rate,217.93,217.93,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,AETNA,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,BCBS,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,CIGNA,COM,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,TRICARE,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,UNITED HEALTHCARE,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,UNITED HEALTHCARE,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,VA,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,VA TRICARE,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,WELLMED,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,HUMANA,MGD,447.85,,,,,,,per diem,447.85,447.85,"Per diem rate, code is bundled with other services"
THROMBIN TIME                 ,38202370,CDM,305,RC,85670,CPT,,,,Inpatient,,,447.85,447.85,HUMANA CHOICE PLUS,MGD,447.85,,,,,,,case rate,447.85,447.85,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,AETNA,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,BCBS,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,CIGNA,COM,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,TRICARE,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,UNITED HEALTHCARE,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,UNITED HEALTHCARE,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,VA,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,VA TRICARE,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,WELLMED,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,HUMANA,MGD,97.65,,,,,,,per diem,97.65,97.65,"Per diem rate, code is bundled with other services"
THYROID STIMULATING IMM GLOB  ,38202384,CDM,301,RC,84445,CPT,,,,Inpatient,,,97.65,97.65,HUMANA CHOICE PLUS,MGD,97.65,,,,,,,case rate,97.65,97.65,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,AETNA,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,BCBS,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,CIGNA,COM,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,TRICARE,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,UNITED HEALTHCARE,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,UNITED HEALTHCARE,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,VA,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,VA TRICARE,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,WELLMED,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,HUMANA,MGD,358.41,,,,,,,per diem,358.41,358.41,"Per diem rate, code is bundled with other services"
TOBRAMYCIN                    ,38202390,CDM,301,RC,80200,CPT,,,,Inpatient,,,358.41,358.41,HUMANA CHOICE PLUS,MGD,358.41,,,,,,,case rate,358.41,358.41,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,AETNA,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,BCBS,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,CIGNA,COM,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,TRICARE,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,UNITED HEALTHCARE,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,UNITED HEALTHCARE,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,VA,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,VA TRICARE,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,WELLMED,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,HUMANA,MGD,77.02,,,,,,,per diem,77.02,77.02,"Per diem rate, code is bundled with other services"
TRANSFERRIN SERUM             ,38202400,CDM,301,RC,84466,CPT,,,,Inpatient,,,77.02,77.02,HUMANA CHOICE PLUS,MGD,77.02,,,,,,,case rate,77.02,77.02,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,AETNA,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,BCBS,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,CIGNA,COM,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,TRICARE,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,UNITED HEALTHCARE,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,UNITED HEALTHCARE,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,VA,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,VA TRICARE,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,WELLMED,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,HUMANA,MGD,98.79,,,,,,,per diem,98.79,98.79,"Per diem rate, code is bundled with other services"
TRIGLYCERIDES                 ,38202410,CDM,301,RC,84478,CPT,,,,Inpatient,,,98.79,98.79,HUMANA CHOICE PLUS,MGD,98.79,,,,,,,case rate,98.79,98.79,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,AETNA,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,BCBS,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,CIGNA,COM,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,TRICARE,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,UNITED HEALTHCARE,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,UNITED HEALTHCARE,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,VA,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,VA TRICARE,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,WELLMED,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,HUMANA,MGD,39.28,,,,,,,per diem,39.28,39.28,"Per diem rate, code is bundled with other services"
TROPONIN (QUANTITATIVE)       ,38202415,CDM,301,RC,84484,CPT,,,,Inpatient,,,39.28,39.28,HUMANA CHOICE PLUS,MGD,39.28,,,,,,,case rate,39.28,39.28,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,AETNA,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,BCBS,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,CIGNA,COM,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,TRICARE,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,UNITED HEALTHCARE,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,UNITED HEALTHCARE,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,VA,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,VA TRICARE,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,WELLMED,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,HUMANA,MGD,114.27,,,,,,,per diem,114.27,114.27,"Per diem rate, code is bundled with other services"
TROPONIN T (QUANTITATIVE)     ,38202416,CDM,301,RC,84484,CPT,,,,Inpatient,,,114.27,114.27,HUMANA CHOICE PLUS,MGD,114.27,,,,,,,case rate,114.27,114.27,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,AETNA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,CIGNA,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,VA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,VA TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,WELLMED,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,HUMANA,MGD,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38202420,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,HUMANA CHOICE PLUS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,AETNA,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,BCBS,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,CIGNA,COM,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,TRICARE,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,UNITED HEALTHCARE,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,UNITED HEALTHCARE,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,VA,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,VA TRICARE,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,WELLMED,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,HUMANA,MGD,85.82,,,,,,,per diem,85.82,85.82,"Per diem rate, code is bundled with other services"
TYPE & CROSSMATCH             ,38202429,CDM,300,RC,86900,CPT,,,,Inpatient,,,85.82,85.82,HUMANA CHOICE PLUS,MGD,85.82,,,,,,,case rate,85.82,85.82,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,AETNA,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,CIGNA,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,TRICARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UNITED HEALTHCARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UNITED HEALTHCARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA TRICARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,WELLMED,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,HUMANA,MGD,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
TYPE & SCREEN                 ,38202430,CDM,300,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,HUMANA CHOICE PLUS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,AETNA,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,BCBS,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,CIGNA,COM,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,TRICARE,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,UNITED HEALTHCARE,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,UNITED HEALTHCARE,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,VA,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,VA TRICARE,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,WELLMED,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,HUMANA,MGD,14.24,,,,,,,per diem,14.24,14.24,"Per diem rate, code is bundled with other services"
"URIC ACID, BLOOD              ",38202440,CDM,301,RC,84550,CPT,,,,Inpatient,,,14.24,14.24,HUMANA CHOICE PLUS,MGD,14.24,,,,,,,case rate,14.24,14.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,AETNA,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,BCBS,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,CIGNA,COM,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,TRICARE,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,UNITED HEALTHCARE,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,UNITED HEALTHCARE,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,VA,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,VA TRICARE,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,WELLMED,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,HUMANA,MGD,93.24,,,,,,,per diem,93.24,93.24,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25 HYDROXY         ",38202456,CDM,301,RC,82306,CPT,,,,Inpatient,,,93.24,93.24,HUMANA CHOICE PLUS,MGD,93.24,,,,,,,case rate,93.24,93.24,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/O MICRO     ,38202460,CDM,307,RC,81003,CPT,,,,Inpatient,,,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,AETNA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,CIGNA,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,VA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,VA TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,WELLMED,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,HUMANA,MGD,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AUTO W/MICROSCOPIC ,38202470,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,HUMANA CHOICE PLUS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,AETNA,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,CIGNA,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,TRICARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,UNITED HEALTHCARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,UNITED HEALTHCARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,VA,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,VA TRICARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,WELLMED,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,HUMANA,MGD,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
UREA NITROGEN (URINE)         ,38202480,CDM,301,RC,84540,CPT,,,,Inpatient,,,53.36,53.36,HUMANA CHOICE PLUS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,AETNA,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,BCBS,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,CIGNA,COM,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,TRICARE,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,UNITED HEALTHCARE,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,UNITED HEALTHCARE,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,VA,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,VA TRICARE,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,WELLMED,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,HUMANA,MGD,357.38,,,,,,,per diem,357.38,357.38,"Per diem rate, code is bundled with other services"
HISTOPLASMA ANTIGEN           ,38202481,CDM,306,RC,87385,CPT,,,,Inpatient,,,357.38,357.38,HUMANA CHOICE PLUS,MGD,357.38,,,,,,,case rate,357.38,357.38,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,AETNA,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,BCBS,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,CIGNA,COM,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,TRICARE,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,UNITED HEALTHCARE,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,UNITED HEALTHCARE,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,VA,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,VA TRICARE,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,WELLMED,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,HUMANA,MGD,147.33,,,,,,,per diem,147.33,147.33,"Per diem rate, code is bundled with other services"
VALPROIC ACID                 ,38202500,CDM,301,RC,80164,CPT,,,,Inpatient,,,147.33,147.33,HUMANA CHOICE PLUS,MGD,147.33,,,,,,,case rate,147.33,147.33,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,AETNA,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,BCBS,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,CIGNA,COM,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,TRICARE,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,UNITED HEALTHCARE,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,UNITED HEALTHCARE,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,VA,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,VA TRICARE,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,WELLMED,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,HUMANA,MGD,130.28,,,,,,,per diem,130.28,130.28,"Per diem rate, code is bundled with other services"
VALPROIC ACID FREE            ,38202505,CDM,301,RC,80165,CPT,,,,Inpatient,,,130.28,130.28,HUMANA CHOICE PLUS,MGD,130.28,,,,,,,case rate,130.28,130.28,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,AETNA,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,BCBS,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,CIGNA,COM,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,TRICARE,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,UNITED HEALTHCARE,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,UNITED HEALTHCARE,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,VA,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,VA TRICARE,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,WELLMED,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,HUMANA,MGD,42.65,,,,,,,per diem,42.65,42.65,"Per diem rate, code is bundled with other services"
VANCOMYCIN                    ,38202510,CDM,301,RC,80202,CPT,,,,Inpatient,,,42.65,42.65,HUMANA CHOICE PLUS,MGD,42.65,,,,,,,case rate,42.65,42.65,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,AETNA,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,BCBS,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,CIGNA,COM,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,TRICARE,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,UNITED HEALTHCARE,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,UNITED HEALTHCARE,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,VA,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,VA TRICARE,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,WELLMED,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,HUMANA,MGD,29.98,,,,,,,per diem,29.98,29.98,"Per diem rate, code is bundled with other services"
VDRL QUANTITATIVE             ,38202530,CDM,302,RC,86593,CPT,,,,Inpatient,,,29.98,29.98,HUMANA CHOICE PLUS,MGD,29.98,,,,,,,case rate,29.98,29.98,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
VENLAFAXINE LEVEL             ,38202533,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,AETNA,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,CIGNA,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,TRICARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,UNITED HEALTHCARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,UNITED HEALTHCARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,VA,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,VA TRICARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,WELLMED,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,HUMANA,MGD,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
VISCOSITY                     ,38202535,CDM,305,RC,85810,CPT,,,,Inpatient,,,138.16,138.16,HUMANA CHOICE PLUS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,AETNA,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,BCBS,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,CIGNA,COM,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,TRICARE,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,UNITED HEALTHCARE,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,UNITED HEALTHCARE,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,VA,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,VA TRICARE,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,WELLMED,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,HUMANA,MGD,19.57,,,,,,,per diem,19.57,19.57,"Per diem rate, code is bundled with other services"
VORICONAZOLE QNT              ,38202536,CDM,300,RC,80299,CPT,,,,Inpatient,,,19.57,19.57,HUMANA CHOICE PLUS,MGD,19.57,,,,,,,case rate,19.57,19.57,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,AETNA,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,BCBS,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,CIGNA,COM,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,TRICARE,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,UNITED HEALTHCARE,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,UNITED HEALTHCARE,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,VA,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,VA TRICARE,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,WELLMED,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,HUMANA,MGD,103.86,,,,,,,per diem,103.86,103.86,"Per diem rate, code is bundled with other services"
FUNGITELL QUAL/SEMIQNT        ,38202537,CDM,300,RC,87449,CPT,,,,Inpatient,,,103.86,103.86,HUMANA CHOICE PLUS,MGD,103.86,,,,,,,case rate,103.86,103.86,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,AETNA,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,BCBS,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,CIGNA,COM,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,TRICARE,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,UNITED HEALTHCARE,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,UNITED HEALTHCARE,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,VA,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,VA TRICARE,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,WELLMED,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,HUMANA,MGD,262.23,,,,,,,per diem,262.23,262.23,"Per diem rate, code is bundled with other services"
VITAMIN B1 (THIAMINE)         ,38202539,CDM,301,RC,84425,CPT,,,,Inpatient,,,262.23,262.23,HUMANA CHOICE PLUS,MGD,262.23,,,,,,,case rate,262.23,262.23,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,AETNA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,CIGNA,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,VA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,VA TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,WELLMED,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,HUMANA,MGD,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38202540,CDM,301,RC,82607,CPT,,,,Inpatient,,,85.05,85.05,HUMANA CHOICE PLUS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,AETNA,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,BCBS,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,CIGNA,COM,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,TRICARE,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,UNITED HEALTHCARE,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,UNITED HEALTHCARE,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,VA,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,VA TRICARE,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,WELLMED,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,HUMANA,MGD,601.9,,,,,,,per diem,601.9,601.9,"Per diem rate, code is bundled with other services"
VMA (URINE)                   ,38202545,CDM,301,RC,84585,CPT,,,,Inpatient,,,601.9,601.9,HUMANA CHOICE PLUS,MGD,601.9,,,,,,,case rate,601.9,601.9,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,AETNA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,CIGNA,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,VA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,VA TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,WELLMED,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,HUMANA,MGD,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
"LEUKOCYTE WBC, AUTO           ",38202550,CDM,305,RC,85048,CPT,,,,Inpatient,,,59.85,59.85,HUMANA CHOICE PLUS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,AETNA,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,BCBS,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,CIGNA,COM,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,TRICARE,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,UNITED HEALTHCARE,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,UNITED HEALTHCARE,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,VA,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,VA TRICARE,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,WELLMED,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,HUMANA,MGD,342.69,,,,,,,per diem,342.69,342.69,"Per diem rate, code is bundled with other services"
WEST NILE VIRUS TITER         ,38202575,CDM,302,RC,86790,CPT,,,,Inpatient,,,342.69,342.69,HUMANA CHOICE PLUS,MGD,342.69,,,,,,,case rate,342.69,342.69,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,AETNA,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,BCBS,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,CIGNA,COM,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,TRICARE,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,UNITED HEALTHCARE,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,UNITED HEALTHCARE,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,VA,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,VA TRICARE,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,WELLMED,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,HUMANA,MGD,169.35,,,,,,,per diem,169.35,169.35,"Per diem rate, code is bundled with other services"
ZINC                          ,38202590,CDM,301,RC,84630,CPT,,,,Inpatient,,,169.35,169.35,HUMANA CHOICE PLUS,MGD,169.35,,,,,,,case rate,169.35,169.35,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
ADENOVIRUS AB                 ,38202610,CDM,302,RC,86603,CPT,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,AETNA,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,BCBS,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,CIGNA,COM,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,TRICARE,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,UNITED HEALTHCARE,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,UNITED HEALTHCARE,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,VA,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,VA TRICARE,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,WELLMED,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,HUMANA,MGD,160.52,,,,,,,per diem,160.52,160.52,"Per diem rate, code is bundled with other services"
ACID FAST BACILLI CULTURE     ,38202615,CDM,306,RC,87116,CPT,,,,Inpatient,,,160.52,160.52,HUMANA CHOICE PLUS,MGD,160.52,,,,,,,case rate,160.52,160.52,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,AETNA,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,BCBS,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,CIGNA,COM,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,TRICARE,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,UNITED HEALTHCARE,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,UNITED HEALTHCARE,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,VA,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,VA TRICARE,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,WELLMED,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,HUMANA,MGD,285.83,,,,,,,per diem,285.83,285.83,"Per diem rate, code is bundled with other services"
ALK PHOS ISOENZYMES           ,38202620,CDM,301,RC,84080,CPT,,,,Inpatient,,,285.83,285.83,HUMANA CHOICE PLUS,MGD,285.83,,,,,,,case rate,285.83,285.83,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
ALUMINUM                      ,38202625,CDM,301,RC,82108,CPT,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
AMPHETAMINES SCRN 1-2         ,38202641,CDM,301,RC,80324,CPT,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,AETNA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,CIGNA,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,WELLMED,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA,MGD,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE FLD                   ,38202645,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA CHOICE PLUS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,AETNA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,CIGNA,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,VA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,VA TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,WELLMED,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,HUMANA,MGD,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
ANAEROBIC ORGANISM ID         ,38202650,CDM,306,RC,87076,CPT,,,,Inpatient,,,113.02,113.02,HUMANA CHOICE PLUS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,AETNA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,CIGNA,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,VA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,VA TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,WELLMED,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,HUMANA,MGD,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
ARSENIC                       ,38202670,CDM,301,RC,82175,CPT,,,,Inpatient,,,431.61,431.61,HUMANA CHOICE PLUS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,AETNA,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,BCBS,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,CIGNA,COM,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,TRICARE,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,UNITED HEALTHCARE,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,UNITED HEALTHCARE,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,VA,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,VA TRICARE,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,WELLMED,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,HUMANA,MGD,231.16,,,,,,,per diem,231.16,231.16,"Per diem rate, code is bundled with other services"
MERCURY QUANTITATIVE          ,38202693,CDM,301,RC,83825,CPT,,,,Inpatient,,,231.16,231.16,HUMANA CHOICE PLUS,MGD,231.16,,,,,,,case rate,231.16,231.16,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,AETNA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,CIGNA,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,VA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,VA TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,WELLMED,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,HUMANA,MGD,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
BARBITURATE SCREEN            ,38202706,CDM,301,RC,80345,CPT,,,,Inpatient,,,212.06,212.06,HUMANA CHOICE PLUS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,AETNA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,CIGNA,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,VA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,VA TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,WELLMED,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,HUMANA,MGD,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
BRUCELLA ANTIBODY             ,38202730,CDM,302,RC,86622,CPT,,,,Inpatient,,,122.09,122.09,HUMANA CHOICE PLUS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,AETNA,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,BCBS,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,CIGNA,COM,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,TRICARE,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,UNITED HEALTHCARE,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,UNITED HEALTHCARE,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,VA,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,VA TRICARE,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,WELLMED,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,HUMANA,MGD,173.65,,,,,,,per diem,173.65,173.65,"Per diem rate, code is bundled with other services"
C. DIFF. CULT.                ,38202735,CDM,312,RC,87230,CPT,,,,Inpatient,,,173.65,173.65,HUMANA CHOICE PLUS,MGD,173.65,,,,,,,case rate,173.65,173.65,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,AETNA,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,BCBS,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,CIGNA,COM,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,TRICARE,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,UNITED HEALTHCARE,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,UNITED HEALTHCARE,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,VA,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,VA TRICARE,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,WELLMED,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,HUMANA,MGD,117.74,,,,,,,per diem,117.74,117.74,"Per diem rate, code is bundled with other services"
"CALCIUM, URINE                ",38202745,CDM,301,RC,82340,CPT,,,,Inpatient,,,117.74,117.74,HUMANA CHOICE PLUS,MGD,117.74,,,,,,,case rate,117.74,117.74,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,AETNA,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,BCBS,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,CIGNA,COM,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,TRICARE,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,UNITED HEALTHCARE,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,UNITED HEALTHCARE,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,VA,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,VA TRICARE,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,WELLMED,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,HUMANA,MGD,384.04,,,,,,,per diem,384.04,384.04,"Per diem rate, code is bundled with other services"
CA-19-9                       ,38202750,CDM,302,RC,86301,CPT,,,,Inpatient,,,384.04,384.04,HUMANA CHOICE PLUS,MGD,384.04,,,,,,,case rate,384.04,384.04,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,AETNA,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,BCBS,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,CIGNA,COM,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,TRICARE,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,UNITED HEALTHCARE,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,UNITED HEALTHCARE,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,VA,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,VA TRICARE,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,WELLMED,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,HUMANA,MGD,220.58,,,,,,,per diem,220.58,220.58,"Per diem rate, code is bundled with other services"
CANNABINOIDS NATURAL          ,38202751,CDM,301,RC,80349,CPT,G0480,HCPCS,,Inpatient,,,220.58,220.58,HUMANA CHOICE PLUS,MGD,220.58,,,,,,,case rate,220.58,220.58,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,AETNA,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,BCBS,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,CIGNA,COM,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,TRICARE,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,UNITED HEALTHCARE,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,UNITED HEALTHCARE,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,VA,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,VA TRICARE,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,WELLMED,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,HUMANA,MGD,177.45,,,,,,,per diem,177.45,177.45,"Per diem rate, code is bundled with other services"
"CATECHOLAMINES, URINE         ",38202760,CDM,301,RC,82382,CPT,,,,Inpatient,,,177.45,177.45,HUMANA CHOICE PLUS,MGD,177.45,,,,,,,case rate,177.45,177.45,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,AETNA,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,BCBS,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,CIGNA,COM,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,TRICARE,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,UNITED HEALTHCARE,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,UNITED HEALTHCARE,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,VA,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,VA TRICARE,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,WELLMED,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,HUMANA,MGD,879.29,,,,,,,per diem,879.29,879.29,"Per diem rate, code is bundled with other services"
CYTOGENETICS PHILADELPHIA     ,38202769,CDM,310,RC,88262,CPT,,,,Inpatient,,,879.29,879.29,HUMANA CHOICE PLUS,MGD,879.29,,,,,,,case rate,879.29,879.29,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,AETNA,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,BCBS,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,CIGNA,COM,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,TRICARE,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,UNITED HEALTHCARE,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,UNITED HEALTHCARE,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,VA,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,VA TRICARE,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,WELLMED,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,HUMANA,MGD,136.74,,,,,,,per diem,136.74,136.74,"Per diem rate, code is bundled with other services"
CHEMILUMINES                  ,38202774,CDM,301,RC,82397,CPT,,,,Inpatient,,,136.74,136.74,HUMANA CHOICE PLUS,MGD,136.74,,,,,,,case rate,136.74,136.74,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,AETNA,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,CIGNA,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,TRICARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,UNITED HEALTHCARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,UNITED HEALTHCARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,VA,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,VA TRICARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,WELLMED,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,HUMANA,MGD,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
PLASMINOGEN                   ,38202778,CDM,305,RC,85420,CPT,,,,Inpatient,,,523.72,523.72,HUMANA CHOICE PLUS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,AETNA,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,BCBS,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,CIGNA,COM,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,TRICARE,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,UNITED HEALTHCARE,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,UNITED HEALTHCARE,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,VA,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,VA TRICARE,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,WELLMED,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,HUMANA,MGD,90.53,,,,,,,per diem,90.53,90.53,"Per diem rate, code is bundled with other services"
CK-MB PANEL                   ,38202790,CDM,301,RC,82553,CPT,,,,Inpatient,,,90.53,90.53,HUMANA CHOICE PLUS,MGD,90.53,,,,,,,case rate,90.53,90.53,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
"CHLORIDE, OTHER SOURCE        ",38202795,CDM,301,RC,82438,CPT,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,AETNA,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,BCBS,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,CIGNA,COM,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,TRICARE,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,UNITED HEALTHCARE,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,UNITED HEALTHCARE,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,VA,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,VA TRICARE,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,WELLMED,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,HUMANA,MGD,17.15,,,,,,,per diem,17.15,17.15,"Per diem rate, code is bundled with other services"
INF AGT AG DET EIA RSV        ,38202797,CDM,300,RC,87807,CPT,,,,Inpatient,,,17.15,17.15,HUMANA CHOICE PLUS,MGD,17.15,,,,,,,case rate,17.15,17.15,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE                  ,38202800,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,AETNA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,CIGNA,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,VA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,VA TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,WELLMED,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,HUMANA,MGD,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
COCAINE SCREEN                ,38202831,CDM,301,RC,80353,CPT,,,,Inpatient,,,213.13,213.13,HUMANA CHOICE PLUS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,AETNA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,CIGNA,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,VA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,VA TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,WELLMED,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,HUMANA,MGD,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
COCCIDIOIDES ANTIBODY         ,38202835,CDM,302,RC,86635,CPT,,,,Inpatient,,,75.17,75.17,HUMANA CHOICE PLUS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
COMPLEMENT C-1                ,38202840,CDM,302,RC,86160,CPT,,,,Inpatient,,,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,AETNA,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,CIGNA,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,TRICARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,UNITED HEALTHCARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,UNITED HEALTHCARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,VA,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,VA TRICARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,WELLMED,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,HUMANA,MGD,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
CORTISOL FREE                 ,38202850,CDM,301,RC,82530,CPT,,,,Inpatient,,,135.45,135.45,HUMANA CHOICE PLUS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,AETNA,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,BCBS,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,CIGNA,COM,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,TRICARE,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,UNITED HEALTHCARE,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,UNITED HEALTHCARE,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,VA,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,VA TRICARE,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,WELLMED,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,HUMANA,MGD,29.75,,,,,,,per diem,29.75,29.75,"Per diem rate, code is bundled with other services"
COXSACKIE B                   ,38202855,CDM,302,RC,86658,CPT,,,,Inpatient,,,29.75,29.75,HUMANA CHOICE PLUS,MGD,29.75,,,,,,,case rate,29.75,29.75,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,AETNA,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,BCBS,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,CIGNA,COM,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,TRICARE,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,UNITED HEALTHCARE,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,UNITED HEALTHCARE,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,VA,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,VA TRICARE,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,WELLMED,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,HUMANA,MGD,144.49,,,,,,,per diem,144.49,144.49,"Per diem rate, code is bundled with other services"
CRYOGLOBULIN                  ,38202865,CDM,301,RC,82595,CPT,,,,Inpatient,,,144.49,144.49,HUMANA CHOICE PLUS,MGD,144.49,,,,,,,case rate,144.49,144.49,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,AETNA,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,BCBS,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,CIGNA,COM,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,TRICARE,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,UNITED HEALTHCARE,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,UNITED HEALTHCARE,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,VA,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,VA TRICARE,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,WELLMED,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,HUMANA,MGD,85.48,,,,,,,per diem,85.48,85.48,"Per diem rate, code is bundled with other services"
CULTURE FLUID/OTHER (NON CSF) ,38202885,CDM,306,RC,87070,CPT,,,,Inpatient,,,85.48,85.48,HUMANA CHOICE PLUS,MGD,85.48,,,,,,,case rate,85.48,85.48,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,AETNA,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,BCBS,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,CIGNA,COM,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,TRICARE,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,UNITED HEALTHCARE,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,UNITED HEALTHCARE,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,VA,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,VA TRICARE,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,WELLMED,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,HUMANA,MGD,268.82,,,,,,,per diem,268.82,268.82,"Per diem rate, code is bundled with other services"
CYCSTATIN C                   ,38202892,CDM,301,RC,82610,CPT,,,,Inpatient,,,268.82,268.82,HUMANA CHOICE PLUS,MGD,268.82,,,,,,,case rate,268.82,268.82,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,AETNA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,CIGNA,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,VA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,VA TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,WELLMED,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,HUMANA,MGD,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
DELTA ALA                     ,38202905,CDM,301,RC,82135,CPT,,,,Inpatient,,,76.04,76.04,HUMANA CHOICE PLUS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE                  ,38202920,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGM (VCA) ,38202935,CDM,302,RC,86664,CPT,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,AETNA,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,CIGNA,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,TRICARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,UNITED HEALTHCARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,UNITED HEALTHCARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,VA,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,VA TRICARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,WELLMED,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,HUMANA,MGD,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
EBV NUCLEAR ANTIGEN IGG (EBNA),38202955,CDM,302,RC,86664,CPT,,,,Inpatient,,,86.1,86.1,HUMANA CHOICE PLUS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,AETNA,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,BCBS,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,CIGNA,COM,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,TRICARE,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,UNITED HEALTHCARE,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,UNITED HEALTHCARE,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,VA,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,VA TRICARE,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,WELLMED,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,HUMANA,MGD,361.64,,,,,,,per diem,361.64,361.64,"Per diem rate, code is bundled with other services"
"FECAL FAT TOTAL, QUANT        ",38202990,CDM,301,RC,82710,CPT,,,,Inpatient,,,361.64,361.64,HUMANA CHOICE PLUS,MGD,361.64,,,,,,,case rate,361.64,361.64,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLECAINIDE                    ,38203000,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FLUOXETINE- PROZAC            ,38203010,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,AETNA,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,BCBS,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,CIGNA,COM,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,TRICARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,UNITED HEALTHCARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,UNITED HEALTHCARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,VA,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,VA TRICARE,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,WELLMED,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,HUMANA,MGD,86.52,,,,,,,per diem,86.52,86.52,"Per diem rate, code is bundled with other services"
T4 FREE (THYROXINE)           ,38203015,CDM,301,RC,84439,CPT,,,,Inpatient,,,86.52,86.52,HUMANA CHOICE PLUS,MGD,86.52,,,,,,,case rate,86.52,86.52,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,AETNA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,CIGNA,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,VA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,VA TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,WELLMED,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,HUMANA,MGD,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGI MOLD ID                 ,38203030,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,HUMANA CHOICE PLUS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,AETNA,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,BCBS,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,CIGNA,COM,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,TRICARE,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,UNITED HEALTHCARE,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,UNITED HEALTHCARE,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,VA,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,VA TRICARE,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,WELLMED,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,HUMANA,MGD,351.36,,,,,,,per diem,351.36,351.36,"Per diem rate, code is bundled with other services"
GROWTH HORMONE                ,38203055,CDM,301,RC,83003,CPT,,,,Inpatient,,,351.36,351.36,HUMANA CHOICE PLUS,MGD,351.36,,,,,,,case rate,351.36,351.36,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,AETNA,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,BCBS,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,CIGNA,COM,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,TRICARE,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,UNITED HEALTHCARE,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,UNITED HEALTHCARE,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,VA,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,VA TRICARE,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,WELLMED,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,HUMANA,MGD,477.17,,,,,,,per diem,477.17,477.17,"Per diem rate, code is bundled with other services"
G6-PD                         ,38203085,CDM,301,RC,82955,CPT,,,,Inpatient,,,477.17,477.17,HUMANA CHOICE PLUS,MGD,477.17,,,,,,,case rate,477.17,477.17,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,AETNA,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,BCBS,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,CIGNA,COM,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,TRICARE,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,UNITED HEALTHCARE,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,UNITED HEALTHCARE,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,VA,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,VA TRICARE,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,WELLMED,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,HUMANA,MGD,115.5,,,,,,,per diem,115.5,115.5,"Per diem rate, code is bundled with other services"
HEAVY METAL SCREEN            ,38203095,CDM,301,RC,83015,CPT,,,,Inpatient,,,115.5,115.5,HUMANA CHOICE PLUS,MGD,115.5,,,,,,,case rate,115.5,115.5,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,AETNA,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,BCBS,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,CIGNA,COM,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,TRICARE,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,UNITED HEALTHCARE,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,UNITED HEALTHCARE,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,VA,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,VA TRICARE,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,WELLMED,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,HUMANA,MGD,52.46,,,,,,,per diem,52.46,52.46,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX TYPE 1 ABY     ,38203110,CDM,302,RC,86695,CPT,,,,Inpatient,,,52.46,52.46,HUMANA CHOICE PLUS,MGD,52.46,,,,,,,case rate,52.46,52.46,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,AETNA,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,BCBS,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,CIGNA,COM,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,TRICARE,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,UNITED HEALTHCARE,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,UNITED HEALTHCARE,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,VA,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,VA TRICARE,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,WELLMED,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,HUMANA,MGD,207.77,,,,,,,per diem,207.77,207.77,"Per diem rate, code is bundled with other services"
HGB-FETAL MATERNAL SCREEN     ,38203125,CDM,305,RC,85461,CPT,,,,Inpatient,,,207.77,207.77,HUMANA CHOICE PLUS,MGD,207.77,,,,,,,case rate,207.77,207.77,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,AETNA,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,BCBS,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,CIGNA,COM,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,TRICARE,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,UNITED HEALTHCARE,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,UNITED HEALTHCARE,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,VA,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,VA TRICARE,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,WELLMED,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,HUMANA,MGD,434.7,,,,,,,per diem,434.7,434.7,"Per diem rate, code is bundled with other services"
"HIV1 ANTIGEN,EIA              ",38203135,CDM,306,RC,87390,CPT,,,,Inpatient,,,434.7,434.7,HUMANA CHOICE PLUS,MGD,434.7,,,,,,,case rate,434.7,434.7,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,AETNA,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,BCBS,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,CIGNA,COM,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,TRICARE,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,UNITED HEALTHCARE,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,UNITED HEALTHCARE,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,VA,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,VA TRICARE,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,WELLMED,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,HUMANA,MGD,459.78,,,,,,,per diem,459.78,459.78,"Per diem rate, code is bundled with other services"
HLA-B27                       ,38203140,CDM,302,RC,86812,CPT,,,,Inpatient,,,459.78,459.78,HUMANA CHOICE PLUS,MGD,459.78,,,,,,,case rate,459.78,459.78,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,AETNA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,CIGNA,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,WELLMED,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,HUMANA,MGD,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGG             ,38203150,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,HUMANA CHOICE PLUS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,AETNA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,CIGNA,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,VA TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,WELLMED,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,HUMANA,MGD,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGA             ,38203155,CDM,301,RC,82784,CPT,,,,Inpatient,,,311.85,311.85,HUMANA CHOICE PLUS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,AETNA,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,BCBS,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,CIGNA,COM,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,TRICARE,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,UNITED HEALTHCARE,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,UNITED HEALTHCARE,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,VA,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,VA TRICARE,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,WELLMED,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,HUMANA,MGD,204.9,,,,,,,per diem,204.9,204.9,"Per diem rate, code is bundled with other services"
IMMUNOFIXATION ELECTROPHORESIS,38203160,CDM,302,RC,86334,CPT,,,,Inpatient,,,204.9,204.9,HUMANA CHOICE PLUS,MGD,204.9,,,,,,,case rate,204.9,204.9,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
KANAMYCIN                     ,38203170,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
LDH FL                        ,38203175,CDM,301,RC,83615,CPT,,,,Inpatient,,,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,AETNA,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,BCBS,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,CIGNA,COM,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,TRICARE,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,UNITED HEALTHCARE,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,UNITED HEALTHCARE,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,VA,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,VA TRICARE,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,WELLMED,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,HUMANA,MGD,327.43,,,,,,,per diem,327.43,327.43,"Per diem rate, code is bundled with other services"
LEAD LEVEL                    ,38203180,CDM,301,RC,83655,CPT,,,,Inpatient,,,327.43,327.43,HUMANA CHOICE PLUS,MGD,327.43,,,,,,,case rate,327.43,327.43,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
LEPTOSPIRA ANTIBODY           ,38203195,CDM,302,RC,86720,CPT,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,AETNA,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,BCBS,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,CIGNA,COM,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,TRICARE,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,UNITED HEALTHCARE,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,UNITED HEALTHCARE,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,VA,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,VA TRICARE,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,WELLMED,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,HUMANA,MGD,170.11,,,,,,,per diem,170.11,170.11,"Per diem rate, code is bundled with other services"
INCLUSION_BODY/PARASITE STAIN ,38203215,CDM,306,RC,87207,CPT,,,,Inpatient,,,170.11,170.11,HUMANA CHOICE PLUS,MGD,170.11,,,,,,,case rate,170.11,170.11,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,AETNA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,CIGNA,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,VA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,VA TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,WELLMED,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,HUMANA,MGD,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
MANGANESE                     ,38203217,CDM,301,RC,83785,CPT,,,,Inpatient,,,102.82,102.82,HUMANA CHOICE PLUS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,AETNA,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,BCBS,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,CIGNA,COM,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,TRICARE,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,UNITED HEALTHCARE,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,UNITED HEALTHCARE,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,VA,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,VA TRICARE,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,WELLMED,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,HUMANA,MGD,328.04,,,,,,,per diem,328.04,328.04,"Per diem rate, code is bundled with other services"
METANEPHRINES (FRACTION)      ,38203220,CDM,301,RC,83835,CPT,,,,Inpatient,,,328.04,328.04,HUMANA CHOICE PLUS,MGD,328.04,,,,,,,case rate,328.04,328.04,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
MEXILETINE                    ,38203245,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,AETNA,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,BCBS,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,CIGNA,COM,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,TRICARE,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,UNITED HEALTHCARE,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,UNITED HEALTHCARE,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,VA,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,VA TRICARE,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,WELLMED,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,HUMANA,MGD,118.37,,,,,,,per diem,118.37,118.37,"Per diem rate, code is bundled with other services"
MUMPS ANTIBODY                ,38203265,CDM,302,RC,86735,CPT,,,,Inpatient,,,118.37,118.37,HUMANA CHOICE PLUS,MGD,118.37,,,,,,,case rate,118.37,118.37,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,AETNA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,CIGNA,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,VA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,VA TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,WELLMED,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,HUMANA,MGD,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
MYCOPLASMA ANTIBODY           ,38203275,CDM,302,RC,86738,CPT,,,,Inpatient,,,248.47,248.47,HUMANA CHOICE PLUS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,AETNA,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,BCBS,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,CIGNA,COM,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,TRICARE,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,UNITED HEALTHCARE,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,UNITED HEALTHCARE,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,VA,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,VA TRICARE,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,WELLMED,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,HUMANA,MGD,114.98,,,,,,,per diem,114.98,114.98,"Per diem rate, code is bundled with other services"
"C DIFFICILE, PCR              ",38203286,CDM,306,RC,87798,CPT,,,,Inpatient,,,114.98,114.98,HUMANA CHOICE PLUS,MGD,114.98,,,,,,,case rate,114.98,114.98,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,AETNA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,CIGNA,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,VA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,VA TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,WELLMED,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,HUMANA,MGD,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
MYELIN BASIC CSF              ,38203290,CDM,301,RC,83873,CPT,,,,Inpatient,,,688.65,688.65,HUMANA CHOICE PLUS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,AETNA,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,BCBS,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,CIGNA,COM,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,TRICARE,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,UNITED HEALTHCARE,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,UNITED HEALTHCARE,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,VA,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,VA TRICARE,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,WELLMED,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,HUMANA,MGD,307.27,,,,,,,per diem,307.27,307.27,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38203295,CDM,301,RC,83874,CPT,,,,Inpatient,,,307.27,307.27,HUMANA CHOICE PLUS,MGD,307.27,,,,,,,case rate,307.27,307.27,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,AETNA,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,BCBS,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,CIGNA,COM,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,TRICARE,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,UNITED HEALTHCARE,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,UNITED HEALTHCARE,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,VA,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,VA TRICARE,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,WELLMED,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,HUMANA,MGD,349.62,,,,,,,per diem,349.62,349.62,"Per diem rate, code is bundled with other services"
PROCAINAMIDE & NAPA LEVEL     ,38203305,CDM,301,RC,80192,CPT,,,,Inpatient,,,349.62,349.62,HUMANA CHOICE PLUS,MGD,349.62,,,,,,,case rate,349.62,349.62,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,AETNA,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,BCBS,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,CIGNA,COM,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,TRICARE,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,UNITED HEALTHCARE,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,UNITED HEALTHCARE,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,VA,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,VA TRICARE,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,WELLMED,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,HUMANA,MGD,157.63,,,,,,,per diem,157.63,157.63,"Per diem rate, code is bundled with other services"
"VITAMIN D, 1, 25-DIHYDROXY    ",38203310,CDM,301,RC,82652,CPT,,,,Inpatient,,,157.63,157.63,HUMANA CHOICE PLUS,MGD,157.63,,,,,,,case rate,157.63,157.63,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,AETNA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,CIGNA,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,VA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,VA TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,WELLMED,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,HUMANA,MGD,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
OLIGOCLONAL BANDS             ,38203315,CDM,301,RC,83916,CPT,,,,Inpatient,,,99.6,99.6,HUMANA CHOICE PLUS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
OPIATES 1 OR MORE             ,38203326,CDM,301,RC,80361,CPT,G0480,HCPCS,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
OXALATE                       ,38203330,CDM,301,RC,83945,CPT,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,AETNA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,CIGNA,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,VA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,VA TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,WELLMED,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,HUMANA,MGD,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
PHENCYCLIDINE (PCP)           ,38203340,CDM,301,RC,83992,CPT,,,,Inpatient,,,204.56,204.56,HUMANA CHOICE PLUS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,AETNA,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,BCBS,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,CIGNA,COM,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,TRICARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,UNITED HEALTHCARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,UNITED HEALTHCARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,VA,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,VA TRICARE,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,WELLMED,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,HUMANA,MGD,14.93,,,,,,,per diem,14.93,14.93,"Per diem rate, code is bundled with other services"
PHOSPHORUS UR                 ,38203345,CDM,301,RC,84105,CPT,,,,Inpatient,,,14.93,14.93,HUMANA CHOICE PLUS,MGD,14.93,,,,,,,case rate,14.93,14.93,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,AETNA,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,BCBS,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,CIGNA,COM,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,TRICARE,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,UNITED HEALTHCARE,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,UNITED HEALTHCARE,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,VA,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,VA TRICARE,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,WELLMED,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,HUMANA,MGD,234.55,,,,,,,per diem,234.55,234.55,"Per diem rate, code is bundled with other services"
PINWORM PREP                  ,38203355,CDM,306,RC,87172,CPT,,,,Inpatient,,,234.55,234.55,HUMANA CHOICE PLUS,MGD,234.55,,,,,,,case rate,234.55,234.55,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,AETNA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,CIGNA,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,VA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,VA TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,WELLMED,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,HUMANA,MGD,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
PORPHYRIN (QUANTITATIVE)      ,38203365,CDM,301,RC,84120,CPT,,,,Inpatient,,,443.39,443.39,HUMANA CHOICE PLUS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
"PORPHOBILINOGEN URINE,QNT     ",38203375,CDM,301,RC,84110,CPT,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,AETNA,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,BCBS,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,CIGNA,COM,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,TRICARE,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,UNITED HEALTHCARE,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,UNITED HEALTHCARE,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,VA,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,VA TRICARE,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,WELLMED,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,HUMANA,MGD,65.97,,,,,,,per diem,65.97,65.97,"Per diem rate, code is bundled with other services"
PRIMIDONE                     ,38203380,CDM,301,RC,80188,CPT,,,,Inpatient,,,65.97,65.97,HUMANA CHOICE PLUS,MGD,65.97,,,,,,,case rate,65.97,65.97,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,AETNA,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,BCBS,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,CIGNA,COM,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,TRICARE,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,UNITED HEALTHCARE,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,UNITED HEALTHCARE,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,VA,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,VA TRICARE,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,WELLMED,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,HUMANA,MGD,240.45,,,,,,,per diem,240.45,240.45,"Per diem rate, code is bundled with other services"
PROCAINAMIDE                  ,38203385,CDM,301,RC,80190,CPT,,,,Inpatient,,,240.45,240.45,HUMANA CHOICE PLUS,MGD,240.45,,,,,,,case rate,240.45,240.45,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,AETNA,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,CIGNA,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,TRICARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,UNITED HEALTHCARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,UNITED HEALTHCARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,VA,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,VA TRICARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,WELLMED,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,HUMANA,MGD,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
REDUCING SUBSTANCES (GLUCOSE) ,38203415,CDM,301,RC,84376,CPT,,,,Inpatient,,,14.99,14.99,HUMANA CHOICE PLUS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,AETNA,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,BCBS,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,CIGNA,COM,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,TRICARE,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,UNITED HEALTHCARE,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,UNITED HEALTHCARE,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,VA,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,VA TRICARE,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,WELLMED,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,HUMANA,MGD,137.58,,,,,,,per diem,137.58,137.58,"Per diem rate, code is bundled with other services"
RICKETTSIA ANTIBODY           ,38203425,CDM,302,RC,86757,CPT,,,,Inpatient,,,137.58,137.58,HUMANA CHOICE PLUS,MGD,137.58,,,,,,,case rate,137.58,137.58,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,AETNA,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,BCBS,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,CIGNA,COM,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,TRICARE,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,UNITED HEALTHCARE,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,UNITED HEALTHCARE,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,VA,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,VA TRICARE,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,WELLMED,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,HUMANA,MGD,510.9,,,,,,,per diem,510.9,510.9,"Per diem rate, code is bundled with other services"
SEROTONIN                     ,38203455,CDM,301,RC,84260,CPT,,,,Inpatient,,,510.9,510.9,HUMANA CHOICE PLUS,MGD,510.9,,,,,,,case rate,510.9,510.9,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,AETNA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,CIGNA,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,VA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,VA TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,WELLMED,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,HUMANA,MGD,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
TESTOSTERONE FREE             ,38203500,CDM,301,RC,84402,CPT,,,,Inpatient,,,41.64,41.64,HUMANA CHOICE PLUS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,AETNA,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,BCBS,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,CIGNA,COM,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,TRICARE,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,UNITED HEALTHCARE,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,UNITED HEALTHCARE,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,VA,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,VA TRICARE,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,WELLMED,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,HUMANA,MGD,448.75,,,,,,,per diem,448.75,448.75,"Per diem rate, code is bundled with other services"
THIOCYANATE                   ,38203520,CDM,301,RC,84430,CPT,,,,Inpatient,,,448.75,448.75,HUMANA CHOICE PLUS,MGD,448.75,,,,,,,case rate,448.75,448.75,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,AETNA,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,BCBS,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,CIGNA,COM,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,TRICARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,UNITED HEALTHCARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,UNITED HEALTHCARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,VA,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,VA TRICARE,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,WELLMED,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,HUMANA,MGD,123.84,,,,,,,per diem,123.84,123.84,"Per diem rate, code is bundled with other services"
MICROSOMAL ANTIBODIES         ,38203533,CDM,302,RC,86376,CPT,,,,Inpatient,,,123.84,123.84,HUMANA CHOICE PLUS,MGD,123.84,,,,,,,case rate,123.84,123.84,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGG)            ,38203555,CDM,302,RC,86777,CPT,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
TOXOPLASM AB (IGM)            ,38203560,CDM,302,RC,86778,CPT,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,AETNA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,CIGNA,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,VA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,VA TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,WELLMED,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,HUMANA,MGD,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38203580,CDM,307,RC,81015,CPT,,,,Inpatient,,,41.1,41.1,HUMANA CHOICE PLUS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,AETNA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,CIGNA,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,VA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,VA TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,WELLMED,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,HUMANA,MGD,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
"PREGNANCY TEST,VISUAL COLOR   ",38203581,CDM,307,RC,81025,CPT,,,,Inpatient,,,9.04,9.04,HUMANA CHOICE PLUS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,AETNA,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,BCBS,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,CIGNA,COM,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,TRICARE,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,UNITED HEALTHCARE,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,UNITED HEALTHCARE,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,VA,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,VA TRICARE,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,WELLMED,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,HUMANA,MGD,29.61,,,,,,,per diem,29.61,29.61,"Per diem rate, code is bundled with other services"
URINE VOLUME MEASUREMENT      ,38203585,CDM,307,RC,81050,CPT,,,,Inpatient,,,29.61,29.61,HUMANA CHOICE PLUS,MGD,29.61,,,,,,,case rate,29.61,29.61,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,AETNA,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,BCBS,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,CIGNA,COM,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,TRICARE,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,UNITED HEALTHCARE,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,UNITED HEALTHCARE,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,VA,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,VA TRICARE,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,WELLMED,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,HUMANA,MGD,162.1,,,,,,,per diem,162.1,162.1,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS LATEX AG SER     ,38203586,CDM,302,RC,86403,CPT,,,,Inpatient,,,162.1,162.1,HUMANA CHOICE PLUS,MGD,162.1,,,,,,,case rate,162.1,162.1,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,AETNA,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,BCBS,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,CIGNA,COM,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,TRICARE,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,UNITED HEALTHCARE,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,UNITED HEALTHCARE,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,VA,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,VA TRICARE,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,WELLMED,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,HUMANA,MGD,30.03,,,,,,,per diem,30.03,30.03,"Per diem rate, code is bundled with other services"
URIC ACID URINE               ,38203590,CDM,305,RC,84560,CPT,,,,Inpatient,,,30.03,30.03,HUMANA CHOICE PLUS,MGD,30.03,,,,,,,case rate,30.03,30.03,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,AETNA,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,BCBS,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,CIGNA,COM,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,TRICARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,UNITED HEALTHCARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,UNITED HEALTHCARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,VA,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,VA TRICARE,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,WELLMED,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,HUMANA,MGD,50.78,,,,,,,per diem,50.78,50.78,"Per diem rate, code is bundled with other services"
VENIPUNCTURE                  ,38203610,CDM,300,RC,36415,CPT,,,,Inpatient,,,50.78,50.78,HUMANA CHOICE PLUS,MGD,50.78,,,,,,,case rate,50.78,50.78,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,AETNA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,CIGNA,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,VA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,VA TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,WELLMED,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,HUMANA,MGD,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
YERSINIA CULT                 ,38203620,CDM,306,RC,87046,CPT,,,,Inpatient,,,102.9,102.9,HUMANA CHOICE PLUS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,AETNA,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,BCBS,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,CIGNA,COM,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,TRICARE,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,UNITED HEALTHCARE,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,UNITED HEALTHCARE,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,VA,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,VA TRICARE,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,WELLMED,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,HUMANA,MGD,92.27,,,,,,,per diem,92.27,92.27,"Per diem rate, code is bundled with other services"
17-HYDROXYCORTICOSTEROID      ,38203625,CDM,301,RC,83491,CPT,,,,Inpatient,,,92.27,92.27,HUMANA CHOICE PLUS,MGD,92.27,,,,,,,case rate,92.27,92.27,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,AETNA,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,BCBS,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,CIGNA,COM,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,TRICARE,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,UNITED HEALTHCARE,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,UNITED HEALTHCARE,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,VA,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,VA TRICARE,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,WELLMED,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,HUMANA,MGD,345.02,,,,,,,per diem,345.02,345.02,"Per diem rate, code is bundled with other services"
5 HIAA                        ,38203640,CDM,301,RC,83497,CPT,,,,Inpatient,,,345.02,345.02,HUMANA CHOICE PLUS,MGD,345.02,,,,,,,case rate,345.02,345.02,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,AETNA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,CIGNA,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,VA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,VA TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,WELLMED,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,HUMANA,MGD,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
5 NUCLEOTIDASE                ,38203645,CDM,301,RC,83915,CPT,,,,Inpatient,,,215.27,215.27,HUMANA CHOICE PLUS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,AETNA,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,BCBS,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,CIGNA,COM,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,TRICARE,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,UNITED HEALTHCARE,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,UNITED HEALTHCARE,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,VA,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,VA TRICARE,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,WELLMED,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,HUMANA,MGD,75.8,,,,,,,per diem,75.8,75.8,"Per diem rate, code is bundled with other services"
"GLUCOSE, QUANTITATIVE         ",38203690,CDM,301,RC,82947,CPT,,,,Inpatient,,,75.8,75.8,HUMANA CHOICE PLUS,MGD,75.8,,,,,,,case rate,75.8,75.8,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,AETNA,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,CIGNA,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,TRICARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,UNITED HEALTHCARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,UNITED HEALTHCARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,VA,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,VA TRICARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,WELLMED,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,HUMANA,MGD,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOGLOBIN                    ,38203695,CDM,305,RC,85018,CPT,,,,Inpatient,,,27.04,27.04,HUMANA CHOICE PLUS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,AETNA,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,BCBS,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,CIGNA,COM,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,TRICARE,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,UNITED HEALTHCARE,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,UNITED HEALTHCARE,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,VA,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,VA TRICARE,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,WELLMED,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,HUMANA,MGD,199.11,,,,,,,per diem,199.11,199.11,"Per diem rate, code is bundled with other services"
GAMMAGLOBULIN IGE             ,38203700,CDM,301,RC,82785,CPT,,,,Inpatient,,,199.11,199.11,HUMANA CHOICE PLUS,MGD,199.11,,,,,,,case rate,199.11,199.11,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,AETNA,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,BCBS,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,CIGNA,COM,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,TRICARE,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,UNITED HEALTHCARE,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,UNITED HEALTHCARE,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,VA,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,VA TRICARE,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,WELLMED,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,HUMANA,MGD,29.2,,,,,,,per diem,29.2,29.2,"Per diem rate, code is bundled with other services"
SED RATE (MANUAL)             ,38203705,CDM,305,RC,85651,CPT,,,,Inpatient,,,29.2,29.2,HUMANA CHOICE PLUS,MGD,29.2,,,,,,,case rate,29.2,29.2,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULTURE ECOLI 0157            ,38203715,CDM,306,RC,87046,CPT,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,AETNA,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,BCBS,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,CIGNA,COM,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,TRICARE,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,UNITED HEALTHCARE,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,UNITED HEALTHCARE,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,VA,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,VA TRICARE,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,WELLMED,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,HUMANA,MGD,86.94,,,,,,,per diem,86.94,86.94,"Per diem rate, code is bundled with other services"
SPEC STAIN FOR O & P          ,38203723,CDM,306,RC,87209,CPT,,,,Inpatient,,,86.94,86.94,HUMANA CHOICE PLUS,MGD,86.94,,,,,,,case rate,86.94,86.94,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,AETNA,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,BCBS,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,CIGNA,COM,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,TRICARE,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,UNITED HEALTHCARE,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,UNITED HEALTHCARE,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,VA,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,VA TRICARE,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,WELLMED,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,HUMANA,MGD,275.25,,,,,,,per diem,275.25,275.25,"Per diem rate, code is bundled with other services"
KOH PREP-HAIR-SKIN-NAILS      ,38203725,CDM,306,RC,87220,CPT,,,,Inpatient,,,275.25,275.25,HUMANA CHOICE PLUS,MGD,275.25,,,,,,,case rate,275.25,275.25,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,AETNA,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,BCBS,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,CIGNA,COM,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,TRICARE,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,UNITED HEALTHCARE,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,UNITED HEALTHCARE,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,VA,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,VA TRICARE,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,WELLMED,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,HUMANA,MGD,54.93,,,,,,,per diem,54.93,54.93,"Per diem rate, code is bundled with other services"
OCCULT BLOOD- OTHER SOURCES   ,38203736,CDM,301,RC,82271,CPT,,,,Inpatient,,,54.93,54.93,HUMANA CHOICE PLUS,MGD,54.93,,,,,,,case rate,54.93,54.93,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,AETNA,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,BCBS,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,CIGNA,COM,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,TRICARE,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,UNITED HEALTHCARE,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,UNITED HEALTHCARE,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,VA,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,VA TRICARE,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,WELLMED,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,HUMANA,MGD,165.24,,,,,,,per diem,165.24,165.24,"Per diem rate, code is bundled with other services"
PLASMA HEMOGLOBIN             ,38203737,CDM,301,RC,83051,CPT,,,,Inpatient,,,165.24,165.24,HUMANA CHOICE PLUS,MGD,165.24,,,,,,,case rate,165.24,165.24,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,AETNA,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,BCBS,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,CIGNA,COM,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,TRICARE,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,UNITED HEALTHCARE,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,UNITED HEALTHCARE,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,VA,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,VA TRICARE,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,WELLMED,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,HUMANA,MGD,298.49,,,,,,,per diem,298.49,298.49,"Per diem rate, code is bundled with other services"
METHYLMALONIC ACID            ,38203741,CDM,301,RC,83921,CPT,,,,Inpatient,,,298.49,298.49,HUMANA CHOICE PLUS,MGD,298.49,,,,,,,case rate,298.49,298.49,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,AETNA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,BCBS,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,CIGNA,COM,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,UNITED HEALTHCARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,VA,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,VA TRICARE,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,WELLMED,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,HUMANA,MGD,113.02,,,,,,,per diem,113.02,113.02,"Per diem rate, code is bundled with other services"
FUNGUS/YEAST IDENTIFICATION   ,38203747,CDM,306,RC,87106,CPT,,,,Inpatient,,,113.02,113.02,HUMANA CHOICE PLUS,MGD,113.02,,,,,,,case rate,113.02,113.02,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,AETNA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,CIGNA,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,VA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,VA TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,WELLMED,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,HUMANA,MGD,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
EOS SMEAR (URINE)             ,38203753,CDM,300,RC,87205,CPT,,,,Inpatient,,,48.2,48.2,HUMANA CHOICE PLUS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
"POTASSIUM, STOOL              ",38203758,CDM,301,RC,84999,CPT,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,AETNA,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,BCBS,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,CIGNA,COM,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,TRICARE,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,UNITED HEALTHCARE,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,UNITED HEALTHCARE,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,VA,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,VA TRICARE,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,WELLMED,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,HUMANA,MGD,332.22,,,,,,,per diem,332.22,332.22,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XII           ,38203766,CDM,305,RC,85280,CPT,,,,Inpatient,,,332.22,332.22,HUMANA CHOICE PLUS,MGD,332.22,,,,,,,case rate,332.22,332.22,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,AETNA,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,CIGNA,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,TRICARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,UNITED HEALTHCARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,UNITED HEALTHCARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,VA,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,VA TRICARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,WELLMED,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,HUMANA,MGD,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XI            ,38203767,CDM,305,RC,85270,CPT,,,,Inpatient,,,342.72,342.72,HUMANA CHOICE PLUS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,AETNA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,CIGNA,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,VA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,VA TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,WELLMED,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,HUMANA,MGD,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR IX            ,38203769,CDM,305,RC,85250,CPT,,,,Inpatient,,,499.09,499.09,HUMANA CHOICE PLUS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,AETNA,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,BCBS,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,CIGNA,COM,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,TRICARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,UNITED HEALTHCARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,UNITED HEALTHCARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,VA,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,VA TRICARE,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,WELLMED,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,HUMANA,MGD,11.9,,,,,,,per diem,11.9,11.9,"Per diem rate, code is bundled with other services"
CRYSTAL IDENTIFICATION        ,38203771,CDM,300,RC,89060,CPT,,,,Inpatient,,,11.9,11.9,HUMANA CHOICE PLUS,MGD,11.9,,,,,,,case rate,11.9,11.9,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,AETNA,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,BCBS,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,CIGNA,COM,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,TRICARE,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,UNITED HEALTHCARE,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,UNITED HEALTHCARE,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,VA,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,VA TRICARE,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,WELLMED,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,HUMANA,MGD,111.55,,,,,,,per diem,111.55,111.55,"Per diem rate, code is bundled with other services"
HEPARIN INDUCED ANTIBODY      ,38203776,CDM,302,RC,86022,CPT,,,,Inpatient,,,111.55,111.55,HUMANA CHOICE PLUS,MGD,111.55,,,,,,,case rate,111.55,111.55,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,AETNA,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,BCBS,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,CIGNA,COM,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,TRICARE,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,UNITED HEALTHCARE,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,UNITED HEALTHCARE,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,VA,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,VA TRICARE,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,WELLMED,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,HUMANA,MGD,145.67,,,,,,,per diem,145.67,145.67,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38203777,CDM,301,RC,82042,CPT,,,,Inpatient,,,145.67,145.67,HUMANA CHOICE PLUS,MGD,145.67,,,,,,,case rate,145.67,145.67,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,AETNA,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,BCBS,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,CIGNA,COM,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,TRICARE,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,UNITED HEALTHCARE,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,UNITED HEALTHCARE,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,VA,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,VA TRICARE,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,WELLMED,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,HUMANA,MGD,346.36,,,,,,,per diem,346.36,346.36,"Per diem rate, code is bundled with other services"
HIV WESTERN BLOT              ,38203779,CDM,302,RC,86689,CPT,,,,Inpatient,,,346.36,346.36,HUMANA CHOICE PLUS,MGD,346.36,,,,,,,case rate,346.36,346.36,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,AETNA,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,BCBS,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,CIGNA,COM,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,TRICARE,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,UNITED HEALTHCARE,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,UNITED HEALTHCARE,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,VA,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,VA TRICARE,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,WELLMED,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,HUMANA,MGD,204.69,,,,,,,per diem,204.69,204.69,"Per diem rate, code is bundled with other services"
"AB EXTRACT NUC ANTIGEN, EACH  ",38203804,CDM,302,RC,86235,CPT,,,,Inpatient,,,204.69,204.69,HUMANA CHOICE PLUS,MGD,204.69,,,,,,,case rate,204.69,204.69,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,AETNA,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,BCBS,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,CIGNA,COM,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,TRICARE,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,UNITED HEALTHCARE,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,UNITED HEALTHCARE,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,VA,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,VA TRICARE,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,WELLMED,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,HUMANA,MGD,282.45,,,,,,,per diem,282.45,282.45,"Per diem rate, code is bundled with other services"
"AMINO ACID QUANT, EA          ",38203806,CDM,301,RC,82131,CPT,,,,Inpatient,,,282.45,282.45,HUMANA CHOICE PLUS,MGD,282.45,,,,,,,case rate,282.45,282.45,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,AETNA,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,BCBS,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,CIGNA,COM,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,TRICARE,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,UNITED HEALTHCARE,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,UNITED HEALTHCARE,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,VA,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,VA TRICARE,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,WELLMED,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,HUMANA,MGD,75.57,,,,,,,per diem,75.57,75.57,"Per diem rate, code is bundled with other services"
CALCULUS (STONE) SPECTROSCOPY ,38203812,CDM,301,RC,82365,CPT,,,,Inpatient,,,75.57,75.57,HUMANA CHOICE PLUS,MGD,75.57,,,,,,,case rate,75.57,75.57,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,AETNA,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,BCBS,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,CIGNA,COM,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,TRICARE,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,UNITED HEALTHCARE,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,UNITED HEALTHCARE,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,VA,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,VA TRICARE,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,WELLMED,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,HUMANA,MGD,393.06,,,,,,,per diem,393.06,393.06,"Per diem rate, code is bundled with other services"
CYANIDE                       ,38203813,CDM,301,RC,82600,CPT,,,,Inpatient,,,393.06,393.06,HUMANA CHOICE PLUS,MGD,393.06,,,,,,,case rate,393.06,393.06,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,AETNA,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,BCBS,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,CIGNA,COM,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,TRICARE,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,UNITED HEALTHCARE,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,UNITED HEALTHCARE,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,VA,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,VA TRICARE,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,WELLMED,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,HUMANA,MGD,293.09,,,,,,,per diem,293.09,293.09,"Per diem rate, code is bundled with other services"
MICROHEMATOCRIT-SPUN          ,38203819,CDM,305,RC,85013,CPT,,,,Inpatient,,,293.09,293.09,HUMANA CHOICE PLUS,MGD,293.09,,,,,,,case rate,293.09,293.09,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,AETNA,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,BCBS,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,CIGNA,COM,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,TRICARE,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,UNITED HEALTHCARE,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,UNITED HEALTHCARE,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,VA,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,VA TRICARE,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,WELLMED,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,HUMANA,MGD,289.8,,,,,,,per diem,289.8,289.8,"Per diem rate, code is bundled with other services"
IMMUNOASSAY NONANTIBODY       ,38203825,CDM,301,RC,83520,CPT,,,,Inpatient,,,289.8,289.8,HUMANA CHOICE PLUS,MGD,289.8,,,,,,,case rate,289.8,289.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
H.PYLORI RAPID UREASE TEST    ,38203856,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,AETNA,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,BCBS,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,CIGNA,COM,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,TRICARE,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,UNITED HEALTHCARE,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,UNITED HEALTHCARE,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,VA,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,VA TRICARE,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,WELLMED,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,HUMANA,MGD,48.55,,,,,,,per diem,48.55,48.55,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-SERUM     ,38203860,CDM,300,RC,84165,CPT,,,,Inpatient,,,48.55,48.55,HUMANA CHOICE PLUS,MGD,48.55,,,,,,,case rate,48.55,48.55,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,AETNA,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,BCBS,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,CIGNA,COM,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,TRICARE,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,UNITED HEALTHCARE,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,UNITED HEALTHCARE,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,VA,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,VA TRICARE,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,WELLMED,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,HUMANA,MGD,126.3,,,,,,,per diem,126.3,126.3,"Per diem rate, code is bundled with other services"
PROTEIN-ELECTROPHOR-OTH FLUID ,38203865,CDM,300,RC,84166,CPT,,,,Inpatient,,,126.3,126.3,HUMANA CHOICE PLUS,MGD,126.3,,,,,,,case rate,126.3,126.3,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,AETNA,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,BCBS,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,CIGNA,COM,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,TRICARE,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,UNITED HEALTHCARE,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,UNITED HEALTHCARE,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,VA,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,VA TRICARE,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,WELLMED,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,HUMANA,MGD,70.28,,,,,,,per diem,70.28,70.28,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-SERUM   ,38203870,CDM,300,RC,86334,CPT,,,,Inpatient,,,70.28,70.28,HUMANA CHOICE PLUS,MGD,70.28,,,,,,,case rate,70.28,70.28,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,AETNA,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,BCBS,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,CIGNA,COM,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,TRICARE,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,UNITED HEALTHCARE,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,UNITED HEALTHCARE,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,VA,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,VA TRICARE,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,WELLMED,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,HUMANA,MGD,285.52,,,,,,,per diem,285.52,285.52,"Per diem rate, code is bundled with other services"
IMMUNOFIX ELECTROPHOR-FLUID   ,38203875,CDM,300,RC,86335,CPT,,,,Inpatient,,,285.52,285.52,HUMANA CHOICE PLUS,MGD,285.52,,,,,,,case rate,285.52,285.52,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,AETNA,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,BCBS,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,CIGNA,COM,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,TRICARE,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,UNITED HEALTHCARE,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,UNITED HEALTHCARE,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,VA,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,VA TRICARE,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,WELLMED,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,HUMANA,MGD,164.59,,,,,,,per diem,164.59,164.59,"Per diem rate, code is bundled with other services"
COLUMN CHROMATOG/MASS SPECT QT,38203885,CDM,301,RC,82542,CPT,,,,Inpatient,,,164.59,164.59,HUMANA CHOICE PLUS,MGD,164.59,,,,,,,case rate,164.59,164.59,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,AETNA,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,BCBS,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,CIGNA,COM,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,TRICARE,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,UNITED HEALTHCARE,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,UNITED HEALTHCARE,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,VA,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,VA TRICARE,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,WELLMED,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,HUMANA,MGD,87.96,,,,,,,per diem,87.96,87.96,"Per diem rate, code is bundled with other services"
EPSTEIN BARR ANTIBODY VCA     ,38203890,CDM,302,RC,86665,CPT,,,,Inpatient,,,87.96,87.96,HUMANA CHOICE PLUS,MGD,87.96,,,,,,,case rate,87.96,87.96,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,AETNA,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,BCBS,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,CIGNA,COM,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,TRICARE,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,UNITED HEALTHCARE,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,UNITED HEALTHCARE,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,VA,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,VA TRICARE,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,WELLMED,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,HUMANA,MGD,210.36,,,,,,,per diem,210.36,210.36,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS DNA QUANT     ,38203895,CDM,306,RC,87497,CPT,,,,Inpatient,,,210.36,210.36,HUMANA CHOICE PLUS,MGD,210.36,,,,,,,case rate,210.36,210.36,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
CARBIDOPA                     ,38203900,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
CROSSMATCH INCUBATION         ,38203910,CDM,302,RC,86921,CPT,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,AETNA,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,BCBS,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,CIGNA,COM,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,TRICARE,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,UNITED HEALTHCARE,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,UNITED HEALTHCARE,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,VA,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,VA TRICARE,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,WELLMED,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,HUMANA,MGD,100.28,,,,,,,per diem,100.28,100.28,"Per diem rate, code is bundled with other services"
D-DIMER SEMI QUANT            ,38204121,CDM,305,RC,85378,CPT,,,,Inpatient,,,100.28,100.28,HUMANA CHOICE PLUS,MGD,100.28,,,,,,,case rate,100.28,100.28,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,AETNA,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,BCBS,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,CIGNA,COM,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,TRICARE,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,UNITED HEALTHCARE,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,UNITED HEALTHCARE,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,VA,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,VA TRICARE,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,WELLMED,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,HUMANA,MGD,109.23,,,,,,,per diem,109.23,109.23,"Per diem rate, code is bundled with other services"
FOLLICLE STIMULATING HORMONE  ,38204150,CDM,301,RC,83001,CPT,,,,Inpatient,,,109.23,109.23,HUMANA CHOICE PLUS,MGD,109.23,,,,,,,case rate,109.23,109.23,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,AETNA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,CIGNA,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,VA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,VA TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,WELLMED,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,HUMANA,MGD,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
PTH RELATED TOTAL PROTEIN     ,38204300,CDM,301,RC,83519,CPT,,,,Inpatient,,,102.9,102.9,HUMANA CHOICE PLUS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
OBSTETRIC PANEL               ,38205040,CDM,301,RC,80055,CPT,,,,Inpatient,,,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,AETNA,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,BCBS,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,CIGNA,COM,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,TRICARE,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,UNITED HEALTHCARE,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,UNITED HEALTHCARE,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,VA,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,VA TRICARE,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,WELLMED,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,HUMANA,MGD,420.37,,,,,,,per diem,420.37,420.37,"Per diem rate, code is bundled with other services"
VITAMIN E LEVEL               ,38205066,CDM,301,RC,84446,CPT,,,,Inpatient,,,420.37,420.37,HUMANA CHOICE PLUS,MGD,420.37,,,,,,,case rate,420.37,420.37,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,AETNA,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,BCBS,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,CIGNA,COM,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,TRICARE,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,UNITED HEALTHCARE,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,UNITED HEALTHCARE,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,VA,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,VA TRICARE,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,WELLMED,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,HUMANA,MGD,120.46,,,,,,,per diem,120.46,120.46,"Per diem rate, code is bundled with other services"
VITAMIN B6 LEVEL              ,38205067,CDM,301,RC,84207,CPT,,,,Inpatient,,,120.46,120.46,HUMANA CHOICE PLUS,MGD,120.46,,,,,,,case rate,120.46,120.46,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,AETNA,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,BCBS,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,CIGNA,COM,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,TRICARE,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,UNITED HEALTHCARE,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,UNITED HEALTHCARE,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,VA,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,VA TRICARE,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,WELLMED,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,HUMANA,MGD,223.89,,,,,,,per diem,223.89,223.89,"Per diem rate, code is bundled with other services"
VITAMIN C (ASCORBIC ACID)     ,38205068,CDM,301,RC,82180,CPT,,,,Inpatient,,,223.89,223.89,HUMANA CHOICE PLUS,MGD,223.89,,,,,,,case rate,223.89,223.89,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,AETNA,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,BCBS,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,CIGNA,COM,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,TRICARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,UNITED HEALTHCARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,UNITED HEALTHCARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,VA,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,VA TRICARE,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,WELLMED,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,HUMANA,MGD,27.58,,,,,,,per diem,27.58,27.58,"Per diem rate, code is bundled with other services"
VITAMIN A LEVEL               ,38205069,CDM,301,RC,84590,CPT,,,,Inpatient,,,27.58,27.58,HUMANA CHOICE PLUS,MGD,27.58,,,,,,,case rate,27.58,27.58,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
FELBAMATE                     ,38205076,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,AETNA,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,BCBS,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,CIGNA,COM,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,TRICARE,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,UNITED HEALTHCARE,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,UNITED HEALTHCARE,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,VA,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,VA TRICARE,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,WELLMED,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,HUMANA,MGD,16.84,,,,,,,per diem,16.84,16.84,"Per diem rate, code is bundled with other services"
NOCARDIA CULTURE              ,38205086,CDM,301,RC,87070,CPT,,,,Inpatient,,,16.84,16.84,HUMANA CHOICE PLUS,MGD,16.84,,,,,,,case rate,16.84,16.84,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,AETNA,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,CIGNA,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,TRICARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UNITED HEALTHCARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UNITED HEALTHCARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA TRICARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,WELLMED,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,HUMANA,MGD,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EAR                  ,38205087,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,HUMANA CHOICE PLUS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,AETNA,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,BCBS,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,CIGNA,COM,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,TRICARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UNITED HEALTHCARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,UNITED HEALTHCARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,VA TRICARE,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,WELLMED,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,HUMANA,MGD,117.33,,,,,,,per diem,117.33,117.33,"Per diem rate, code is bundled with other services"
CULTURE- EYE                  ,38205088,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.33,117.33,HUMANA CHOICE PLUS,MGD,117.33,,,,,,,case rate,117.33,117.33,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,AETNA,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,BCBS,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,CIGNA,COM,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,TRICARE,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,UNITED HEALTHCARE,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,UNITED HEALTHCARE,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,VA,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,VA TRICARE,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,WELLMED,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,HUMANA,MGD,90.93,,,,,,,per diem,90.93,90.93,"Per diem rate, code is bundled with other services"
CULTURE- GENITAL              ,38205089,CDM,306,RC,87070,CPT,,,,Inpatient,,,90.93,90.93,HUMANA CHOICE PLUS,MGD,90.93,,,,,,,case rate,90.93,90.93,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,AETNA,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,BCBS,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,CIGNA,COM,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,TRICARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UNITED HEALTHCARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,UNITED HEALTHCARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,VA TRICARE,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,WELLMED,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,HUMANA,MGD,117.19,,,,,,,per diem,117.19,117.19,"Per diem rate, code is bundled with other services"
CULTURE- TISSUE               ,38205090,CDM,306,RC,87070,CPT,,,,Inpatient,,,117.19,117.19,HUMANA CHOICE PLUS,MGD,117.19,,,,,,,case rate,117.19,117.19,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,AETNA,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,CIGNA,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,TRICARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,UNITED HEALTHCARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,UNITED HEALTHCARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,VA,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,VA TRICARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,WELLMED,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,HUMANA,MGD,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
THYROXINE BINDING GLOBULIN    ,38205091,CDM,301,RC,84442,CPT,,,,Inpatient,,,32.45,32.45,HUMANA CHOICE PLUS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,AETNA,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,BCBS,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,CIGNA,COM,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,TRICARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,UNITED HEALTHCARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,UNITED HEALTHCARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,VA,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,VA TRICARE,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,WELLMED,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,HUMANA,MGD,118.79,,,,,,,per diem,118.79,118.79,"Per diem rate, code is bundled with other services"
CULTURE- RESPIRATORY          ,38205100,CDM,306,RC,87070,CPT,,,,Inpatient,,,118.79,118.79,HUMANA CHOICE PLUS,MGD,118.79,,,,,,,case rate,118.79,118.79,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,AETNA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,CIGNA,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,VA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,VA TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,WELLMED,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,HUMANA,MGD,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
"ASSAY, TOXIN OR ANTITOXIN     ",38205210,CDM,306,RC,87230,CPT,,,,Inpatient,,,117.6,117.6,HUMANA CHOICE PLUS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,AETNA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,CIGNA,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,VA TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,WELLMED,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA,MGD,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
AMYLASE PROFILE               ,38205330,CDM,301,RC,82150,CPT,,,,Inpatient,,,129.15,129.15,HUMANA CHOICE PLUS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
OXYCODNE SCREEN               ,38205402,CDM,301,RC,80365,CPT,G0480,HCPCS,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,AETNA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,CIGNA,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,VA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,VA TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,WELLMED,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,HUMANA,MGD,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
BENZ0DIAZEPINES 1-12          ,38205405,CDM,301,RC,80346,CPT,,,,Inpatient,,,598.69,598.69,HUMANA CHOICE PLUS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
BENZODIAZEPIINES 13+          ,38205406,CDM,301,RC,80347,CPT,,,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
METHYLENEDIOXYAMPHETAMINES    ,38205450,CDM,301,RC,80359,CPT,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SERUM DRUG SCRN W/ VOLATILES  ,38205520,CDM,301,RC,82003,CPT,,,,Inpatient,,,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,AETNA,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,BCBS,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,CIGNA,COM,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,TRICARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,UNITED HEALTHCARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,UNITED HEALTHCARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,VA,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,VA TRICARE,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,WELLMED,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,HUMANA,MGD,98.19,,,,,,,per diem,98.19,98.19,"Per diem rate, code is bundled with other services"
BILIRUBIN                     ,38205526,CDM,301,RC,82247,CPT,,,,Inpatient,,,98.19,98.19,HUMANA CHOICE PLUS,MGD,98.19,,,,,,,case rate,98.19,98.19,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,AETNA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,CIGNA,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,VA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,VA TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,WELLMED,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,HUMANA,MGD,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
"CALCIUM, MISC FLUID           ",38205530,CDM,301,RC,82310,CPT,,,,Inpatient,,,22.14,22.14,HUMANA CHOICE PLUS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,AETNA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,BCBS,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,CIGNA,COM,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,UNITED HEALTHCARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,VA,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,VA TRICARE,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,WELLMED,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,HUMANA,MGD,131.9,,,,,,,per diem,131.9,131.9,"Per diem rate, code is bundled with other services"
"CREATININE, MISC FLUID        ",38205534,CDM,301,RC,82570,CPT,,,,Inpatient,,,131.9,131.9,HUMANA CHOICE PLUS,MGD,131.9,,,,,,,case rate,131.9,131.9,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,AETNA,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,BCBS,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,CIGNA,COM,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,TRICARE,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,UNITED HEALTHCARE,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,UNITED HEALTHCARE,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,VA,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,VA TRICARE,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,WELLMED,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,HUMANA,MGD,127.49,,,,,,,per diem,127.49,127.49,"Per diem rate, code is bundled with other services"
VITAMIN B12 & FOLATE          ,38205535,CDM,301,RC,82607,CPT,,,,Inpatient,,,127.49,127.49,HUMANA CHOICE PLUS,MGD,127.49,,,,,,,case rate,127.49,127.49,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,AETNA,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,BCBS,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,CIGNA,COM,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,TRICARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,UNITED HEALTHCARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,UNITED HEALTHCARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,VA,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,VA TRICARE,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,WELLMED,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,HUMANA,MGD,241.5,,,,,,,per diem,241.5,241.5,"Per diem rate, code is bundled with other services"
IMMUNOGLOBULIN PROFILE        ,38205536,CDM,301,RC,82784,CPT,,,,Inpatient,,,241.5,241.5,HUMANA CHOICE PLUS,MGD,241.5,,,,,,,case rate,241.5,241.5,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
IRON PANEL                    ,38205540,CDM,301,RC,83540,CPT,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,AETNA,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,BCBS,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,CIGNA,COM,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,TRICARE,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,UNITED HEALTHCARE,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,UNITED HEALTHCARE,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,VA,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,VA TRICARE,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,WELLMED,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,HUMANA,MGD,139.65,,,,,,,per diem,139.65,139.65,"Per diem rate, code is bundled with other services"
"LIPASE, MISC FLUID            ",38205542,CDM,301,RC,83690,CPT,,,,Inpatient,,,139.65,139.65,HUMANA CHOICE PLUS,MGD,139.65,,,,,,,case rate,139.65,139.65,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,AETNA,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,BCBS,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,CIGNA,COM,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,TRICARE,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,UNITED HEALTHCARE,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,UNITED HEALTHCARE,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,VA,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,VA TRICARE,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,WELLMED,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,HUMANA,MGD,74.04,,,,,,,per diem,74.04,74.04,"Per diem rate, code is bundled with other services"
APO E GENOTYPING              ,38205545,CDM,301,RC,83891,CPT,,,,Inpatient,,,74.04,74.04,HUMANA CHOICE PLUS,MGD,74.04,,,,,,,case rate,74.04,74.04,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,AETNA,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,BCBS,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,CIGNA,COM,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,TRICARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,UNITED HEALTHCARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,UNITED HEALTHCARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,VA,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,VA TRICARE,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,WELLMED,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,HUMANA,MGD,532.29,,,,,,,per diem,532.29,532.29,"Per diem rate, code is bundled with other services"
JAK2 V617 MUTATION            ,38205555,CDM,301,RC,81270,CPT,,,,Inpatient,,,532.29,532.29,HUMANA CHOICE PLUS,MGD,532.29,,,,,,,case rate,532.29,532.29,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,AETNA,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,BCBS,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,CIGNA,COM,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,TRICARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,UNITED HEALTHCARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,UNITED HEALTHCARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,VA,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,VA TRICARE,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,WELLMED,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,HUMANA,MGD,61.65,,,,,,,per diem,61.65,61.65,"Per diem rate, code is bundled with other services"
"PROTEIN, TOTAL 24 HR URINE    ",38205559,CDM,301,RC,84156,CPT,,,,Inpatient,,,61.65,61.65,HUMANA CHOICE PLUS,MGD,61.65,,,,,,,case rate,61.65,61.65,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,AETNA,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,BCBS,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,CIGNA,COM,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,TRICARE,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,UNITED HEALTHCARE,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,UNITED HEALTHCARE,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,VA,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,VA TRICARE,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,WELLMED,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,HUMANA,MGD,176.4,,,,,,,per diem,176.4,176.4,"Per diem rate, code is bundled with other services"
THYROID FUNCTION PANEL        ,38205563,CDM,301,RC,84439,CPT,,,,Inpatient,,,176.4,176.4,HUMANA CHOICE PLUS,MGD,176.4,,,,,,,case rate,176.4,176.4,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,AETNA,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,BCBS,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,CIGNA,COM,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,TRICARE,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,UNITED HEALTHCARE,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,UNITED HEALTHCARE,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,VA,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,VA TRICARE,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,WELLMED,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,HUMANA,MGD,30.48,,,,,,,per diem,30.48,30.48,"Per diem rate, code is bundled with other services"
"UREA NITRO, FLUID             ",38205565,CDM,301,RC,84520,CPT,,,,Inpatient,,,30.48,30.48,HUMANA CHOICE PLUS,MGD,30.48,,,,,,,case rate,30.48,30.48,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,AETNA,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,BCBS,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,CIGNA,COM,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,TRICARE,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,UNITED HEALTHCARE,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,UNITED HEALTHCARE,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,VA,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,VA TRICARE,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,WELLMED,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,HUMANA,MGD,166.55,,,,,,,per diem,166.55,166.55,"Per diem rate, code is bundled with other services"
UNFRACTIONATED HEPARIN        ,38205568,CDM,305,RC,85520,CPT,,,,Inpatient,,,166.55,166.55,HUMANA CHOICE PLUS,MGD,166.55,,,,,,,case rate,166.55,166.55,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,AETNA,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,BCBS,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,CIGNA,COM,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,TRICARE,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,UNITED HEALTHCARE,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,UNITED HEALTHCARE,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,VA,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,VA TRICARE,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,WELLMED,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,HUMANA,MGD,95.79,,,,,,,per diem,95.79,95.79,"Per diem rate, code is bundled with other services"
PLATELET FUNCTION ANALYSIS    ,38205569,CDM,305,RC,85576,CPT,,,,Inpatient,,,95.79,95.79,HUMANA CHOICE PLUS,MGD,95.79,,,,,,,case rate,95.79,95.79,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,AETNA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,CIGNA,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,VA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,VA TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,WELLMED,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,HUMANA,MGD,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
DIC SCREEN                    ,38205570,CDM,305,RC,85610,CPT,,,,Inpatient,,,59.85,59.85,HUMANA CHOICE PLUS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,AETNA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,BCBS,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,CIGNA,COM,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,UNITED HEALTHCARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,VA,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,VA TRICARE,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,WELLMED,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,HUMANA,MGD,77.7,,,,,,,per diem,77.7,77.7,"Per diem rate, code is bundled with other services"
PT/PTT                        ,38205571,CDM,305,RC,85610,CPT,,,,Inpatient,,,77.7,77.7,HUMANA CHOICE PLUS,MGD,77.7,,,,,,,case rate,77.7,77.7,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
ANTISMOOTH MUSCLE TITER       ,38205590,CDM,302,RC,86256,CPT,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,AETNA,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,BCBS,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,CIGNA,COM,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,TRICARE,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,UNITED HEALTHCARE,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,UNITED HEALTHCARE,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,VA,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,VA TRICARE,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,WELLMED,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,HUMANA,MGD,288.75,,,,,,,per diem,288.75,288.75,"Per diem rate, code is bundled with other services"
CYTOMEGALOVIRUS IGG & IGM     ,38205596,CDM,302,RC,86644,CPT,,,,Inpatient,,,288.75,288.75,HUMANA CHOICE PLUS,MGD,288.75,,,,,,,case rate,288.75,288.75,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,AETNA,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,BCBS,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,CIGNA,COM,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,TRICARE,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,UNITED HEALTHCARE,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,UNITED HEALTHCARE,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,VA,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,VA TRICARE,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,WELLMED,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,HUMANA,MGD,18.76,,,,,,,per diem,18.76,18.76,"Per diem rate, code is bundled with other services"
HIV-1&2 AB SCREEN             ,38205601,CDM,302,RC,86703,CPT,,,,Inpatient,,,18.76,18.76,HUMANA CHOICE PLUS,MGD,18.76,,,,,,,case rate,18.76,18.76,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,AETNA,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,BCBS,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,CIGNA,COM,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,TRICARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UNITED HEALTHCARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,UNITED HEALTHCARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,VA TRICARE,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,WELLMED,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,HUMANA,MGD,169.05,,,,,,,per diem,169.05,169.05,"Per diem rate, code is bundled with other services"
DIRECT & INDIRECT COOMBS      ,38205611,CDM,302,RC,86850,CPT,,,,Inpatient,,,169.05,169.05,HUMANA CHOICE PLUS,MGD,169.05,,,,,,,case rate,169.05,169.05,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,AETNA,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,BCBS,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,CIGNA,COM,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,TRICARE,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,UNITED HEALTHCARE,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,UNITED HEALTHCARE,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,VA,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,VA TRICARE,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,WELLMED,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,HUMANA,MGD,175.92,,,,,,,per diem,175.92,175.92,"Per diem rate, code is bundled with other services"
AHG COMPLEMENT                ,38205612,CDM,302,RC,86880,CPT,,,,Inpatient,,,175.92,175.92,HUMANA CHOICE PLUS,MGD,175.92,,,,,,,case rate,175.92,175.92,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,AETNA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,CIGNA,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,WELLMED,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA,MGD,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
ABO & RH TYPE                 ,38205613,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA CHOICE PLUS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,AETNA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,CIGNA,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,VA TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,WELLMED,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA,MGD,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
PRENATAL PANEL                ,38205614,CDM,302,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA CHOICE PLUS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,AETNA,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,BCBS,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,CIGNA,COM,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,TRICARE,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,UNITED HEALTHCARE,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,UNITED HEALTHCARE,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,VA,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,VA TRICARE,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,WELLMED,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,HUMANA,MGD,62.73,,,,,,,per diem,62.73,62.73,"Per diem rate, code is bundled with other services"
AHG CROSSMATCH COMPATIBLE     ,38205619,CDM,302,RC,86922,CPT,,,,Inpatient,,,62.73,62.73,HUMANA CHOICE PLUS,MGD,62.73,,,,,,,case rate,62.73,62.73,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,AETNA,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,BCBS,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,CIGNA,COM,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,TRICARE,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,UNITED HEALTHCARE,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,UNITED HEALTHCARE,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,VA,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,VA TRICARE,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,WELLMED,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,HUMANA,MGD,238.78,,,,,,,per diem,238.78,238.78,"Per diem rate, code is bundled with other services"
ENZYME PANEL                  ,38205621,CDM,302,RC,86971,CPT,,,,Inpatient,,,238.78,238.78,HUMANA CHOICE PLUS,MGD,238.78,,,,,,,case rate,238.78,238.78,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,AETNA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,BCBS,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,CIGNA,COM,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,UNITED HEALTHCARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,VA,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,VA TRICARE,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,WELLMED,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,HUMANA,MGD,77.87,,,,,,,per diem,77.87,77.87,"Per diem rate, code is bundled with other services"
PARASITE EXAM                 ,38205622,CDM,306,RC,87015,CPT,,,,Inpatient,,,77.87,77.87,HUMANA CHOICE PLUS,MGD,77.87,,,,,,,case rate,77.87,77.87,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,AETNA,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,BCBS,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,CIGNA,COM,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,TRICARE,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,UNITED HEALTHCARE,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,UNITED HEALTHCARE,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,VA,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,VA TRICARE,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,WELLMED,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,HUMANA,MGD,109.9,,,,,,,per diem,109.9,109.9,"Per diem rate, code is bundled with other services"
CULTURE AEROBIC               ,38205624,CDM,306,RC,87070,CPT,,,,Inpatient,,,109.9,109.9,HUMANA CHOICE PLUS,MGD,109.9,,,,,,,case rate,109.9,109.9,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,AETNA,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,CIGNA,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,TRICARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UNITED HEALTHCARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UNITED HEALTHCARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA TRICARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,WELLMED,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,HUMANA,MGD,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
LEGIONELLA CULTURE            ,38205625,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,HUMANA CHOICE PLUS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,AETNA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,BCBS,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,CIGNA,COM,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,UNITED HEALTHCARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,VA,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,VA TRICARE,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,WELLMED,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,HUMANA,MGD,129.15,,,,,,,per diem,129.15,129.15,"Per diem rate, code is bundled with other services"
CULTURE TRANS                 ,38205626,CDM,306,RC,87081,CPT,,,,Inpatient,,,129.15,129.15,HUMANA CHOICE PLUS,MGD,129.15,,,,,,,case rate,129.15,129.15,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,AETNA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,BCBS,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,CIGNA,COM,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,UNITED HEALTHCARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,VA TRICARE,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,WELLMED,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA,MGD,78.8,,,,,,,per diem,78.8,78.8,"Per diem rate, code is bundled with other services"
BETA STREP SCREEN             ,38205627,CDM,306,RC,87081,CPT,,,,Inpatient,,,78.8,78.8,HUMANA CHOICE PLUS,MGD,78.8,,,,,,,case rate,78.8,78.8,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,AETNA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,BCBS,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,CIGNA,COM,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,UNITED HEALTHCARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,VA,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,VA TRICARE,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,WELLMED,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,HUMANA,MGD,137.9,,,,,,,per diem,137.9,137.9,"Per diem rate, code is bundled with other services"
FUNGUS CULTURE SKIN           ,38205628,CDM,306,RC,87101,CPT,,,,Inpatient,,,137.9,137.9,HUMANA CHOICE PLUS,MGD,137.9,,,,,,,case rate,137.9,137.9,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,AETNA,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,BCBS,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,CIGNA,COM,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,TRICARE,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,UNITED HEALTHCARE,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,UNITED HEALTHCARE,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,VA,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,VA TRICARE,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,WELLMED,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,HUMANA,MGD,81.55,,,,,,,per diem,81.55,81.55,"Per diem rate, code is bundled with other services"
ERM CONFIRM                   ,38205629,CDM,306,RC,87184,CPT,,,,Inpatient,,,81.55,81.55,HUMANA CHOICE PLUS,MGD,81.55,,,,,,,case rate,81.55,81.55,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM                  ,38205630,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
ESBL CONFIRM 2                ,38205631,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
OXACILLIN SUSCEPT CONFIRM     ,38205632,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY KB       ,38205633,CDM,306,RC,87184,CPT,,,,Inpatient,,,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,AETNA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,CIGNA,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,WELLMED,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,HUMANA,MGD,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MOLD SUSCEPTIBILITY           ,38205634,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,HUMANA CHOICE PLUS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,AETNA,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,BCBS,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,CIGNA,COM,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,TRICARE,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,UNITED HEALTHCARE,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,UNITED HEALTHCARE,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,VA,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,VA TRICARE,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,WELLMED,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,HUMANA,MGD,141.1,,,,,,,per diem,141.1,141.1,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY          ,38205635,CDM,306,RC,87186,CPT,,,,Inpatient,,,141.1,141.1,HUMANA CHOICE PLUS,MGD,141.1,,,,,,,case rate,141.1,141.1,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,AETNA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,CIGNA,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,VA TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,WELLMED,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,HUMANA,MGD,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
YEAST SUSCEPTIBILITY MIC      ,38205636,CDM,306,RC,87186,CPT,,,,Inpatient,,,165.9,165.9,HUMANA CHOICE PLUS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,AETNA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,CIGNA,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,VA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,VA TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,WELLMED,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,HUMANA,MGD,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
GRAM STAIN CREDIT             ,38205637,CDM,306,RC,87205,CPT,,,,Inpatient,,,41.64,41.64,HUMANA CHOICE PLUS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,AETNA,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,BCBS,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,CIGNA,COM,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,TRICARE,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,UNITED HEALTHCARE,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,UNITED HEALTHCARE,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,VA,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,VA TRICARE,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,WELLMED,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,HUMANA,MGD,46.11,,,,,,,per diem,46.11,46.11,"Per diem rate, code is bundled with other services"
SPUTUM GRAM STAIN             ,38205638,CDM,306,RC,87205,CPT,,,,Inpatient,,,46.11,46.11,HUMANA CHOICE PLUS,MGD,46.11,,,,,,,case rate,46.11,46.11,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,AETNA,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,BCBS,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,CIGNA,COM,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,TRICARE,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,UNITED HEALTHCARE,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,UNITED HEALTHCARE,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,VA,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,VA TRICARE,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,WELLMED,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,HUMANA,MGD,382.5,,,,,,,per diem,382.5,382.5,"Per diem rate, code is bundled with other services"
HERPES CULTURE                ,38205643,CDM,306,RC,87252,CPT,,,,Inpatient,,,382.5,382.5,HUMANA CHOICE PLUS,MGD,382.5,,,,,,,case rate,382.5,382.5,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,AETNA,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,BCBS,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,CIGNA,COM,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,TRICARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,UNITED HEALTHCARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,UNITED HEALTHCARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,VA,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,VA TRICARE,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,WELLMED,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,HUMANA,MGD,380.1,,,,,,,per diem,380.1,380.1,"Per diem rate, code is bundled with other services"
HEP C PCR QUAL                ,38205650,CDM,306,RC,87521,CPT,,,,Inpatient,,,380.1,380.1,HUMANA CHOICE PLUS,MGD,380.1,,,,,,,case rate,380.1,380.1,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,AETNA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,CIGNA,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,VA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,VA TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,WELLMED,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,HUMANA,MGD,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
WRIGHT STAIN FOR EOSINOPHIL   ,38205656,CDM,300,RC,89190,CPT,,,,Inpatient,,,22.49,22.49,HUMANA CHOICE PLUS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,AETNA,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,BCBS,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,CIGNA,COM,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,TRICARE,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,UNITED HEALTHCARE,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,UNITED HEALTHCARE,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,VA,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,VA TRICARE,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,WELLMED,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,HUMANA,MGD,142.99,,,,,,,per diem,142.99,142.99,"Per diem rate, code is bundled with other services"
THYROID CASCADE               ,38205662,CDM,300,RC,84443,CPT,,,,Inpatient,,,142.99,142.99,HUMANA CHOICE PLUS,MGD,142.99,,,,,,,case rate,142.99,142.99,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,AETNA,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,BCBS,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,CIGNA,COM,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,TRICARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UNITED HEALTHCARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,UNITED HEALTHCARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,VA TRICARE,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,WELLMED,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,HUMANA,MGD,197.4,,,,,,,per diem,197.4,197.4,"Per diem rate, code is bundled with other services"
SOLUTION CULTURE              ,38205667,CDM,306,RC,87070,CPT,,,,Inpatient,,,197.4,197.4,HUMANA CHOICE PLUS,MGD,197.4,,,,,,,case rate,197.4,197.4,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,AETNA,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,BCBS,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,CIGNA,COM,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,TRICARE,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,UNITED HEALTHCARE,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,UNITED HEALTHCARE,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,VA,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,VA TRICARE,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,WELLMED,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,HUMANA,MGD,73.34,,,,,,,per diem,73.34,73.34,"Per diem rate, code is bundled with other services"
URINE PRESUMPTIVE ID CREDIT   ,38205669,CDM,306,RC,87088,CPT,,,,Inpatient,,,73.34,73.34,HUMANA CHOICE PLUS,MGD,73.34,,,,,,,case rate,73.34,73.34,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,AETNA,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,BCBS,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,CIGNA,COM,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,TRICARE,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,UNITED HEALTHCARE,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,UNITED HEALTHCARE,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,VA,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,VA TRICARE,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,WELLMED,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,HUMANA,MGD,298.81,,,,,,,per diem,298.81,298.81,"Per diem rate, code is bundled with other services"
MTHFR                         ,38205680,CDM,301,RC,81291,CPT,,,,Inpatient,,,298.81,298.81,HUMANA CHOICE PLUS,MGD,298.81,,,,,,,case rate,298.81,298.81,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,AETNA,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,CIGNA,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,TRICARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,UNITED HEALTHCARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,UNITED HEALTHCARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,VA,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,VA TRICARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,WELLMED,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,HUMANA,MGD,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
EOS SMEAR (NASAL)             ,38206009,CDM,300,RC,89190,CPT,,,,Inpatient,,,106.53,106.53,HUMANA CHOICE PLUS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,AETNA,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,BCBS,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,CIGNA,COM,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,TRICARE,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,UNITED HEALTHCARE,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,UNITED HEALTHCARE,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,VA,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,VA TRICARE,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,WELLMED,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,HUMANA,MGD,103.62,,,,,,,per diem,103.62,103.62,"Per diem rate, code is bundled with other services"
STOOL CRYPTOSPORIDIU          ,38206022,CDM,300,RC,87015,CPT,,,,Inpatient,,,103.62,103.62,HUMANA CHOICE PLUS,MGD,103.62,,,,,,,case rate,103.62,103.62,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,AETNA,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,BCBS,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,CIGNA,COM,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,TRICARE,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,UNITED HEALTHCARE,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,UNITED HEALTHCARE,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,VA,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,VA TRICARE,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,WELLMED,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,HUMANA,MGD,46.95,,,,,,,per diem,46.95,46.95,"Per diem rate, code is bundled with other services"
URINALYSIS NONAUTO W/MICROSCOP,38206028,CDM,307,RC,81000,CPT,,,,Inpatient,,,46.95,46.95,HUMANA CHOICE PLUS,MGD,46.95,,,,,,,case rate,46.95,46.95,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,AETNA,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,BCBS,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,CIGNA,COM,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,TRICARE,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,UNITED HEALTHCARE,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,UNITED HEALTHCARE,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,VA,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,VA TRICARE,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,WELLMED,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,HUMANA,MGD,219.92,,,,,,,per diem,219.92,219.92,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR XIII          ,38206434,CDM,305,RC,85291,CPT,,,,Inpatient,,,219.92,219.92,HUMANA CHOICE PLUS,MGD,219.92,,,,,,,case rate,219.92,219.92,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,AETNA,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,BCBS,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,CIGNA,COM,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,TRICARE,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,UNITED HEALTHCARE,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,UNITED HEALTHCARE,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,VA,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,VA TRICARE,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,WELLMED,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,HUMANA,MGD,74.43,,,,,,,per diem,74.43,74.43,"Per diem rate, code is bundled with other services"
MOLEC DIAG SEPARATION         ,38206520,CDM,301,RC,83894,CPT,,,,Inpatient,,,74.43,74.43,HUMANA CHOICE PLUS,MGD,74.43,,,,,,,case rate,74.43,74.43,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,AETNA,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,BCBS,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,CIGNA,COM,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,TRICARE,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,UNITED HEALTHCARE,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,UNITED HEALTHCARE,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,VA,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,VA TRICARE,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,WELLMED,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,HUMANA,MGD,629.04,,,,,,,per diem,629.04,629.04,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR V             ,38206560,CDM,305,RC,85220,CPT,,,,Inpatient,,,629.04,629.04,HUMANA CHOICE PLUS,MGD,629.04,,,,,,,case rate,629.04,629.04,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
PROTHROMBIN SUBSTITUTION      ,38206590,CDM,305,RC,85611,CPT,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,AETNA,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,BCBS,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,CIGNA,COM,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,TRICARE,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,UNITED HEALTHCARE,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,UNITED HEALTHCARE,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,VA,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,VA TRICARE,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,WELLMED,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,HUMANA,MGD,48.37,,,,,,,per diem,48.37,48.37,"Per diem rate, code is bundled with other services"
THROMBOPLASTIN SUBSTITUTION   ,38206600,CDM,305,RC,85732,CPT,,,,Inpatient,,,48.37,48.37,HUMANA CHOICE PLUS,MGD,48.37,,,,,,,case rate,48.37,48.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,AETNA,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,BCBS,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,CIGNA,COM,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,TRICARE,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,UNITED HEALTHCARE,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,UNITED HEALTHCARE,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,VA,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,VA TRICARE,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,WELLMED,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,HUMANA,MGD,61.37,,,,,,,per diem,61.37,61.37,"Per diem rate, code is bundled with other services"
CARDIOLIPIN ANTIBODY          ,38206700,CDM,302,RC,86147,CPT,,,,Inpatient,,,61.37,61.37,HUMANA CHOICE PLUS,MGD,61.37,,,,,,,case rate,61.37,61.37,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,AETNA,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,BCBS,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,CIGNA,COM,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,TRICARE,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,UNITED HEALTHCARE,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,UNITED HEALTHCARE,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,VA,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,VA TRICARE,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,WELLMED,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,HUMANA,MGD,280.71,,,,,,,per diem,280.71,280.71,"Per diem rate, code is bundled with other services"
ASPERGILLUS ANTIBODY          ,38206710,CDM,302,RC,86606,CPT,,,,Inpatient,,,280.71,280.71,HUMANA CHOICE PLUS,MGD,280.71,,,,,,,case rate,280.71,280.71,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,AETNA,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,BCBS,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,CIGNA,COM,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,TRICARE,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,UNITED HEALTHCARE,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,UNITED HEALTHCARE,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,VA,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,VA TRICARE,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,WELLMED,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,HUMANA,MGD,197.38,,,,,,,per diem,197.38,197.38,"Per diem rate, code is bundled with other services"
HOMOCYSTINE                   ,38206757,CDM,301,RC,83090,CPT,,,,Inpatient,,,197.38,197.38,HUMANA CHOICE PLUS,MGD,197.38,,,,,,,case rate,197.38,197.38,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,AETNA,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,BCBS,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,CIGNA,COM,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,TRICARE,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,UNITED HEALTHCARE,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,UNITED HEALTHCARE,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,VA,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,VA TRICARE,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,WELLMED,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,HUMANA,MGD,440.39,,,,,,,per diem,440.39,440.39,"Per diem rate, code is bundled with other services"
HEPATITIS B VIRUS QUANT       ,38206802,CDM,306,RC,87517,CPT,,,,Inpatient,,,440.39,440.39,HUMANA CHOICE PLUS,MGD,440.39,,,,,,,case rate,440.39,440.39,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CARNITINE                     ,38206806,CDM,301,RC,82379,CPT,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,AETNA,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,BCBS,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,CIGNA,COM,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,TRICARE,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,UNITED HEALTHCARE,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,UNITED HEALTHCARE,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,VA,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,VA TRICARE,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,WELLMED,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,HUMANA,MGD,67.79,,,,,,,per diem,67.79,67.79,"Per diem rate, code is bundled with other services"
IMMUNOFLUR STDY EA AB INDIRECT,38206810,CDM,311,RC,88347,CPT,,,,Inpatient,,,67.79,67.79,HUMANA CHOICE PLUS,MGD,67.79,,,,,,,case rate,67.79,67.79,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,AETNA,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,BCBS,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,CIGNA,COM,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,TRICARE,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,UNITED HEALTHCARE,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,UNITED HEALTHCARE,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,VA,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,VA TRICARE,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,WELLMED,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,HUMANA,MGD,56.07,,,,,,,per diem,56.07,56.07,"Per diem rate, code is bundled with other services"
"ENZYME DETECTION, PER ENZYME  ",38207001,CDM,306,RC,87185,CPT,,,,Inpatient,,,56.07,56.07,HUMANA CHOICE PLUS,MGD,56.07,,,,,,,case rate,56.07,56.07,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
HEELSTICK                     ,38207002,CDM,300,RC,36416,CPT,,,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,AETNA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,BCBS,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,CIGNA,COM,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,UNITED HEALTHCARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,VA,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,VA TRICARE,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,WELLMED,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,HUMANA,MGD,41.1,,,,,,,per diem,41.1,41.1,"Per diem rate, code is bundled with other services"
"HIV1 & HIV2, SINGLE ASSSAY    ",38207004,CDM,300,RC,86703,CPT,G0432,HCPCS,,Inpatient,,,41.1,41.1,HUMANA CHOICE PLUS,MGD,41.1,,,,,,,case rate,41.1,41.1,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,AETNA,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,BCBS,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,CIGNA,COM,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,TRICARE,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,UNITED HEALTHCARE,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,UNITED HEALTHCARE,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,VA,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,VA TRICARE,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,WELLMED,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,HUMANA,MGD,238.53,,,,,,,per diem,238.53,238.53,"Per diem rate, code is bundled with other services"
CHROMIUM                      ,38207006,CDM,300,RC,82495,CPT,,,,Inpatient,,,238.53,238.53,HUMANA CHOICE PLUS,MGD,238.53,,,,,,,case rate,238.53,238.53,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,AETNA,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,CIGNA,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,TRICARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,UNITED HEALTHCARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,UNITED HEALTHCARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,VA,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,VA TRICARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,WELLMED,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,HUMANA,MGD,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR II            ,38207007,CDM,305,RC,85210,CPT,,,,Inpatient,,,466.96,466.96,HUMANA CHOICE PLUS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, CALIFORNIA      ",38207008,CDM,300,RC,86651,CPT,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, EASTERN EQUINE  ",38207009,CDM,300,RC,86652,CPT,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, ST. LOUIS       ",38207010,CDM,300,RC,86653,CPT,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
"ENCEPHALITIS, WESTERN EQUINE  ",38207011,CDM,300,RC,86654,CPT,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,AETNA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,CIGNA,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,VA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,VA TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,WELLMED,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,HUMANA,MGD,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
BARTONELLA/CAT SCRATCH DISEASE,38207012,CDM,300,RC,86611,CPT,,,,Inpatient,,,42.84,42.84,HUMANA CHOICE PLUS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,AETNA,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,BCBS,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,CIGNA,COM,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,TRICARE,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,UNITED HEALTHCARE,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,UNITED HEALTHCARE,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,VA,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,VA TRICARE,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,WELLMED,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,HUMANA,MGD,164.14,,,,,,,per diem,164.14,164.14,"Per diem rate, code is bundled with other services"
"HELICOBACTER PYLORI, STOOL    ",38207013,CDM,300,RC,87338,CPT,,,,Inpatient,,,164.14,164.14,HUMANA CHOICE PLUS,MGD,164.14,,,,,,,case rate,164.14,164.14,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,AETNA,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,BCBS,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,CIGNA,COM,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,TRICARE,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,UNITED HEALTHCARE,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,UNITED HEALTHCARE,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,VA,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,VA TRICARE,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,WELLMED,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,HUMANA,MGD,155.2,,,,,,,per diem,155.2,155.2,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS BLOOD          ,38207014,CDM,306,RC,87103,CPT,,,,Inpatient,,,155.2,155.2,HUMANA CHOICE PLUS,MGD,155.2,,,,,,,case rate,155.2,155.2,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,AETNA,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,BCBS,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,CIGNA,COM,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,TRICARE,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,UNITED HEALTHCARE,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,UNITED HEALTHCARE,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,VA,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,VA TRICARE,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,WELLMED,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,HUMANA,MGD,124.65,,,,,,,per diem,124.65,124.65,"Per diem rate, code is bundled with other services"
KB SENSITIVITY                ,38207015,CDM,306,RC,87184,CPT,,,,Inpatient,,,124.65,124.65,HUMANA CHOICE PLUS,MGD,124.65,,,,,,,case rate,124.65,124.65,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,AETNA,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,BCBS,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,CIGNA,COM,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,TRICARE,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,UNITED HEALTHCARE,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,UNITED HEALTHCARE,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,VA,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,VA TRICARE,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,WELLMED,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,HUMANA,MGD,34.07,,,,,,,per diem,34.07,34.07,"Per diem rate, code is bundled with other services"
PROTEIN S FUNCTIONAL          ,38207016,CDM,305,RC,85306,CPT,,,,Inpatient,,,34.07,34.07,HUMANA CHOICE PLUS,MGD,34.07,,,,,,,case rate,34.07,34.07,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,AETNA,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,CIGNA,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,TRICARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,UNITED HEALTHCARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,UNITED HEALTHCARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,VA,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,VA TRICARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,WELLMED,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,HUMANA,MGD,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
PNEUMOCYSTIS CARINII          ,38207018,CDM,306,RC,87281,CPT,,,,Inpatient,,,230.27,230.27,HUMANA CHOICE PLUS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
METHEMOGLOBIN QUANT           ,38207019,CDM,301,RC,83050,CPT,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,AETNA,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,BCBS,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,CIGNA,COM,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,TRICARE,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,UNITED HEALTHCARE,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,UNITED HEALTHCARE,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,VA,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,VA TRICARE,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,WELLMED,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,HUMANA,MGD,122.6,,,,,,,per diem,122.6,122.6,"Per diem rate, code is bundled with other services"
SUSCEPT STUDY AGAR(ESTRIP)    ,38207020,CDM,306,RC,87181,CPT,,,,Inpatient,,,122.6,122.6,HUMANA CHOICE PLUS,MGD,122.6,,,,,,,case rate,122.6,122.6,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,AETNA,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,BCBS,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,CIGNA,COM,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,TRICARE,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,UNITED HEALTHCARE,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,UNITED HEALTHCARE,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,VA,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,VA TRICARE,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,WELLMED,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,HUMANA,MGD,266.05,,,,,,,per diem,266.05,266.05,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUCLEIC ACID     ,38207023,CDM,306,RC,87149,CPT,,,,Inpatient,,,266.05,266.05,HUMANA CHOICE PLUS,MGD,266.05,,,,,,,case rate,266.05,266.05,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,AETNA,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,BCBS,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,CIGNA,COM,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,TRICARE,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,UNITED HEALTHCARE,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,UNITED HEALTHCARE,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,VA,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,VA TRICARE,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,WELLMED,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,HUMANA,MGD,185.15,,,,,,,per diem,185.15,185.15,"Per diem rate, code is bundled with other services"
DRUG TEST PRSMV CHEM ANLYZR   ,38207024,CDM,300,RC,80307,CPT,,,,Inpatient,,,185.15,185.15,HUMANA CHOICE PLUS,MGD,185.15,,,,,,,case rate,185.15,185.15,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,AETNA,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,BCBS,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,CIGNA,COM,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,TRICARE,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,UNITED HEALTHCARE,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,UNITED HEALTHCARE,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,VA,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,VA TRICARE,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,WELLMED,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,HUMANA,MGD,352.67,,,,,,,per diem,352.67,352.67,"Per diem rate, code is bundled with other services"
GI PATHOGEN 12-25 TARGETS     ,38207027,CDM,300,RC,87507,CPT,,,,Inpatient,,,352.67,352.67,HUMANA CHOICE PLUS,MGD,352.67,,,,,,,case rate,352.67,352.67,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,AETNA,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,BCBS,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,CIGNA,COM,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,TRICARE,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,UNITED HEALTHCARE,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,UNITED HEALTHCARE,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,VA,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,VA TRICARE,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,WELLMED,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,HUMANA,MGD,262.62,,,,,,,per diem,262.62,262.62,"Per diem rate, code is bundled with other services"
HIV-2 ANTIBODY                ,38207034,CDM,300,RC,86702,CPT,,,,Inpatient,,,262.62,262.62,HUMANA CHOICE PLUS,MGD,262.62,,,,,,,case rate,262.62,262.62,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,AETNA,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,BCBS,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,CIGNA,COM,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,TRICARE,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,UNITED HEALTHCARE,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,UNITED HEALTHCARE,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,VA,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,VA TRICARE,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,WELLMED,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,HUMANA,MGD,123.91,,,,,,,per diem,123.91,123.91,"Per diem rate, code is bundled with other services"
HIV-1 AG W/HIV-1 & HIV-2 AB   ,38207035,CDM,300,RC,87389,CPT,,,,Inpatient,,,123.91,123.91,HUMANA CHOICE PLUS,MGD,123.91,,,,,,,case rate,123.91,123.91,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,AETNA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,CIGNA,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,VA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,VA TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,WELLMED,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,HUMANA,MGD,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
FUNGI IDENTIFICATION MOLD     ,38207037,CDM,300,RC,87107,CPT,,,,Inpatient,,,14.77,14.77,HUMANA CHOICE PLUS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
CRYPTOCOCCUS AG SERUM TITER   ,38220001,CDM,306,RC,86406,CPT,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
IMMFLUOR TYPE                 ,38220510,CDM,306,RC,87140,CPT,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,AETNA,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,BCBS,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,CIGNA,COM,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,TRICARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,UNITED HEALTHCARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,UNITED HEALTHCARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,VA,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,VA TRICARE,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,WELLMED,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,HUMANA,MGD,116.8,,,,,,,per diem,116.8,116.8,"Per diem rate, code is bundled with other services"
CREATININE RANDOM URINE       ,38243603,CDM,301,RC,82570,CPT,,,,Inpatient,,,116.8,116.8,HUMANA CHOICE PLUS,MGD,116.8,,,,,,,case rate,116.8,116.8,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,AETNA,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,BCBS,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,CIGNA,COM,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,TRICARE,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,UNITED HEALTHCARE,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,UNITED HEALTHCARE,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,VA,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,VA TRICARE,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,WELLMED,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,HUMANA,MGD,82.75,,,,,,,per diem,82.75,82.75,"Per diem rate, code is bundled with other services"
PHOSPHOROUS URINE             ,38243604,CDM,301,RC,84105,CPT,,,,Inpatient,,,82.75,82.75,HUMANA CHOICE PLUS,MGD,82.75,,,,,,,case rate,82.75,82.75,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
PROTEIN URINE                 ,38243605,CDM,301,RC,84156,CPT,,,,Inpatient,,,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,AETNA,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,BCBS,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,CIGNA,COM,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,TRICARE,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,UNITED HEALTHCARE,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,UNITED HEALTHCARE,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,VA,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,VA TRICARE,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,WELLMED,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,HUMANA,MGD,44.55,,,,,,,per diem,44.55,44.55,"Per diem rate, code is bundled with other services"
"URIC ACID, NON-BLOOD          ",38243608,CDM,301,RC,84560,CPT,,,,Inpatient,,,44.55,44.55,HUMANA CHOICE PLUS,MGD,44.55,,,,,,,case rate,44.55,44.55,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
PROINSULIN                    ,38243613,CDM,301,RC,84206,CPT,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
"RHEUMATOID FACTOR, QUANT      ",38243614,CDM,302,RC,86431,CPT,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,AETNA,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,BCBS,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,CIGNA,COM,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,TRICARE,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,UNITED HEALTHCARE,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,UNITED HEALTHCARE,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,VA,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,VA TRICARE,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,WELLMED,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,HUMANA,MGD,181.48,,,,,,,per diem,181.48,181.48,"Per diem rate, code is bundled with other services"
DHEA (DEHYDROEPIANDROSTERONE) ,38243615,CDM,301,RC,82626,CPT,,,,Inpatient,,,181.48,181.48,HUMANA CHOICE PLUS,MGD,181.48,,,,,,,case rate,181.48,181.48,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,AETNA,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,CIGNA,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,TRICARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,UNITED HEALTHCARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,UNITED HEALTHCARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,VA,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,VA TRICARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,WELLMED,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,HUMANA,MGD,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
PARAINFLUENZA VIRUS (IFA)     ,38243616,CDM,306,RC,87279,CPT,,,,Inpatient,,,155.3,155.3,HUMANA CHOICE PLUS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
ALPROZOLAM (XANAX)            ,38243617,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,AETNA,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,BCBS,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,CIGNA,COM,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,TRICARE,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,UNITED HEALTHCARE,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,UNITED HEALTHCARE,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,VA,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,VA TRICARE,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,WELLMED,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,HUMANA,MGD,151.91,,,,,,,per diem,151.91,151.91,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR X             ,38243620,CDM,305,RC,85260,CPT,,,,Inpatient,,,151.91,151.91,HUMANA CHOICE PLUS,MGD,151.91,,,,,,,case rate,151.91,151.91,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,AETNA,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,BCBS,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,CIGNA,COM,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,TRICARE,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,UNITED HEALTHCARE,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,UNITED HEALTHCARE,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,VA,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,VA TRICARE,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,WELLMED,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,HUMANA,MGD,34.61,,,,,,,per diem,34.61,34.61,"Per diem rate, code is bundled with other services"
SOMATOMEDIN                   ,38243621,CDM,301,RC,84305,CPT,,,,Inpatient,,,34.61,34.61,HUMANA CHOICE PLUS,MGD,34.61,,,,,,,case rate,34.61,34.61,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,AETNA,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,BCBS,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,CIGNA,COM,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,TRICARE,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,UNITED HEALTHCARE,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,UNITED HEALTHCARE,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,VA,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,VA TRICARE,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,WELLMED,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,HUMANA,MGD,319.59,,,,,,,per diem,319.59,319.59,"Per diem rate, code is bundled with other services"
HEPATITIS C VIRUS AB RNA      ,38243624,CDM,306,RC,87522,CPT,,,,Inpatient,,,319.59,319.59,HUMANA CHOICE PLUS,MGD,319.59,,,,,,,case rate,319.59,319.59,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,AETNA,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,BCBS,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,CIGNA,COM,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,TRICARE,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,UNITED HEALTHCARE,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,UNITED HEALTHCARE,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,VA,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,VA TRICARE,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,WELLMED,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,HUMANA,MGD,174.42,,,,,,,per diem,174.42,174.42,"Per diem rate, code is bundled with other services"
GIARDIA ANTIGEN               ,38243626,CDM,306,RC,87329,CPT,,,,Inpatient,,,174.42,174.42,HUMANA CHOICE PLUS,MGD,174.42,,,,,,,case rate,174.42,174.42,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,AETNA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,CIGNA,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,VA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,VA TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,WELLMED,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,HUMANA,MGD,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ETHYLENE GLYCOL               ,38243628,CDM,301,RC,82693,CPT,,,,Inpatient,,,100.67,100.67,HUMANA CHOICE PLUS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,AETNA,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,BCBS,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,CIGNA,COM,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,TRICARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,UNITED HEALTHCARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,UNITED HEALTHCARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,VA,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,VA TRICARE,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,WELLMED,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,HUMANA,MGD,157.44,,,,,,,per diem,157.44,157.44,"Per diem rate, code is bundled with other services"
METHYL ALCOHOL                ,38243630,CDM,301,RC,84600,CPT,,,,Inpatient,,,157.44,157.44,HUMANA CHOICE PLUS,MGD,157.44,,,,,,,case rate,157.44,157.44,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,AETNA,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,CIGNA,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,TRICARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,UNITED HEALTHCARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,UNITED HEALTHCARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,VA,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,VA TRICARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,WELLMED,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,HUMANA,MGD,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
PARVOVIRUS ANTIBODY           ,38243631,CDM,302,RC,86747,CPT,,,,Inpatient,,,140.49,140.49,HUMANA CHOICE PLUS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,AETNA,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,BCBS,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,CIGNA,COM,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,TRICARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,UNITED HEALTHCARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,UNITED HEALTHCARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,VA,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,VA TRICARE,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,WELLMED,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,HUMANA,MGD,106.53,,,,,,,per diem,106.53,106.53,"Per diem rate, code is bundled with other services"
CRYPTOSPORIDIUM IMMUNOFLUOR   ,38243650,CDM,306,RC,87272,CPT,,,,Inpatient,,,106.53,106.53,HUMANA CHOICE PLUS,MGD,106.53,,,,,,,case rate,106.53,106.53,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,AETNA,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,CIGNA,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,TRICARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,UNITED HEALTHCARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,UNITED HEALTHCARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,VA,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,VA TRICARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,WELLMED,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,HUMANA,MGD,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250000,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,HUMANA CHOICE PLUS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,AETNA,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,CIGNA,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,TRICARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,UNITED HEALTHCARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,UNITED HEALTHCARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,VA,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,VA TRICARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,WELLMED,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,HUMANA,MGD,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250001,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,HUMANA CHOICE PLUS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38250002,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,AETNA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,CIGNA,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,VA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,VA TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,WELLMED,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA,MGD,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38250003,CDM,311,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA CHOICE PLUS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250004,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250005,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250006,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250007,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38250008,CDM,311,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,AETNA,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,CIGNA,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,TRICARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,UNITED HEALTHCARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,UNITED HEALTHCARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,VA,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,VA TRICARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,WELLMED,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,HUMANA,MGD,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250009,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,HUMANA CHOICE PLUS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38250010,CDM,311,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,AETNA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,CIGNA,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,WELLMED,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA,MGD,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38250011,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA CHOICE PLUS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,AETNA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,CIGNA,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,VA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,VA TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,WELLMED,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA,MGD,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ZAP-70 ANLYSIS            ,38250013,CDM,311,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA CHOICE PLUS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,AETNA,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,BCBS,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,CIGNA,COM,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,TRICARE,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,UNITED HEALTHCARE,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,UNITED HEALTHCARE,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,VA,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,VA TRICARE,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,WELLMED,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,HUMANA,MGD,979.97,,,,,,,per diem,979.97,979.97,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 1            ,38250014,CDM,301,RC,,,,,,Inpatient,,,979.97,979.97,HUMANA CHOICE PLUS,MGD,979.97,,,,,,,case rate,979.97,979.97,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,AETNA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,CIGNA,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,WELLMED,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA,MGD,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 3            ,38250015,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA CHOICE PLUS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,AETNA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,CIGNA,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,WELLMED,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA,MGD,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O IGG SUBCLASS 4            ,38250016,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA CHOICE PLUS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BEEF              ,38250017,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CARROT            ,38250018,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHOCOLATE         ,38250019,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CODFISH IGE       ,38250020,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGEY CORN             ,38250021,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORANGE            ,38250022,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PORK              ,38250023,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY STRAWBERRY        ,38250024,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN           ,38250025,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BERMUDA     ,38250026,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAT DANDER        ,38250027,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCKROACH GER     ,38250028,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE COTTONWD     ,38250029,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES             ,38250030,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MESQUITE     ,38250031,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE CEDAR        ,38250032,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OLIVE        ,38250033,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS RYE         ,38250034,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED PIGWEED      ,38250035,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED THISTLE      ,38250036,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED SCALE        ,38250037,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY APPLE             ,38250038,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHITE         ,38250039,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY MILK COW          ,38250040,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY OAT               ,38250041,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOMATO            ,38250042,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEANUT            ,38250043,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY BARLEY            ,38250044,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RYE               ,38250045,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY RICE              ,38250046,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLUTEN            ,38250047,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEAT             ,38250048,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ASH          ,38250049,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY SALMON            ,38250050,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O ALLERGY SHRIMP            ,38250051,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TROUT             ,38250052,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY TURKEY            ,38250053,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,AETNA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,CIGNA,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,WELLMED,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA,MGD,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG ALTERNARIA ALT     ,38250054,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA CHOICE PLUS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY BRAZIL NUT        ,38250055,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASHEW            ,38250056,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,AETNA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,CIGNA,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,WELLMED,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA,MGD,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY MITES D PTERO     ,38250057,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA CHOICE PLUS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,AETNA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,CIGNA,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,WELLMED,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA,MGD,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG YOLK          ,38250058,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA CHOICE PLUS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAZELNUT          ,38250059,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PECAN             ,38250060,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,AETNA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,BCBS,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,CIGNA,COM,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,UNITED HEALTHCARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,VA TRICARE,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,WELLMED,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA,MGD,48.2,,,,,,,per diem,48.2,48.2,"Per diem rate, code is bundled with other services"
S/O ALLERG PENICILLM NOTA     ,38250061,CDM,302,RC,,,,,,Inpatient,,,48.2,48.2,HUMANA CHOICE PLUS,MGD,48.2,,,,,,,case rate,48.2,48.2,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY PISTACHIO         ,38250062,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEST RAGWEED      ,38250063,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMOXICILLIN       ,38250064,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AMPICILLIN        ,38250065,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN G      ,38250066,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PENICILLIN V      ,38250067,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARAKEET DROP     ,38250068,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKEN FEATH     ,38250069,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY COW HAIR/DAND     ,38250070,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY DOG DANDER        ,38250071,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOOSE FEATHER     ,38250072,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HAMSTER EPITH     ,38250073,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG HORSE HAIR/DND     ,38250074,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE EPITHEL     ,38250075,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARAKEET FEATH     ,38250076,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RABBIT EPITH      ,38250077,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG SHEEP EPITH/WL     ,38250078,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALMOND            ,38250079,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY APRICOT           ,38250080,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY AVOCADO           ,38250081,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BANANA            ,38250082,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER BELL       ,38250083,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK PEPPER      ,38250084,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUEBERRY         ,38250085,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BROCCOLI          ,38250086,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CABBAGE           ,38250087,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CASEIN            ,38250088,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CELERY            ,38250089,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE CHEDDR     ,38250090,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEESE MOLD       ,38250091,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHESTNUT          ,38250092,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHICKPEA          ,38250093,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEPPER CHILI      ,38250094,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLAM              ,38250095,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COCONUT           ,38250096,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY COFFEE            ,38250097,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRAB              ,38250098,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGGPLANT          ,38250099,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY EGG WHOLE         ,38250100,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLOUNDER GULF     ,38250101,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GARLIC            ,38250102,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPE             ,38250103,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRAPEFRUIT        ,38250104,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GREEN BEAN        ,38250105,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HALIBUT           ,38250106,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HOPS              ,38250107,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIDNEY BEAN       ,38250108,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY KIWI              ,38250109,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LAMB              ,38250110,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEMON             ,38250111,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LENTIL            ,38250112,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY LETTUCE           ,38250113,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG LIMA/WHIT BEAN     ,38250114,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LIME IGE          ,38250115,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LOBSTER           ,38250116,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACKEREL          ,38250117,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MALT              ,38250118,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MANGO             ,38250119,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYDEW/CANTA     ,38250120,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA LACTALB     ,38250121,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BETA LACTOGLO     ,38250122,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSHROOM          ,38250123,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLUE MUSSEL       ,38250124,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MUSTARD           ,38250125,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY NAVY BEAN         ,38250126,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY ONION             ,38250127,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY OYSTER            ,38250128,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,AETNA,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,BCBS,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,CIGNA,COM,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,TRICARE,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,UNITED HEALTHCARE,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,UNITED HEALTHCARE,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,VA,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,VA TRICARE,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,WELLMED,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,HUMANA,MGD,252.38,,,,,,,per diem,252.38,252.38,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPAYA            ,38250129,CDM,302,RC,,,,,,Inpatient,,,252.38,252.38,HUMANA CHOICE PLUS,MGD,252.38,,,,,,,case rate,252.38,252.38,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEA               ,38250130,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEACH             ,38250131,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PEAR              ,38250132,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINE NUT          ,38250133,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PINEAPPLE         ,38250134,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PLUM              ,38250135,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY POTATO            ,38250136,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SCALLOP           ,38250137,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SESAME SEED       ,38250138,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOYBEAN           ,38250139,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SPINACH           ,38250140,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TEA               ,38250141,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TUNA              ,38250142,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY VANILLA           ,38250143,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALNUT IGE        ,38250144,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WATERMELON IGE     ,38250145,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHEY IGE          ,38250146,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BAHIA       ,38250147,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS BENT/RED     ,38250148,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BROME       ,38250149,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS CANARY      ,38250150,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULTCORN     ,38250151,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULT OAT     ,38250152,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS CULWHEAT     ,38250153,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS JOHNSON     ,38250154,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS JUN/KENT     ,38250155,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS MEADOW      ,38250156,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS ORCHARD     ,38250157,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG GRASS SWEETVER     ,38250158,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS TIMOTHY     ,38250159,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY FIRE ANT          ,38250160,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG HONEYBEE VENOM     ,38250161,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY LEPIDOGLYPHUS     ,38250162,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TRICHOPHYTON      ,38250163,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY PAPER WASP        ,38250164,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET WHITE      ,38250165,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY HORNET YELLOW     ,38250166,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY YELLOW JACKET     ,38250167,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD ASPERGIL     ,38250168,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD AUREOBAS     ,38250169,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CANDIDA      ,38250170,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CEPHALOS     ,38250171,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD CURVULAR     ,38250172,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD EPICOCCUM     ,38250173,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD FUSARIUM     ,38250174,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD HELMINTHO     ,38250175,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD HORMODEN     ,38250176,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD MUCOR RAC     ,38250177,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD PHOMA BET     ,38250178,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD RHIZOPUS      ,38250179,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG MOLD STEMPHYL      ,38250180,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE HDI     ,38250181,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE MDI     ,38250182,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ISOCYANATE TDI     ,38250183,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUNFLOWER IGE     ,38250184,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TOBACCO           ,38250185,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG PARASITE ASCAR     ,38250186,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ACACIA       ,38250187,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ALDER        ,38250188,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE/BOX     ,38250189,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE ELM          ,38250190,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MOUN CEDR     ,38250191,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE OAK          ,38250192,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PECAN        ,38250193,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE WHIT PINE     ,38250194,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE PRIVET       ,38250195,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE SWEET GUM     ,38250196,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,AETNA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,CIGNA,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,WELLMED,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA,MGD,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE SYCAMORE     ,38250197,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA CHOICE PLUS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE VIRG OAK      ,38250198,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WALNUT       ,38250199,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE MULBERRY     ,38250200,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY TREE WILLOW       ,38250201,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED COCKLEBUR     ,38250202,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEEG C/S       ,38250203,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED FALSE     ,38250204,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAGWEED GIANT     ,38250205,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED DANDELION     ,38250206,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED ENGL PLAN     ,38250207,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED GOLDENROD     ,38250208,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED KOCH/FIRE     ,38250209,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED LAMB QRT     ,38250210,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED MARSH ELD     ,38250211,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED MUGWORT      ,38250212,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED NETTLE       ,38250213,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SAGE/WOOD     ,38250214,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SHEEP SOR     ,38250215,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ACARUS SIRO       ,38250216,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALFALFA IGE       ,38250217,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ARIZ      ,38250218,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CYPRESS ITAL      ,38250219,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ASPARAGUS IGE     ,38250220,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PARROT DROP       ,38250221,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE GROUNDSEL     ,38250222,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS BARLEY      ,38250223,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BASS BLACK        ,38250224,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY BAYBERRY IGE      ,38250225,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHERRY IGE        ,38250226,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CLOVE IGE         ,38250227,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CINNAMON          ,38250228,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CRANBERRY IGE     ,38250229,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY CUCUMBER IGE      ,38250230,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG D MICROCER IGE     ,38250231,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG ETHYLENE OXIDE     ,38250232,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY EUROGLYPHUS       ,38250233,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY FORMALDEHYDE      ,38250234,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GINGER IGE        ,38250235,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GLYCOPHAGUS       ,38250236,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT EPITHEL      ,38250237,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GUINEA PIG EP     ,38250238,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY HADDOCK IGE       ,38250239,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MELALEUCA     ,38250240,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOSQUITO IGE      ,38250241,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOUSE URINE       ,38250242,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ORRIS ROOT        ,38250243,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE PALM/QUEN     ,38250244,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIG EPITH IGE     ,38250245,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY PIGEON STOOL      ,38250246,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE POPLAR WH     ,38250247,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY POPPY SEED        ,38250248,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERG PTHALIC ANHYDR     ,38250249,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RASPBERRY IGE     ,38250250,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT EPITHIL       ,38250251,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY RAT URINE IGE     ,38250252,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY REED POLLEN       ,38250253,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY GRASS SALT        ,38250254,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY MOLD STEMPHYL     ,38250255,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARBEET IGE     ,38250256,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SUGARCANE IGE     ,38250257,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SQUASH SUMMER     ,38250258,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWEET POTATO      ,38250259,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY TYROPHAGUS        ,38250260,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY YAM IGE           ,38250261,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY WEED YEL DOCK     ,38250262,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O ALLERGY ZUCCHINI IGE      ,38250263,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKOLIVE IGG     ,38250264,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERGY MACADAMIA NUT     ,38250265,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ALLERGY LATEX IGE         ,38250266,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLERG ASPERGIL NIGER     ,38250267,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O ALLERGY ARTICHOKE IGE     ,38250268,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY ANCHOVY IGE       ,38250269,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CAROB GUM IGE     ,38250270,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY NUTMEG IGE        ,38250271,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG PUMPK SEED IGE     ,38250272,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED DYE 4 IgE     ,38250273,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY RED SNAPP IGE     ,38250274,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SAGE IGE          ,38250275,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SOLE IGE          ,38250276,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY SWORDFISH IGE     ,38250277,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY THYME IGE         ,38250278,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY TILAPIA IGE       ,38250279,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY FLAXSEED IGE      ,38250280,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHITEFISH IGE     ,38250281,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLRG DOUGLAS FIR IGE     ,38250282,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED SUNFLOWER     ,38250283,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BLACKBERRY IGE     ,38250284,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY CILANTRO IGE      ,38250285,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY GOAT MILK IGE     ,38250286,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HONEY IGE         ,38250287,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY MINT IGE          ,38250288,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY WALLEYE PIKE      ,38250289,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG CHAETOMIUM IGE     ,38250290,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BUMBLE BEE IGE     ,38250291,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG BALD CYPRESS       ,38250292,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERGY HACKBERRY IGE     ,38250293,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O ALLERG WEED CARELESS      ,38250294,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG CUMIN SEED IGE     ,38250295,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE ASPEN IGE     ,38250296,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERGY BLACK WILLOW      ,38250297,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O ALLERG TREE MAPLE SUG     ,38250298,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,AETNA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,CIGNA,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,WELLMED,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA,MGD,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O ALLERGY ALPHA GAL IGE     ,38250299,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA CHOICE PLUS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250300,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250301,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST GREER     ,38250302,CDM,302,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG HOUS DUST STIER     ,38250303,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,AETNA,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,CIGNA,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,TRICARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,UNITED HEALTHCARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,UNITED HEALTHCARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,VA,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,VA TRICARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,WELLMED,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,HUMANA,MGD,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250304,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,HUMANA CHOICE PLUS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,AETNA,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,BCBS,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,CIGNA,COM,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,TRICARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,UNITED HEALTHCARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,UNITED HEALTHCARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,VA,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,VA TRICARE,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,WELLMED,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,HUMANA,MGD,329.87,,,,,,,per diem,329.87,329.87,"Per diem rate, code is bundled with other services"
S/O VARICELLA ZOST AB IGG     ,38250305,CDM,302,RC,,,,,,Inpatient,,,329.87,329.87,HUMANA CHOICE PLUS,MGD,329.87,,,,,,,case rate,329.87,329.87,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,AETNA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,CIGNA,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,WELLMED,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA,MGD,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL G IGG        ,38250306,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA CHOICE PLUS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,AETNA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,CIGNA,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,WELLMED,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA,MGD,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBUL M IGM        ,38250307,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA CHOICE PLUS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,AETNA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,CIGNA,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,WELLMED,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA,MGD,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250308,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA CHOICE PLUS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,AETNA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,BCBS,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,CIGNA,COM,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,UNITED HEALTHCARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,VA TRICARE,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,WELLMED,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA,MGD,206.7,,,,,,,per diem,206.7,206.7,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250309,CDM,301,RC,,,,,,Inpatient,,,206.7,206.7,HUMANA CHOICE PLUS,MGD,206.7,,,,,,,case rate,206.7,206.7,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,AETNA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,CIGNA,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,WELLMED,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA,MGD,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250310,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA CHOICE PLUS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN D SERM     ,38250311,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,AETNA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,CIGNA,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,WELLMED,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA,MGD,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250312,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA CHOICE PLUS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250313,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,AETNA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,CIGNA,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,WELLMED,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA,MGD,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250314,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA CHOICE PLUS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250315,CDM,301,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250316,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,AETNA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,CIGNA,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,VA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,VA TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,WELLMED,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA,MGD,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O ABO DISCREPANCY UBS       ,38250317,CDM,309,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA CHOICE PLUS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,AETNA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,CIGNA,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,VA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,VA TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,WELLMED,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA,MGD,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O RH DISCREPANCY UBS        ,38250318,CDM,309,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA CHOICE PLUS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O RH TYPE                   ,38250319,CDM,309,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,AETNA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,CIGNA,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,VA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,VA TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,WELLMED,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA,MGD,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O PCCA/ANNA IFA W/RFLX      ,38250320,CDM,302,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA CHOICE PLUS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,AETNA,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,BCBS,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,CIGNA,COM,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,TRICARE,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,UNITED HEALTHCARE,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,UNITED HEALTHCARE,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,VA,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,VA TRICARE,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,WELLMED,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,HUMANA,MGD,604.04,,,,,,,per diem,604.04,604.04,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA W RFLX      ,38250321,CDM,302,RC,,,,,,Inpatient,,,604.04,604.04,HUMANA CHOICE PLUS,MGD,604.04,,,,,,,case rate,604.04,604.04,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,AETNA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,CIGNA,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,VA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,VA TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,WELLMED,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA,MGD,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
S/O STRIATED MUSCLE IGG       ,38250322,CDM,302,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA CHOICE PLUS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL AB IGG         ,38250323,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,AETNA,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,BCBS,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,CIGNA,COM,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,TRICARE,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,UNITED HEALTHCARE,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,UNITED HEALTHCARE,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,VA,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,VA TRICARE,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,WELLMED,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,HUMANA,MGD,812.89,,,,,,,per diem,812.89,812.89,"Per diem rate, code is bundled with other services"
S/O YO AB CSF W/RFLX          ,38250324,CDM,302,RC,,,,,,Inpatient,,,812.89,812.89,HUMANA CHOICE PLUS,MGD,812.89,,,,,,,case rate,812.89,812.89,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,AETNA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,CIGNA,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,VA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,VA TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,WELLMED,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA,MGD,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O ANCA W REFLEX             ,38250325,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA CHOICE PLUS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,AETNA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,CIGNA,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,VA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,VA TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,WELLMED,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA,MGD,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250326,CDM,302,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA CHOICE PLUS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O HU IFA W/RFLX             ,38250327,CDM,302,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250328,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG WRFLX         ,38250329,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,AETNA,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,BCBS,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,CIGNA,COM,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,TRICARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,UNITED HEALTHCARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,UNITED HEALTHCARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,VA,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,VA TRICARE,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,WELLMED,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,HUMANA,MGD,1311.98,,,,,,,per diem,1311.98,1311.98,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 RCPT AB CSF     ,38250330,CDM,302,RC,,,,,,Inpatient,,,1311.98,1311.98,HUMANA CHOICE PLUS,MGD,1311.98,,,,,,,case rate,1311.98,1311.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O BETA HCG QN TUMR MARK     ,38250331,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250332,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LIPOPROFILE NMR           ,38250333,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PLEURAL      ,38250334,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ADENO DEAMIN PERITON      ,38250335,CDM,301,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,AETNA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,CIGNA,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,VA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,VA TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,WELLMED,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA,MGD,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
S/O PORPHYRIN TTL PLM/SRM     ,38250336,CDM,301,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA CHOICE PLUS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250337,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250338,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,AETNA,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,BCBS,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,CIGNA,COM,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,TRICARE,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,UNITED HEALTHCARE,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,UNITED HEALTHCARE,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,VA,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,VA TRICARE,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,WELLMED,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,HUMANA,MGD,223.84,,,,,,,per diem,223.84,223.84,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250339,CDM,305,RC,,,,,,Inpatient,,,223.84,223.84,HUMANA CHOICE PLUS,MGD,223.84,,,,,,,case rate,223.84,223.84,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,AETNA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,CIGNA,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,VA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,VA TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,WELLMED,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA,MGD,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O FREE KAPPA/LAMBDA         ,38250340,CDM,301,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA CHOICE PLUS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,AETNA,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,CIGNA,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,TRICARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,UNITED HEALTHCARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,UNITED HEALTHCARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,VA,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,VA TRICARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,WELLMED,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,HUMANA,MGD,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O TRYPTASE                  ,38250341,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,HUMANA CHOICE PLUS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG SUGARCANE IGG4     ,38250342,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,AETNA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,CIGNA,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,VA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,VA TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,WELLMED,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA,MGD,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 6             ,38250343,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA CHOICE PLUS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O TSH RECEPTOR AB           ,38250344,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O INHIBIN B                 ,38250345,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O INTERLEUKIN 1 BETA        ,38250346,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O TUMOR NECROSIS FACTOR     ,38250347,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O ANTI MULLERIAN HORMON     ,38250348,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,AETNA,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,CIGNA,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,TRICARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,UNITED HEALTHCARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,UNITED HEALTHCARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,VA,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,VA TRICARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,WELLMED,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,HUMANA,MGD,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
S/O TOTAL INHIBIN             ,38250349,CDM,301,RC,,,,,,Inpatient,,,741.13,741.13,HUMANA CHOICE PLUS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PANCREATC ELAST FECAL     ,38250350,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,AETNA,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,CIGNA,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,TRICARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,UNITED HEALTHCARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,UNITED HEALTHCARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,VA,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,VA TRICARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,WELLMED,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,HUMANA,MGD,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O ALPHA SUBUNIT PGH         ,38250351,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,HUMANA CHOICE PLUS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O INTERLEUK 2 RCPT CD25     ,38250352,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,AETNA,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,CIGNA,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,TRICARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,UNITED HEALTHCARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,UNITED HEALTHCARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,VA,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,VA TRICARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,WELLMED,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,HUMANA,MGD,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250353,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,HUMANA CHOICE PLUS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,AETNA,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,BCBS,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,CIGNA,COM,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,TRICARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,UNITED HEALTHCARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,UNITED HEALTHCARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,VA,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,VA TRICARE,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,WELLMED,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,HUMANA,MGD,1681.47,,,,,,,per diem,1681.47,1681.47,"Per diem rate, code is bundled with other services"
S/O ADMARK CSF ANALYS         ,38250354,CDM,301,RC,,,,,,Inpatient,,,1681.47,1681.47,HUMANA CHOICE PLUS,MGD,1681.47,,,,,,,case rate,1681.47,1681.47,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,AETNA,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,BCBS,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,CIGNA,COM,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,TRICARE,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,UNITED HEALTHCARE,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,UNITED HEALTHCARE,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,VA,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,VA TRICARE,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,WELLMED,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,HUMANA,MGD,384.49,,,,,,,per diem,384.49,384.49,"Per diem rate, code is bundled with other services"
S/O VITAMIN B7                ,38250356,CDM,301,RC,,,,,,Inpatient,,,384.49,384.49,HUMANA CHOICE PLUS,MGD,384.49,,,,,,,case rate,384.49,384.49,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,AETNA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,CIGNA,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,WELLMED,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA,MGD,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250357,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA CHOICE PLUS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,AETNA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,CIGNA,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,WELLMED,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA,MGD,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250358,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA CHOICE PLUS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,AETNA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,CIGNA,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,VA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,VA TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,WELLMED,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA,MGD,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
S/O ALPHA FETOPROTEIN         ,38250359,CDM,301,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA CHOICE PLUS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,AETNA,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,BCBS,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,CIGNA,COM,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,TRICARE,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,UNITED HEALTHCARE,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,UNITED HEALTHCARE,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,VA,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,VA TRICARE,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,WELLMED,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,HUMANA,MGD,568.7,,,,,,,per diem,568.7,568.7,"Per diem rate, code is bundled with other services"
S/O ALDOSTERONE SERUM         ,38250360,CDM,301,RC,,,,,,Inpatient,,,568.7,568.7,HUMANA CHOICE PLUS,MGD,568.7,,,,,,,case rate,568.7,568.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250361,CDM,301,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,AETNA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,CIGNA,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,VA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,VA TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,WELLMED,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA,MGD,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN TROUGH LEVEL     ,38250362,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA CHOICE PLUS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,AETNA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,CIGNA,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,VA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,VA TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,WELLMED,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA,MGD,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O AMIKACIN RANDOM LEVEL     ,38250363,CDM,301,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA CHOICE PLUS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O SULFONAMIDES              ,38250364,CDM,301,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O STREPTOMYCIN HPLC S/P     ,38250365,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,AETNA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,CIGNA,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,VA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,VA TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,WELLMED,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA,MGD,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O AMIODARONE METABOLITE     ,38250366,CDM,301,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA CHOICE PLUS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O 5 FLUOROCYTOSINE          ,38250367,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O FLECAINIDE                ,38250368,CDM,301,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O METHOTREXATE              ,38250369,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,AETNA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,CIGNA,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,VA TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,WELLMED,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA,MGD,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CLOZAPINE QNT SRM/PLS     ,38250370,CDM,301,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA CHOICE PLUS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
ACETONE/KETONES QN            ,38250371,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,AETNA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,BCBS,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,CIGNA,COM,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,UNITED HEALTHCARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,VA,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,VA TRICARE,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,WELLMED,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA,MGD,439.11,,,,,,,per diem,439.11,439.11,"Per diem rate, code is bundled with other services"
S/O CA 15-3                   ,38250372,CDM,302,RC,,,,,,Inpatient,,,439.11,439.11,HUMANA CHOICE PLUS,MGD,439.11,,,,,,,case rate,439.11,439.11,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,AETNA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,CIGNA,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,VA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,VA TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,WELLMED,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA,MGD,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250373,CDM,305,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA CHOICE PLUS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250374,CDM,305,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
AMYLASE                       ,38250375,CDM,301,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O AMYLASE ISOENZYME         ,38250376,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250377,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250378,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,AETNA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,CIGNA,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,WELLMED,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA,MGD,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O ANA ANTINUCLEAR BLD       ,38250379,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA CHOICE PLUS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250380,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O SCLER ANA IGG IFA         ,38250381,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,AETNA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,CIGNA,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,VA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,VA TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,WELLMED,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA,MGD,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
S/O ANGIOTEN CONVERT CSF      ,38250382,CDM,301,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA CHOICE PLUS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O CYSTICERCO AB IGG CSF     ,38250383,CDM,302,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O STRONGYLOD AB IGG SRM     ,38250384,CDM,302,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O TOXOCARA AB IGG ELISA     ,38250385,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,AETNA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,CIGNA,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,VA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,VA TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,WELLMED,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA,MGD,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O SCHISTOSOMA AB IGG        ,38250386,CDM,302,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA CHOICE PLUS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,AETNA,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,BCBS,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,CIGNA,COM,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,TRICARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,UNITED HEALTHCARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,UNITED HEALTHCARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,VA,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,VA TRICARE,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,WELLMED,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,HUMANA,MGD,539.78,,,,,,,per diem,539.78,539.78,"Per diem rate, code is bundled with other services"
S/O ECHINOCOCCUS AB IGG       ,38250387,CDM,302,RC,,,,,,Inpatient,,,539.78,539.78,HUMANA CHOICE PLUS,MGD,539.78,,,,,,,case rate,539.78,539.78,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,AETNA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,CIGNA,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,VA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,VA TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,WELLMED,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA,MGD,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
AB ID RBC EACH PANEL          ,38250388,CDM,309,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA CHOICE PLUS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,AETNA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,CIGNA,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,VA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,VA TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,WELLMED,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,HUMANA,MGD,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
S/O ANTIBODY ID UBS           ,38250389,CDM,309,RC,,,,,,Inpatient,,,198.14,198.14,HUMANA CHOICE PLUS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,AETNA,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,CIGNA,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,TRICARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,UNITED HEALTHCARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,UNITED HEALTHCARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,VA,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,VA TRICARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,WELLMED,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,HUMANA,MGD,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O FICIN AB ID UBS           ,38250390,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,HUMANA CHOICE PLUS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,AETNA,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,BCBS,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,CIGNA,COM,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,TRICARE,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,UNITED HEALTHCARE,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,UNITED HEALTHCARE,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,VA,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,VA TRICARE,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,WELLMED,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,HUMANA,MGD,216.34,,,,,,,per diem,216.34,216.34,"Per diem rate, code is bundled with other services"
S/O AB ID RBC EACH PANEL      ,38250391,CDM,309,RC,,,,,,Inpatient,,,216.34,216.34,HUMANA CHOICE PLUS,MGD,216.34,,,,,,,case rate,216.34,216.34,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,AETNA,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,BCBS,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,CIGNA,COM,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,TRICARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,UNITED HEALTHCARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,UNITED HEALTHCARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,VA,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,VA TRICARE,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,WELLMED,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,HUMANA,MGD,104.96,,,,,,,per diem,104.96,104.96,"Per diem rate, code is bundled with other services"
S/O ANTIBODY DETECT UBS       ,38250392,CDM,309,RC,,,,,,Inpatient,,,104.96,104.96,HUMANA CHOICE PLUS,MGD,104.96,,,,,,,case rate,104.96,104.96,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250393,CDM,309,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,AETNA,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,BCBS,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,CIGNA,COM,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,TRICARE,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,UNITED HEALTHCARE,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,UNITED HEALTHCARE,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,VA,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,VA TRICARE,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,WELLMED,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,HUMANA,MGD,379.13,,,,,,,per diem,379.13,379.13,"Per diem rate, code is bundled with other services"
S/O ANTI-DSDNA                ,38250394,CDM,302,RC,,,,,,Inpatient,,,379.13,379.13,HUMANA CHOICE PLUS,MGD,379.13,,,,,,,case rate,379.13,379.13,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG ELISA           ,38250395,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,AETNA,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,BCBS,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,CIGNA,COM,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,TRICARE,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,UNITED HEALTHCARE,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,UNITED HEALTHCARE,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,VA,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,VA TRICARE,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,WELLMED,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,HUMANA,MGD,1489.76,,,,,,,per diem,1489.76,1489.76,"Per diem rate, code is bundled with other services"
S/O SRA UNFRAC HEPARIN        ,38250396,CDM,302,RC,,,,,,Inpatient,,,1489.76,1489.76,HUMANA CHOICE PLUS,MGD,1489.76,,,,,,,case rate,1489.76,1489.76,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,AETNA,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,CIGNA,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,TRICARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,UNITED HEALTHCARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,UNITED HEALTHCARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,VA,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,VA TRICARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,WELLMED,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,HUMANA,MGD,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
S/O PLATELET AB INDIRECT      ,38250397,CDM,302,RC,,,,,,Inpatient,,,589.05,589.05,HUMANA CHOICE PLUS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,AETNA,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,BCBS,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,CIGNA,COM,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,TRICARE,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,UNITED HEALTHCARE,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,UNITED HEALTHCARE,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,VA,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,VA TRICARE,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,WELLMED,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,HUMANA,MGD,538.38,,,,,,,per diem,538.38,538.38,"Per diem rate, code is bundled with other services"
S/O PLATELET ANTIBODY ID      ,38250398,CDM,302,RC,,,,,,Inpatient,,,538.38,538.38,HUMANA CHOICE PLUS,MGD,538.38,,,,,,,case rate,538.38,538.38,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,AETNA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,CIGNA,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,VA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,VA TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,WELLMED,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA,MGD,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O PLATELET AB HIT ASSAY     ,38250399,CDM,302,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA CHOICE PLUS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,AETNA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,CIGNA,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,VA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,VA TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,WELLMED,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA,MGD,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
S/O PLATELET CROSSM ELISA     ,38250400,CDM,302,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA CHOICE PLUS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,AETNA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,CIGNA,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,VA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,VA TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,WELLMED,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,HUMANA,MGD,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O PLATELET AB SCR ELISA     ,38250401,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,HUMANA CHOICE PLUS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,AETNA,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,CIGNA,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,TRICARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,UNITED HEALTHCARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,UNITED HEALTHCARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,VA,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,VA TRICARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,WELLMED,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,HUMANA,MGD,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250402,CDM,305,RC,,,,,,Inpatient,,,524.79,524.79,HUMANA CHOICE PLUS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,AETNA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,CIGNA,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,VA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,VA TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,WELLMED,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,HUMANA,MGD,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O TISSUE PLASM ACTIV AG     ,38250403,CDM,305,RC,,,,,,Inpatient,,,79.25,79.25,HUMANA CHOICE PLUS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250404,CDM,305,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,AETNA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,CIGNA,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,VA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,VA TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,WELLMED,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA,MGD,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
"S/O 1,3 BETA D GLUCAN         ",38250405,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA CHOICE PLUS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,AETNA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,BCBS,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,CIGNA,COM,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,UNITED HEALTHCARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,VA,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,VA TRICARE,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,WELLMED,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA,MGD,501.23,,,,,,,per diem,501.23,501.23,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES DERM EIA      ,38250406,CDM,306,RC,,,,,,Inpatient,,,501.23,501.23,HUMANA CHOICE PLUS,MGD,501.23,,,,,,,case rate,501.23,501.23,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA A AB IGM        ,38250407,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGG        ,38250408,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O INFLUENZA B AB IGM        ,38250409,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,AETNA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,CIGNA,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,WELLMED,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA,MGD,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O PROBNP NT                 ,38250410,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA CHOICE PLUS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250411,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250412,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250413,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250414,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250415,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250416,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250417,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250418,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250419,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,AETNA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,BCBS,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,CIGNA,COM,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,UNITED HEALTHCARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,VA TRICARE,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,WELLMED,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA,MGD,352.36,,,,,,,per diem,352.36,352.36,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38250420,CDM,306,RC,,,,,,Inpatient,,,352.36,352.36,HUMANA CHOICE PLUS,MGD,352.36,,,,,,,case rate,352.36,352.36,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O UREA NITROGEN FLUID       ,38250421,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,AETNA,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,CIGNA,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,TRICARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,UNITED HEALTHCARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,UNITED HEALTHCARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,VA,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,VA TRICARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,WELLMED,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,HUMANA,MGD,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250422,CDM,301,RC,,,,,,Inpatient,,,232.41,232.41,HUMANA CHOICE PLUS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,AETNA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,CIGNA,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,VA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,VA TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,WELLMED,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA,MGD,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CRP HIGH SENSITIVITY          ,38250423,CDM,302,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA CHOICE PLUS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O CALCIUM IONIZED SERUM     ,38250424,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYON AG FLD     ,38250425,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONIC AG       ,38250426,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,AETNA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,CIGNA,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,VA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,VA TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,WELLMED,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA,MGD,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O CARCINOEMBRYONC AG BF     ,38250427,CDM,301,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA CHOICE PLUS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,AETNA,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,BCBS,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,CIGNA,COM,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,TRICARE,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,UNITED HEALTHCARE,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,UNITED HEALTHCARE,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,VA,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,VA TRICARE,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,WELLMED,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,HUMANA,MGD,545.14,,,,,,,per diem,545.14,545.14,"Per diem rate, code is bundled with other services"
S/O CATECHOLAMIN FRAC UR      ,38250428,CDM,301,RC,,,,,,Inpatient,,,545.14,545.14,HUMANA CHOICE PLUS,MGD,545.14,,,,,,,case rate,545.14,545.14,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O MTB SUSCEPT/BROTH DIL     ,38250429,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NOCARD     ,38250430,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O BETA2 GLYCOPR1 AB         ,38250431,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250432,CDM,302,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250433,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGCC AB                   ,38250434,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O VGKC AB                   ,38250435,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PANCREATIC POLYPEPTID     ,38250436,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O 21 HYDROXYLASE AB         ,38250437,CDM,301,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM ALPHA     ,38250438,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM GAMMA     ,38250439,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
S/O MELANOCYTE STIM BETA      ,38250440,CDM,301,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,AETNA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,CIGNA,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,VA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,VA TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,WELLMED,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA,MGD,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
RL-A-IGF 2 2007565            ,38250441,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA CHOICE PLUS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,AETNA,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,BCBS,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,CIGNA,COM,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,TRICARE,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,UNITED HEALTHCARE,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,UNITED HEALTHCARE,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,VA,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,VA TRICARE,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,WELLMED,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,HUMANA,MGD,196.35,,,,,,,per diem,196.35,196.35,"Per diem rate, code is bundled with other services"
CELL CT FLUID W/DIFF          ,38250442,CDM,309,RC,,,,,,Inpatient,,,196.35,196.35,HUMANA CHOICE PLUS,MGD,196.35,,,,,,,case rate,196.35,196.35,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O M TUBERCULOSIS AMP DD     ,38250443,CDM,306,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,AETNA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,CIGNA,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,WELLMED,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA,MGD,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250444,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA CHOICE PLUS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250445,CDM,302,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,AETNA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,CIGNA,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,VA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,VA TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,WELLMED,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA,MGD,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250446,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA CHOICE PLUS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,AETNA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,CIGNA,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,VA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,VA TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,WELLMED,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA,MGD,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
S/O VONWILLE MULT PNL         ,38250447,CDM,305,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA CHOICE PLUS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,AETNA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,CIGNA,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,VA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,VA TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,WELLMED,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA,MGD,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O FACTOR VIII ACTIVITY      ,38250448,CDM,305,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA CHOICE PLUS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,AETNA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,CIGNA,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,VA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,VA TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,WELLMED,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA,MGD,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 2         ,38250449,CDM,302,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA CHOICE PLUS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT COMP 1Q        ,38250450,CDM,302,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,AETNA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,CIGNA,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,VA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,VA TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,WELLMED,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,HUMANA,MGD,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C3             ,38250451,CDM,302,RC,,,,,,Inpatient,,,499.09,499.09,HUMANA CHOICE PLUS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,AETNA,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,BCBS,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,CIGNA,COM,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,TRICARE,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,UNITED HEALTHCARE,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,UNITED HEALTHCARE,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,VA,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,VA TRICARE,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,WELLMED,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,HUMANA,MGD,555.85,,,,,,,per diem,555.85,555.85,"Per diem rate, code is bundled with other services"
S/O COMPLEMENT C4             ,38250452,CDM,302,RC,,,,,,Inpatient,,,555.85,555.85,HUMANA CHOICE PLUS,MGD,555.85,,,,,,,case rate,555.85,555.85,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,AETNA,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,BCBS,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,CIGNA,COM,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,TRICARE,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,UNITED HEALTHCARE,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,UNITED HEALTHCARE,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,VA,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,VA TRICARE,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,WELLMED,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,HUMANA,MGD,209.92,,,,,,,per diem,209.92,209.92,"Per diem rate, code is bundled with other services"
S/O COPPER SERUM/PLASMA       ,38250453,CDM,301,RC,,,,,,Inpatient,,,209.92,209.92,HUMANA CHOICE PLUS,MGD,209.92,,,,,,,case rate,209.92,209.92,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,AETNA,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,CIGNA,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,TRICARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,UNITED HEALTHCARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,UNITED HEALTHCARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,VA,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,VA TRICARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,WELLMED,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,HUMANA,MGD,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
S/O COPPER URINE              ,38250454,CDM,301,RC,,,,,,Inpatient,,,397.34,397.34,HUMANA CHOICE PLUS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,AETNA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,CIGNA,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,VA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,VA TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,WELLMED,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA,MGD,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
CORTISOL TOTAL                ,38250455,CDM,301,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA CHOICE PLUS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,AETNA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,CIGNA,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,VA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,VA TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,WELLMED,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA,MGD,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O CORTISOL SALIVA           ,38250456,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA CHOICE PLUS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,AETNA,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,CIGNA,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,TRICARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,UNITED HEALTHCARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,UNITED HEALTHCARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,VA,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,VA TRICARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,WELLMED,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,HUMANA,MGD,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250457,CDM,302,RC,,,,,,Inpatient,,,283.82,283.82,HUMANA CHOICE PLUS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250458,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O SACCHAR CEREVIS AB        ,38250459,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250460,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O INFLAMM BOWEL PROFILE     ,38250461,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGA WRFLX     ,38250462,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IGM WRFLX     ,38250463,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250464,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250465,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O B PERTUSSIS IMMUN         ,38250466,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O CELIAC PANEL              ,38250467,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGA      ,38250468,CDM,301,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,AETNA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,CIGNA,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,VA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,VA TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,WELLMED,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA,MGD,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGA            ,38250469,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA CHOICE PLUS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,AETNA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,CIGNA,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,VA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,VA TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,WELLMED,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA,MGD,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O GLIADIN DP IGG            ,38250470,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA CHOICE PLUS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O TISSUE TRANSGLUT IGG      ,38250471,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,AETNA,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,BCBS,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,CIGNA,COM,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,TRICARE,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,UNITED HEALTHCARE,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,UNITED HEALTHCARE,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,VA,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,VA TRICARE,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,WELLMED,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,HUMANA,MGD,147.67,,,,,,,per diem,147.67,147.67,"Per diem rate, code is bundled with other services"
S/O SOLUBLE LIVER AG IGG      ,38250472,CDM,301,RC,,,,,,Inpatient,,,147.67,147.67,HUMANA CHOICE PLUS,MGD,147.67,,,,,,,case rate,147.67,147.67,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O MAG AB IGM                ,38250473,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,AETNA,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,CIGNA,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,TRICARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,UNITED HEALTHCARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,UNITED HEALTHCARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,VA,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,VA TRICARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,WELLMED,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,HUMANA,MGD,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O GLUTAMIC ACID DECARB      ,38250474,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,HUMANA CHOICE PLUS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,AETNA,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,BCBS,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,CIGNA,COM,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,TRICARE,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,UNITED HEALTHCARE,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,UNITED HEALTHCARE,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,VA,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,VA TRICARE,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,WELLMED,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,HUMANA,MGD,182.07,,,,,,,per diem,182.07,182.07,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC BLOCK AB     ,38250475,CDM,301,RC,,,,,,Inpatient,,,182.07,182.07,HUMANA CHOICE PLUS,MGD,182.07,,,,,,,case rate,182.07,182.07,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,AETNA,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,CIGNA,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,TRICARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,UNITED HEALTHCARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,UNITED HEALTHCARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,VA,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,VA TRICARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,WELLMED,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,HUMANA,MGD,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O ACETYLCH REC MODUL AB     ,38250476,CDM,301,RC,,,,,,Inpatient,,,188.5,188.5,HUMANA CHOICE PLUS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O SIGNAL RECOG PARTICLE     ,38250477,CDM,301,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,AETNA,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,CIGNA,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,TRICARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,UNITED HEALTHCARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,UNITED HEALTHCARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,VA,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,VA TRICARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,WELLMED,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,HUMANA,MGD,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O GASTRIC PARIETAL IGG      ,38250478,CDM,301,RC,,,,,,Inpatient,,,285.96,285.96,HUMANA CHOICE PLUS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,AETNA,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,BCBS,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,CIGNA,COM,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,TRICARE,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,UNITED HEALTHCARE,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,UNITED HEALTHCARE,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,VA,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,VA TRICARE,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,WELLMED,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,HUMANA,MGD,403.77,,,,,,,per diem,403.77,403.77,"Per diem rate, code is bundled with other services"
S/O HISTONE ANTIBODY IGG      ,38250479,CDM,301,RC,,,,,,Inpatient,,,403.77,403.77,HUMANA CHOICE PLUS,MGD,403.77,,,,,,,case rate,403.77,403.77,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O AQUAPORIN 4 RECEPT AB     ,38250480,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O TITAN ANTIBODY            ,38250481,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,AETNA,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,BCBS,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,CIGNA,COM,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,TRICARE,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,UNITED HEALTHCARE,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,UNITED HEALTHCARE,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,VA,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,VA TRICARE,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,WELLMED,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,HUMANA,MGD,159.55,,,,,,,per diem,159.55,159.55,"Per diem rate, code is bundled with other services"
S/O RNA POLYMERAS III IGG     ,38250482,CDM,301,RC,,,,,,Inpatient,,,159.55,159.55,HUMANA CHOICE PLUS,MGD,159.55,,,,,,,case rate,159.55,159.55,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O F-ACTIN ANTIBODY IGA      ,38250483,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O F-ACTIN AB IGG ELISA      ,38250484,CDM,301,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O MYELOPEROXIDASE AB        ,38250485,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O SERINE PROTEASE 3 AB      ,38250486,CDM,301,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250487,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250488,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250489,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250490,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250491,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250492,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250493,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250494,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250495,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,AETNA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,CIGNA,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,VA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,VA TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,WELLMED,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA,MGD,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250496,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA CHOICE PLUS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,AETNA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,CIGNA,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,VA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,VA TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,WELLMED,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA,MGD,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
"S/O IGG DESMOGLEN 1,3         ",38250497,CDM,301,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA CHOICE PLUS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250498,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250499,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250500,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250501,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250502,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O GANGLIOSID IGG/IGM        ,38250503,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,AETNA,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,CIGNA,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,TRICARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,UNITED HEALTHCARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,UNITED HEALTHCARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,VA,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,VA TRICARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,WELLMED,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,HUMANA,MGD,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250504,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,HUMANA CHOICE PLUS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,AETNA,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,BCBS,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,CIGNA,COM,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,TRICARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,UNITED HEALTHCARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,UNITED HEALTHCARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,VA,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,VA TRICARE,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,WELLMED,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,HUMANA,MGD,441.25,,,,,,,per diem,441.25,441.25,"Per diem rate, code is bundled with other services"
S/O BP 180 230 AG IGG         ,38250505,CDM,301,RC,,,,,,Inpatient,,,441.25,441.25,HUMANA CHOICE PLUS,MGD,441.25,,,,,,,case rate,441.25,441.25,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O GBM IGG MBA IFA           ,38250506,CDM,301,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O CHROMATIN AB IGG          ,38250507,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,AETNA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,CIGNA,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,VA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,VA TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,WELLMED,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA,MGD,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER TH/TO BY IPP        ,38250508,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA CHOICE PLUS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,AETNA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,CIGNA,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,VA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,VA TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,WELLMED,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA,MGD,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNA POL III IGG     ,38250509,CDM,301,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA CHOICE PLUS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP JO-1 IGG     ,38250510,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP MI-2         ,38250511,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-7         ,38250512,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PL-12        ,38250513,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP P155/140     ,38250514,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP EJ           ,38250515,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP KU           ,38250516,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SRP          ,38250517,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP OJ           ,38250518,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP PM/SCL       ,38250519,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250520,CDM,301,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HISTAMINE URINE           ,38250521,CDM,301,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE FLD                ,38250522,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
CREATININE OTHER              ,38250523,CDM,301,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250524,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,AETNA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,CIGNA,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,VA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,VA TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,WELLMED,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA,MGD,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O CK ISOENZYMES             ,38250525,CDM,301,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA CHOICE PLUS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O C-REACTIVE PROTEIN        ,38250526,CDM,302,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O THROM RISK REPTL TIME     ,38250527,CDM,305,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PLATELET ASSOC AB         ,38250528,CDM,302,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250529,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250530,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250531,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250532,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250533,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250534,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250535,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250536,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250537,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,AETNA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,BCBS,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,CIGNA,COM,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,UNITED HEALTHCARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,VA TRICARE,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,WELLMED,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA,MGD,113.53,,,,,,,per diem,113.53,113.53,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250538,CDM,302,RC,,,,,,Inpatient,,,113.53,113.53,HUMANA CHOICE PLUS,MGD,113.53,,,,,,,case rate,113.53,113.53,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250539,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB PANEL        ,38250540,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250541,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250542,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250543,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AB DIFF         ,38250544,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,AETNA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,CIGNA,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,VA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,VA TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,WELLMED,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA,MGD,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O PHENYTOIN FREE/TOTAL      ,38250545,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA CHOICE PLUS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
AMPHETAMINE PRESUM NO OPT     ,38250546,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BARBITURATE PRESUM NO OPT     ,38250547,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
BENZODIAZEP PRESUM NO OPT     ,38250548,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CANNABINOID PRESUM NO OPT     ,38250549,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
COCAINE PRESUMP NOT OPT       ,38250550,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
CHAIN OF CUSTODY CHG          ,38250551,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
OPIATES PRESUMP NOT OPT       ,38250552,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
PCP SCRN PRESUMP NOT OPT      ,38250553,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TRICYCLIC ANTIDEPRESS     ,38250554,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O ETHANOL URINE QUAL        ,38250555,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,AETNA,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,BCBS,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,CIGNA,COM,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,TRICARE,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,UNITED HEALTHCARE,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,UNITED HEALTHCARE,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,VA,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,VA TRICARE,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,WELLMED,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,HUMANA,MGD,399.48,,,,,,,per diem,399.48,399.48,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM          ,38250556,CDM,301,RC,,,,,,Inpatient,,,399.48,399.48,HUMANA CHOICE PLUS,MGD,399.48,,,,,,,case rate,399.48,399.48,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,AETNA,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,BCBS,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,CIGNA,COM,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,TRICARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,UNITED HEALTHCARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,UNITED HEALTHCARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,VA,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,VA TRICARE,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,WELLMED,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,HUMANA,MGD,112.46,,,,,,,per diem,112.46,112.46,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250557,CDM,301,RC,,,,,,Inpatient,,,112.46,112.46,HUMANA CHOICE PLUS,MGD,112.46,,,,,,,case rate,112.46,112.46,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,AETNA,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,BCBS,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,CIGNA,COM,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,TRICARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,UNITED HEALTHCARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,UNITED HEALTHCARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,VA,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,VA TRICARE,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,WELLMED,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,HUMANA,MGD,149.94,,,,,,,per diem,149.94,149.94,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250558,CDM,301,RC,,,,,,Inpatient,,,149.94,149.94,HUMANA CHOICE PLUS,MGD,149.94,,,,,,,case rate,149.94,149.94,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,AETNA,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,BCBS,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,CIGNA,COM,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,TRICARE,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,UNITED HEALTHCARE,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,UNITED HEALTHCARE,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,VA,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,VA TRICARE,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,WELLMED,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,HUMANA,MGD,808.61,,,,,,,per diem,808.61,808.61,"Per diem rate, code is bundled with other services"
SALICYLATE                    ,38250560,CDM,301,RC,,,,,,Inpatient,,,808.61,808.61,HUMANA CHOICE PLUS,MGD,808.61,,,,,,,case rate,808.61,808.61,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,AETNA,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,CIGNA,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,TRICARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,UNITED HEALTHCARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,UNITED HEALTHCARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,VA,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,VA TRICARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,WELLMED,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,HUMANA,MGD,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O ETHYL GLUC UR W/RFLX      ,38250561,CDM,301,RC,,,,,,Inpatient,,,433.76,433.76,HUMANA CHOICE PLUS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,AETNA,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,BCBS,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,CIGNA,COM,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,TRICARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UNITED HEALTHCARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,UNITED HEALTHCARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,VA,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,VA TRICARE,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,WELLMED,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,HUMANA,MGD,776.48,,,,,,,per diem,776.48,776.48,"Per diem rate, code is bundled with other services"
S/O GHB URINE W/RFLX          ,38250562,CDM,301,RC,,,,,,Inpatient,,,776.48,776.48,HUMANA CHOICE PLUS,MGD,776.48,,,,,,,case rate,776.48,776.48,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,AETNA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,CIGNA,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,VA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,VA TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,WELLMED,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA,MGD,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O ISOPROPANOL               ,38250563,CDM,301,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA CHOICE PLUS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN UR QUAL         ,38250564,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O DRUG SCRN SERUM           ,38250565,CDM,301,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,AETNA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,CIGNA,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,VA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,VA TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,WELLMED,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA,MGD,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
S/O ESTRADIOL                 ,38250566,CDM,301,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA CHOICE PLUS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,AETNA,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,BCBS,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,CIGNA,COM,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,TRICARE,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,UNITED HEALTHCARE,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,UNITED HEALTHCARE,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,VA,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,VA TRICARE,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,WELLMED,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,HUMANA,MGD,517.29,,,,,,,per diem,517.29,517.29,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38250567,CDM,301,RC,,,,,,Inpatient,,,517.29,517.29,HUMANA CHOICE PLUS,MGD,517.29,,,,,,,case rate,517.29,517.29,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,AETNA,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,CIGNA,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,TRICARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,UNITED HEALTHCARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,UNITED HEALTHCARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,VA,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,VA TRICARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,WELLMED,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,HUMANA,MGD,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250568,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,HUMANA CHOICE PLUS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,AETNA,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,BCBS,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,CIGNA,COM,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,TRICARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,UNITED HEALTHCARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,UNITED HEALTHCARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,VA,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,VA TRICARE,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,WELLMED,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,HUMANA,MGD,288.1,,,,,,,per diem,288.1,288.1,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250569,CDM,305,RC,,,,,,Inpatient,,,288.1,288.1,HUMANA CHOICE PLUS,MGD,288.1,,,,,,,case rate,288.1,288.1,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O T PALLIDUM IGG TP-PA      ,38250570,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TEPONEMA PALL IGG CSF     ,38250571,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGM           ,38250572,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,AETNA,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,BCBS,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,CIGNA,COM,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,TRICARE,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,UNITED HEALTHCARE,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,UNITED HEALTHCARE,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,VA,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,VA TRICARE,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,WELLMED,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,HUMANA,MGD,445.54,,,,,,,per diem,445.54,445.54,"Per diem rate, code is bundled with other services"
S/O H PYLORI AB IGG           ,38250573,CDM,302,RC,,,,,,Inpatient,,,445.54,445.54,HUMANA CHOICE PLUS,MGD,445.54,,,,,,,case rate,445.54,445.54,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O HEPATITIS A AB TOTAL      ,38250574,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O HEPATITIS C AB CIA        ,38250575,CDM,302,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O DRVVT 1:1 MIX RFLX        ,38250576,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O DRVVT CONFIRM RFLX        ,38250577,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250578,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O THROM RISK DRVVT CONF     ,38250579,CDM,305,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST CLT         ,38250580,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O HIV-1 AB DIFFERENTIAT     ,38250581,CDM,302,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 2 GLYCO IGG      ,38250582,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O TRYPANOSOMA CRUZI IGM     ,38250583,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,AETNA,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,BCBS,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,CIGNA,COM,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,TRICARE,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,UNITED HEALTHCARE,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,UNITED HEALTHCARE,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,VA,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,VA TRICARE,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,WELLMED,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,HUMANA,MGD,373.78,,,,,,,per diem,373.78,373.78,"Per diem rate, code is bundled with other services"
S/O ENTAMOEBA HIST AB IGG     ,38250584,CDM,302,RC,,,,,,Inpatient,,,373.78,373.78,HUMANA CHOICE PLUS,MGD,373.78,,,,,,,case rate,373.78,373.78,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGG       ,38250585,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O BABESIA MICROTI IGM       ,38250586,CDM,302,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,AETNA,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,BCBS,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,CIGNA,COM,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,TRICARE,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,UNITED HEALTHCARE,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,UNITED HEALTHCARE,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,VA,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,VA TRICARE,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,WELLMED,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,HUMANA,MGD,571.91,,,,,,,per diem,571.91,571.91,"Per diem rate, code is bundled with other services"
S/O INSULIN TOTAL             ,38250587,CDM,301,RC,,,,,,Inpatient,,,571.91,571.91,HUMANA CHOICE PLUS,MGD,571.91,,,,,,,case rate,571.91,571.91,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O LACTIC ACID BODY FLUD     ,38250588,CDM,301,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,AETNA,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,CIGNA,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,TRICARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,UNITED HEALTHCARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,UNITED HEALTHCARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,VA,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,VA TRICARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,WELLMED,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,HUMANA,MGD,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LDH TOTAL BODY FLUID      ,38250589,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,HUMANA CHOICE PLUS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,AETNA,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,BCBS,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,CIGNA,COM,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,TRICARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,UNITED HEALTHCARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,UNITED HEALTHCARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,VA,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,VA TRICARE,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,WELLMED,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,HUMANA,MGD,18.21,,,,,,,per diem,18.21,18.21,"Per diem rate, code is bundled with other services"
S/O LD ISOENZYMES             ,38250590,CDM,301,RC,,,,,,Inpatient,,,18.21,18.21,HUMANA CHOICE PLUS,MGD,18.21,,,,,,,case rate,18.21,18.21,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,AETNA,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,BCBS,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,CIGNA,COM,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,TRICARE,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,UNITED HEALTHCARE,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,UNITED HEALTHCARE,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,VA,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,VA TRICARE,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,WELLMED,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,HUMANA,MGD,491.59,,,,,,,per diem,491.59,491.59,"Per diem rate, code is bundled with other services"
S/O LEGIONEL TYP1 IGM IFA     ,38250591,CDM,302,RC,,,,,,Inpatient,,,491.59,491.59,HUMANA CHOICE PLUS,MGD,491.59,,,,,,,case rate,491.59,491.59,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LAP STAIN                 ,38250592,CDM,305,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250593,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38250594,CDM,301,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,AETNA,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,CIGNA,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,TRICARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,UNITED HEALTHCARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,UNITED HEALTHCARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,VA,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,VA TRICARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,WELLMED,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,HUMANA,MGD,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
S/O BORRELIA BURG TTL CSF     ,38250595,CDM,302,RC,,,,,,Inpatient,,,650.1,650.1,HUMANA CHOICE PLUS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM URINE           ,38250596,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MAGNESIUM RBC             ,38250597,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250598,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB W/RFLX     ,38250599,CDM,302,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250600,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250601,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250602,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250603,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O PRIMIDONE METABOL         ,38250604,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PHENOBARBITAL             ,38250605,CDM,301,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250606,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,AETNA,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,CIGNA,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,TRICARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,UNITED HEALTHCARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,UNITED HEALTHCARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,VA,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,VA TRICARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,WELLMED,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,HUMANA,MGD,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250607,CDM,301,RC,,,,,,Inpatient,,,27.5,27.5,HUMANA CHOICE PLUS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250608,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250609,CDM,301,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O MACROPROLACTIN            ,38250610,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,AETNA,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,BCBS,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,CIGNA,COM,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,TRICARE,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,UNITED HEALTHCARE,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,UNITED HEALTHCARE,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,VA,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,VA TRICARE,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,WELLMED,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,HUMANA,MGD,835.38,,,,,,,per diem,835.38,835.38,"Per diem rate, code is bundled with other services"
S/O PROLACTIN ASSAY           ,38250611,CDM,301,RC,,,,,,Inpatient,,,835.38,835.38,HUMANA CHOICE PLUS,MGD,835.38,,,,,,,case rate,835.38,835.38,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O PSA FREE/TOTAL            ,38250612,CDM,301,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,AETNA,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,BCBS,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,CIGNA,COM,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,TRICARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,UNITED HEALTHCARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,UNITED HEALTHCARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,VA,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,VA TRICARE,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,WELLMED,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,HUMANA,MGD,138.16,,,,,,,per diem,138.16,138.16,"Per diem rate, code is bundled with other services"
PSA SCRN                      ,38250613,CDM,301,RC,,,,,,Inpatient,,,138.16,138.16,HUMANA CHOICE PLUS,MGD,138.16,,,,,,,case rate,138.16,138.16,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTRO SRM       ,38250614,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECT CSF         ,38250615,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,AETNA,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,BCBS,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,CIGNA,COM,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,TRICARE,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,UNITED HEALTHCARE,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,UNITED HEALTHCARE,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,VA,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,VA TRICARE,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,WELLMED,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,HUMANA,MGD,195.99,,,,,,,per diem,195.99,195.99,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250616,CDM,301,RC,,,,,,Inpatient,,,195.99,195.99,HUMANA CHOICE PLUS,MGD,195.99,,,,,,,case rate,195.99,195.99,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT W/RFLX     ,38250617,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250618,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250619,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,AETNA,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,BCBS,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,CIGNA,COM,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,TRICARE,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,UNITED HEALTHCARE,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,UNITED HEALTHCARE,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,VA,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,VA TRICARE,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,WELLMED,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,HUMANA,MGD,421.97,,,,,,,per diem,421.97,421.97,"Per diem rate, code is bundled with other services"
S/O PTH INTACT W/CA GRAPH     ,38250620,CDM,301,RC,,,,,,Inpatient,,,421.97,421.97,HUMANA CHOICE PLUS,MGD,421.97,,,,,,,case rate,421.97,421.97,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,AETNA,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,BCBS,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,CIGNA,COM,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,TRICARE,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,UNITED HEALTHCARE,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,UNITED HEALTHCARE,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,VA,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,VA TRICARE,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,WELLMED,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,HUMANA,MGD,302.02,,,,,,,per diem,302.02,302.02,"Per diem rate, code is bundled with other services"
PTH INTRAOPERATIVE            ,38250621,CDM,301,RC,,,,,,Inpatient,,,302.02,302.02,HUMANA CHOICE PLUS,MGD,302.02,,,,,,,case rate,302.02,302.02,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O LUPUS ANTICOAGULANT       ,38250622,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38250623,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PTT WRFLX     ,38250624,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250625,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250626,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT            ,38250627,CDM,305,RC,,,,,,Inpatient,,,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O HAEMOPH INFL B AB IGG     ,38250628,CDM,302,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O DIPTHERIA AB IGG          ,38250629,CDM,302,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,AETNA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,CIGNA,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,VA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,VA TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,WELLMED,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA,MGD,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O TETANUS AB IGG            ,38250630,CDM,302,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA CHOICE PLUS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250631,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250632,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250633,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250634,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250635,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250636,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250637,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250638,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250639,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250640,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250641,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250642,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O STREP PNEUM IGG14         ,38250643,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250644,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250645,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250646,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250647,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250648,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250649,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250650,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250651,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250652,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250653,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250654,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250655,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250656,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250657,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250658,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250659,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250660,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250661,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250662,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250663,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250664,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250665,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O PNEUMO AB IGG 23          ,38250666,CDM,302,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGM            ,38250667,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,AETNA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,CIGNA,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,VA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,VA TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,WELLMED,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA,MGD,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O RUBELLA AB IGG            ,38250668,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA CHOICE PLUS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250669,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,AETNA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,CIGNA,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,WELLMED,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA,MGD,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250670,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA CHOICE PLUS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,AETNA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,CIGNA,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,VA TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,WELLMED,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA,MGD,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O RUBEOLLA AB IGG           ,38250671,CDM,302,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA CHOICE PLUS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O SODIUM FLUID              ,38250672,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,AETNA,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,BCBS,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,CIGNA,COM,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,TRICARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,UNITED HEALTHCARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,UNITED HEALTHCARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,VA,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,VA TRICARE,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,WELLMED,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,HUMANA,MGD,130.66,,,,,,,per diem,130.66,130.66,"Per diem rate, code is bundled with other services"
S/O TESTOSTER FEMALE/CHLD     ,38250673,CDM,301,RC,,,,,,Inpatient,,,130.66,130.66,HUMANA CHOICE PLUS,MGD,130.66,,,,,,,case rate,130.66,130.66,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE TOTAL        ,38250674,CDM,301,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O THEOPHYLLINE HCCL         ,38250675,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,AETNA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,CIGNA,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,VA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,VA TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,WELLMED,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA,MGD,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME 1:1 MIX     ,38250676,CDM,305,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA CHOICE PLUS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,AETNA,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,CIGNA,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,TRICARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,UNITED HEALTHCARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,UNITED HEALTHCARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,VA,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,VA TRICARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,WELLMED,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,HUMANA,MGD,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROMBIN TIME RLFX        ,38250677,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,HUMANA CHOICE PLUS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,AETNA,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,BCBS,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,CIGNA,COM,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,TRICARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,UNITED HEALTHCARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,UNITED HEALTHCARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,VA,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,VA TRICARE,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,WELLMED,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,HUMANA,MGD,389.84,,,,,,,per diem,389.84,389.84,"Per diem rate, code is bundled with other services"
S/O THROM RISK THROM TIME     ,38250678,CDM,305,RC,,,,,,Inpatient,,,389.84,389.84,HUMANA CHOICE PLUS,MGD,389.84,,,,,,,case rate,389.84,389.84,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O VAP CHOLESTEROL           ,38250679,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
UA AUTO W/O MICRO             ,38250680,CDM,307,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,AETNA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,CIGNA,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,VA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,VA TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,WELLMED,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA,MGD,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AG EIA UR     ,38250681,CDM,306,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA CHOICE PLUS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O HTLV I/II AB ELISA        ,38250682,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGG        ,38250683,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O HEPATITIS E AB IGM        ,38250684,CDM,302,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,AETNA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,CIGNA,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,VA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,VA TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,WELLMED,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA,MGD,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O DENGUE FEVER IGG          ,38250685,CDM,302,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA CHOICE PLUS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250686,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS W RFLX         ,38250687,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGG CONF       ,38250688,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O HANTAVIRUS IGM CONF       ,38250689,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGG           ,38250690,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,AETNA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,BCBS,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,CIGNA,COM,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,UNITED HEALTHCARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,VA,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,VA TRICARE,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,WELLMED,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA,MGD,53.55,,,,,,,per diem,53.55,53.55,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA IGM           ,38250691,CDM,302,RC,,,,,,Inpatient,,,53.55,53.55,HUMANA CHOICE PLUS,MGD,53.55,,,,,,,case rate,53.55,53.55,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS AB IGG         ,38250692,CDM,302,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,AETNA,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,BCBS,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,CIGNA,COM,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,TRICARE,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,UNITED HEALTHCARE,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,UNITED HEALTHCARE,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,VA,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,VA TRICARE,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,WELLMED,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,HUMANA,MGD,451.96,,,,,,,per diem,451.96,451.96,"Per diem rate, code is bundled with other services"
S/O ALK PHOS SRM/PLSM         ,38250693,CDM,301,RC,,,,,,Inpatient,,,451.96,451.96,HUMANA CHOICE PLUS,MGD,451.96,,,,,,,case rate,451.96,451.96,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,AETNA,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,BCBS,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,CIGNA,COM,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,TRICARE,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,UNITED HEALTHCARE,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,UNITED HEALTHCARE,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,VA,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,VA TRICARE,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,WELLMED,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,HUMANA,MGD,418.76,,,,,,,per diem,418.76,418.76,"Per diem rate, code is bundled with other services"
S/O ARSENIC URINE W/RFLX      ,38250694,CDM,301,RC,,,,,,Inpatient,,,418.76,418.76,HUMANA CHOICE PLUS,MGD,418.76,,,,,,,case rate,418.76,418.76,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,AETNA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,CIGNA,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,VA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,VA TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,WELLMED,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA,MGD,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O ARSENIC FRAC URINE        ,38250695,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA CHOICE PLUS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,AETNA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,CIGNA,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,VA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,VA TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,WELLMED,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA,MGD,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250696,CDM,301,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA CHOICE PLUS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,AETNA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,CIGNA,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,VA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,VA TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,WELLMED,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,HUMANA,MGD,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
S/O MERCURY WHOLE BLOOD       ,38250697,CDM,301,RC,,,,,,Inpatient,,,306.31,306.31,HUMANA CHOICE PLUS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,AETNA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,CIGNA,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,VA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,VA TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,WELLMED,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA,MGD,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250698,CDM,301,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA CHOICE PLUS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,AETNA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,CIGNA,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,VA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,VA TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,WELLMED,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA,MGD,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O PENTOBARBITAL             ,38250699,CDM,301,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA CHOICE PLUS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250700,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,AETNA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,CIGNA,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,VA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,VA TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,WELLMED,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA,MGD,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O THC METAB URINE QUANT     ,38250701,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA CHOICE PLUS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,AETNA,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,BCBS,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,CIGNA,COM,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,TRICARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,UNITED HEALTHCARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,UNITED HEALTHCARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,VA,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,VA TRICARE,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,WELLMED,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,HUMANA,MGD,1118.12,,,,,,,per diem,1118.12,1118.12,"Per diem rate, code is bundled with other services"
S/O CHR ANL BONE MARR         ,38250702,CDM,311,RC,,,,,,Inpatient,,,1118.12,1118.12,HUMANA CHOICE PLUS,MGD,1118.12,,,,,,,case rate,1118.12,1118.12,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,AETNA,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,CIGNA,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,TRICARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,UNITED HEALTHCARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,UNITED HEALTHCARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,VA,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,VA TRICARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,WELLMED,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,HUMANA,MGD,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38250703,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,HUMANA CHOICE PLUS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,AETNA,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,BCBS,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,CIGNA,COM,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,TRICARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,UNITED HEALTHCARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,UNITED HEALTHCARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,VA,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,VA TRICARE,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,WELLMED,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,HUMANA,MGD,1926.73,,,,,,,per diem,1926.73,1926.73,"Per diem rate, code is bundled with other services"
S/O CHR ANL LYMPH NOD         ,38250704,CDM,311,RC,,,,,,Inpatient,,,1926.73,1926.73,HUMANA CHOICE PLUS,MGD,1926.73,,,,,,,case rate,1926.73,1926.73,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,AETNA,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,CIGNA,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,TRICARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,UNITED HEALTHCARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,UNITED HEALTHCARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,VA,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,VA TRICARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,WELLMED,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,HUMANA,MGD,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38250705,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,HUMANA CHOICE PLUS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,AETNA,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,BCBS,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,CIGNA,COM,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,TRICARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,UNITED HEALTHCARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,UNITED HEALTHCARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,VA,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,VA TRICARE,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,WELLMED,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,HUMANA,MGD,1098.85,,,,,,,per diem,1098.85,1098.85,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38250706,CDM,311,RC,,,,,,Inpatient,,,1098.85,1098.85,HUMANA CHOICE PLUS,MGD,1098.85,,,,,,,case rate,1098.85,1098.85,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,AETNA,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,BCBS,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,CIGNA,COM,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,TRICARE,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,UNITED HEALTHCARE,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,UNITED HEALTHCARE,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,VA,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,VA TRICARE,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,WELLMED,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,HUMANA,MGD,183.14,,,,,,,per diem,183.14,183.14,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38250707,CDM,311,RC,,,,,,Inpatient,,,183.14,183.14,HUMANA CHOICE PLUS,MGD,183.14,,,,,,,case rate,183.14,183.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,AETNA,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,BCBS,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,CIGNA,COM,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,TRICARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,UNITED HEALTHCARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,UNITED HEALTHCARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,VA,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,VA TRICARE,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,WELLMED,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,HUMANA,MGD,914.63,,,,,,,per diem,914.63,914.63,"Per diem rate, code is bundled with other services"
S/O CHR ANL LEUK BLD          ,38250708,CDM,311,RC,,,,,,Inpatient,,,914.63,914.63,HUMANA CHOICE PLUS,MGD,914.63,,,,,,,case rate,914.63,914.63,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,AETNA,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,BCBS,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,CIGNA,COM,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,TRICARE,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,UNITED HEALTHCARE,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,UNITED HEALTHCARE,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,VA,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,VA TRICARE,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,WELLMED,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,HUMANA,MGD,726.14,,,,,,,per diem,726.14,726.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38250709,CDM,311,RC,,,,,,Inpatient,,,726.14,726.14,HUMANA CHOICE PLUS,MGD,726.14,,,,,,,case rate,726.14,726.14,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O IGF BINDING PROTEIN 3     ,38250710,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O CHLORIDE FLUID            ,38250711,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,AETNA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,CIGNA,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,VA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,VA TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,WELLMED,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,HUMANA,MGD,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O COCAINE URINE QUANT       ,38250712,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,HUMANA CHOICE PLUS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,AETNA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,CIGNA,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,VA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,VA TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,WELLMED,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA,MGD,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CORTISOL SERUM FREE       ,38250713,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA CHOICE PLUS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,AETNA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,CIGNA,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,VA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,VA TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,WELLMED,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA,MGD,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O COXSACKIE A9 AB CF        ,38250714,CDM,302,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA CHOICE PLUS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250715,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250716,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250717,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O ECHOVIRUS AB              ,38250718,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250719,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250720,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250721,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250722,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250723,CDM,302,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,AETNA,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,BCBS,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,CIGNA,COM,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,TRICARE,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,UNITED HEALTHCARE,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,UNITED HEALTHCARE,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,VA,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,VA TRICARE,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,WELLMED,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,HUMANA,MGD,435.9,,,,,,,per diem,435.9,435.9,"Per diem rate, code is bundled with other services"
S/O COXSACKIE B AB            ,38250724,CDM,302,RC,,,,,,Inpatient,,,435.9,435.9,HUMANA CHOICE PLUS,MGD,435.9,,,,,,,case rate,435.9,435.9,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,AETNA,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,CIGNA,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,TRICARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,UNITED HEALTHCARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,UNITED HEALTHCARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,VA,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,VA TRICARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,WELLMED,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,HUMANA,MGD,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 48H       ,38250725,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,HUMANA CHOICE PLUS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,AETNA,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,BCBS,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,CIGNA,COM,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,TRICARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,UNITED HEALTHCARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,UNITED HEALTHCARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,VA,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,VA TRICARE,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,WELLMED,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,HUMANA,MGD,607.26,,,,,,,per diem,607.26,607.26,"Per diem rate, code is bundled with other services"
S/O FAT FECAL QUANT 72H       ,38250726,CDM,301,RC,,,,,,Inpatient,,,607.26,607.26,HUMANA CHOICE PLUS,MGD,607.26,,,,,,,case rate,607.26,607.26,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O HSV TYPE 1 GLYCO IGG      ,38250727,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYELOMA I                 ,38250728,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,AETNA,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,BCBS,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,CIGNA,COM,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,TRICARE,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,UNITED HEALTHCARE,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,UNITED HEALTHCARE,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,VA,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,VA TRICARE,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,WELLMED,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,HUMANA,MGD,44.98,,,,,,,per diem,44.98,44.98,"Per diem rate, code is bundled with other services"
S/O BETA2 TRANSFERRIN         ,38250729,CDM,302,RC,,,,,,Inpatient,,,44.98,44.98,HUMANA CHOICE PLUS,MGD,44.98,,,,,,,case rate,44.98,44.98,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,AETNA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,CIGNA,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,WELLMED,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA,MGD,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD URINE                ,38250730,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA CHOICE PLUS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,AETNA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,CIGNA,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,WELLMED,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA,MGD,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD VENOUS         ,38250731,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA CHOICE PLUS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,AETNA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,CIGNA,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,WELLMED,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA,MGD,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O LEAD BLOOD CAPILLARY      ,38250732,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA CHOICE PLUS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,AETNA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,CIGNA,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,VA TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,WELLMED,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA,MGD,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38250733,CDM,301,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA CHOICE PLUS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,AETNA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,CIGNA,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,VA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,VA TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,WELLMED,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA,MGD,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LEPTOSPIRA AB IGM DOT     ,38250734,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA CHOICE PLUS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,AETNA,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,BCBS,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,CIGNA,COM,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,TRICARE,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,UNITED HEALTHCARE,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,UNITED HEALTHCARE,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,VA,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,VA TRICARE,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,WELLMED,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,HUMANA,MGD,797.9,,,,,,,per diem,797.9,797.9,"Per diem rate, code is bundled with other services"
S/O METANEPHRINE FRAC UR      ,38250735,CDM,301,RC,,,,,,Inpatient,,,797.9,797.9,HUMANA CHOICE PLUS,MGD,797.9,,,,,,,case rate,797.9,797.9,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,AETNA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,CIGNA,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,WELLMED,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA,MGD,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250736,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA CHOICE PLUS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,AETNA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,CIGNA,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,VA TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,WELLMED,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA,MGD,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
S/O MUMPS AB IGG              ,38250737,CDM,302,RC,,,,,,Inpatient,,,190.64,190.64,HUMANA CHOICE PLUS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUMO IGM     ,38250738,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,AETNA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,CIGNA,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,VA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,VA TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,WELLMED,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,HUMANA,MGD,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA AB IGG         ,38250739,CDM,302,RC,,,,,,Inpatient,,,248.47,248.47,HUMANA CHOICE PLUS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O VARIC ZOST/VZV RT PCR     ,38250740,CDM,306,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,AETNA,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,CIGNA,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,TRICARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,UNITED HEALTHCARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,UNITED HEALTHCARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,VA,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,VA TRICARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,WELLMED,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,HUMANA,MGD,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O TOXOPLASMA GONDII PCR     ,38250741,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,HUMANA CHOICE PLUS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,AETNA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,CIGNA,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,VA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,VA TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,WELLMED,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA,MGD,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR        ,38250742,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA CHOICE PLUS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,AETNA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,CIGNA,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,VA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,VA TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,WELLMED,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA,MGD,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 PCR BM     ,38250743,CDM,306,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA CHOICE PLUS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR VIRU PCR     ,38250744,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,AETNA,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,BCBS,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,CIGNA,COM,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,TRICARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,UNITED HEALTHCARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,UNITED HEALTHCARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,VA,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,VA TRICARE,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,WELLMED,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,HUMANA,MGD,508.73,,,,,,,per diem,508.73,508.73,"Per diem rate, code is bundled with other services"
S/O WEST NILE RNA RT PCR      ,38250745,CDM,306,RC,,,,,,Inpatient,,,508.73,508.73,HUMANA CHOICE PLUS,MGD,508.73,,,,,,,case rate,508.73,508.73,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,AETNA,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,BCBS,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,CIGNA,COM,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,TRICARE,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,UNITED HEALTHCARE,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,UNITED HEALTHCARE,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,VA,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,VA TRICARE,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,WELLMED,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,HUMANA,MGD,941.41,,,,,,,per diem,941.41,941.41,"Per diem rate, code is bundled with other services"
S/O TROPHERY WHIPPLEI PCR     ,38250746,CDM,306,RC,,,,,,Inpatient,,,941.41,941.41,HUMANA CHOICE PLUS,MGD,941.41,,,,,,,case rate,941.41,941.41,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,AETNA,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,BCBS,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,CIGNA,COM,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,TRICARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,UNITED HEALTHCARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,UNITED HEALTHCARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,VA,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,VA TRICARE,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,WELLMED,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,HUMANA,MGD,259.18,,,,,,,per diem,259.18,259.18,"Per diem rate, code is bundled with other services"
S/O JC VIRUS BY PCR           ,38250747,CDM,306,RC,,,,,,Inpatient,,,259.18,259.18,HUMANA CHOICE PLUS,MGD,259.18,,,,,,,case rate,259.18,259.18,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,AETNA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,CIGNA,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,WELLMED,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA,MGD,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250748,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA CHOICE PLUS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,AETNA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,CIGNA,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,WELLMED,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA,MGD,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250749,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA CHOICE PLUS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,AETNA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,BCBS,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,CIGNA,COM,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,UNITED HEALTHCARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,VA TRICARE,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,WELLMED,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA,MGD,239.9,,,,,,,per diem,239.9,239.9,"Per diem rate, code is bundled with other services"
S/O EHRLIC/ANAPLAS PCR        ,38250750,CDM,306,RC,,,,,,Inpatient,,,239.9,239.9,HUMANA CHOICE PLUS,MGD,239.9,,,,,,,case rate,239.9,239.9,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,AETNA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,CIGNA,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,VA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,VA TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,WELLMED,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA,MGD,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O M TB RIF RES PCR          ,38250751,CDM,306,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA CHOICE PLUS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,AETNA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,CIGNA,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,VA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,VA TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,WELLMED,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA,MGD,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
S/O NOROVIRUS 1&2 PCR         ,38250752,CDM,360,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA CHOICE PLUS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,AETNA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,CIGNA,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,WELLMED,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA,MGD,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O CHIKUNGUNYA BY PCR        ,38250753,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA CHOICE PLUS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,AETNA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,BCBS,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,CIGNA,COM,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,UNITED HEALTHCARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,VA,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,VA TRICARE,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,WELLMED,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA,MGD,326.66,,,,,,,per diem,326.66,326.66,"Per diem rate, code is bundled with other services"
S/O MYOGLOBIN URINE           ,38250754,CDM,301,RC,,,,,,Inpatient,,,326.66,326.66,HUMANA CHOICE PLUS,MGD,326.66,,,,,,,case rate,326.66,326.66,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,AETNA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,CIGNA,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,VA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,VA TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,WELLMED,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA,MGD,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O OLIGO BAND PROF           ,38250755,CDM,301,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA CHOICE PLUS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250756,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O RMSF AB IFA IGG           ,38250757,CDM,302,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250758,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O RICKETTSIA IGG/IGM        ,38250759,CDM,302,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O TESTOST FREE FEML/CHD     ,38250760,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O TESTOSTERONE FREE         ,38250761,CDM,301,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,AETNA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,BCBS,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,CIGNA,COM,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,UNITED HEALTHCARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,VA,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,VA TRICARE,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,WELLMED,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA,MGD,202.42,,,,,,,per diem,202.42,202.42,"Per diem rate, code is bundled with other services"
S/O LIVER/KIDNY MICROSOME     ,38250762,CDM,302,RC,,,,,,Inpatient,,,202.42,202.42,HUMANA CHOICE PLUS,MGD,202.42,,,,,,,case rate,202.42,202.42,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,AETNA,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,CIGNA,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,TRICARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,UNITED HEALTHCARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,UNITED HEALTHCARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,VA,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,VA TRICARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,WELLMED,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,HUMANA,MGD,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
S/O LKM1 AB IGG               ,38250763,CDM,302,RC,,,,,,Inpatient,,,40.7,40.7,HUMANA CHOICE PLUS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O TOXOPLSM GONDI AB IGG     ,38250764,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,AETNA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,CIGNA,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,VA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,VA TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,WELLMED,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA,MGD,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250765,CDM,302,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA CHOICE PLUS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD POC             ,38250766,CDM,301,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O STAPH AUREUS PANL         ,38250767,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O IMMUNOGLOBULIN E          ,38250768,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
S/O OVA & PARASIT FECL        ,38250769,CDM,306,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O OSMOLALITY FECAL          ,38250770,CDM,301,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,AETNA,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,BCBS,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,CIGNA,COM,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,TRICARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,UNITED HEALTHCARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,UNITED HEALTHCARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,VA,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,VA TRICARE,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,WELLMED,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,HUMANA,MGD,236.69,,,,,,,per diem,236.69,236.69,"Per diem rate, code is bundled with other services"
S/O POTASSIUM BODY FLUID      ,38250771,CDM,301,RC,,,,,,Inpatient,,,236.69,236.69,HUMANA CHOICE PLUS,MGD,236.69,,,,,,,case rate,236.69,236.69,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O POTASSIUM FLUID           ,38250772,CDM,301,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR IX ACTIVITY        ,38250773,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,AETNA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,BCBS,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,CIGNA,COM,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,UNITED HEALTHCARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,VA TRICARE,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,WELLMED,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA,MGD,224.91,,,,,,,per diem,224.91,224.91,"Per diem rate, code is bundled with other services"
S/O IGG CSF INDEX             ,38250774,CDM,301,RC,,,,,,Inpatient,,,224.91,224.91,HUMANA CHOICE PLUS,MGD,224.91,,,,,,,case rate,224.91,224.91,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,AETNA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,CIGNA,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,VA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,VA TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,WELLMED,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,HUMANA,MGD,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
S/O ALBUMIN CSF               ,38250775,CDM,301,RC,,,,,,Inpatient,,,10.71,10.71,HUMANA CHOICE PLUS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,AETNA,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,CIGNA,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,TRICARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,UNITED HEALTHCARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,UNITED HEALTHCARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,VA,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,VA TRICARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,WELLMED,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,HUMANA,MGD,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
S/O HIV2 AB CONF IMMBLOT      ,38250776,CDM,302,RC,,,,,,Inpatient,,,460.53,460.53,HUMANA CHOICE PLUS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,AETNA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,CIGNA,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,VA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,VA TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,WELLMED,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA,MGD,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O HIV1 CONF WESTRN BLOT     ,38250777,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA CHOICE PLUS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SSA                  ,38250778,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,AETNA,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,CIGNA,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,TRICARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,UNITED HEALTHCARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,UNITED HEALTHCARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,VA,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,VA TRICARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,WELLMED,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,HUMANA,MGD,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O ANTI RNP                  ,38250779,CDM,302,RC,,,,,,Inpatient,,,95.32,95.32,HUMANA CHOICE PLUS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ANTI JO 1                 ,38250780,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O ANTI SMITH                ,38250781,CDM,302,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O ANTI CHROMATIN AB         ,38250782,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,AETNA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,CIGNA,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,VA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,VA TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,WELLMED,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA,MGD,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ANTI SCL 70               ,38250783,CDM,302,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA CHOICE PLUS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250784,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250785,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250786,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250787,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250788,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250789,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250790,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250791,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ANA REFLEX T              ,38250792,CDM,302,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA RNP-U1 AB IGG         ,38250793,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SMITH AB IGG          ,38250794,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SCL-70 AB IGG         ,38250795,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSA AB IGG            ,38250796,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O ENA SSB AB IGG            ,38250797,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O PM/SCL-100 AB IGG         ,38250798,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,AETNA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,CIGNA,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,VA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,VA TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,WELLMED,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA,MGD,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U3 AB IGG       ,38250799,CDM,302,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA CHOICE PLUS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER RNP-U1 AB IGG       ,38250800,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER SCL-70 AB IGG       ,38250801,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SCLER PM/SCL-100 IGG      ,38250802,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU2IGG     ,38250803,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP RNPU1IGG     ,38250804,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O MYOS AB COMP SSA IGG      ,38250805,CDM,302,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,AETNA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,CIGNA,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,VA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,VA TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,WELLMED,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA,MGD,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR RAN     ,38250806,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA CHOICE PLUS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,AETNA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,CIGNA,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,VA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,VA TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,WELLMED,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA,MGD,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN ELECTR UR 24H     ,38250807,CDM,301,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA CHOICE PLUS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,AETNA,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,BCBS,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,CIGNA,COM,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,TRICARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,UNITED HEALTHCARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,UNITED HEALTHCARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,VA,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,VA TRICARE,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,WELLMED,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,HUMANA,MGD,293.45,,,,,,,per diem,293.45,293.45,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250808,CDM,302,RC,,,,,,Inpatient,,,293.45,293.45,HUMANA CHOICE PLUS,MGD,293.45,,,,,,,case rate,293.45,293.45,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,AETNA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,CIGNA,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,VA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,VA TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,WELLMED,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA,MGD,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O BENCE JONES PROTN IFE     ,38250809,CDM,302,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA CHOICE PLUS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,AETNA,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,CIGNA,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,TRICARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,UNITED HEALTHCARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,UNITED HEALTHCARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,VA,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,VA TRICARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,WELLMED,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,HUMANA,MGD,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O IMMUNOFIX ELECTRO-URN     ,38250810,CDM,302,RC,,,,,,Inpatient,,,131.73,131.73,HUMANA CHOICE PLUS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,AETNA,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,BCBS,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,CIGNA,COM,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,TRICARE,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,UNITED HEALTHCARE,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,UNITED HEALTHCARE,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,VA,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,VA TRICARE,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,WELLMED,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,HUMANA,MGD,380.21,,,,,,,per diem,380.21,380.21,"Per diem rate, code is bundled with other services"
S/O COENZYME Q10 TOTAL        ,38250811,CDM,301,RC,,,,,,Inpatient,,,380.21,380.21,HUMANA CHOICE PLUS,MGD,380.21,,,,,,,case rate,380.21,380.21,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O PTH RELATED PEPTIDE       ,38250812,CDM,301,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV VCA IGM               ,38250813,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,AETNA,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,BCBS,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,CIGNA,COM,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,TRICARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,UNITED HEALTHCARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,UNITED HEALTHCARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,VA,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,VA TRICARE,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,WELLMED,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,HUMANA,MGD,354.5,,,,,,,per diem,354.5,354.5,"Per diem rate, code is bundled with other services"
S/O LIBRIUM/NORDIAZEPAM       ,38250814,CDM,301,RC,,,,,,Inpatient,,,354.5,354.5,HUMANA CHOICE PLUS,MGD,354.5,,,,,,,case rate,354.5,354.5,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,AETNA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,CIGNA,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,VA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,VA TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,WELLMED,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA,MGD,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O LORAZEPAM                 ,38250815,CDM,301,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA CHOICE PLUS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O BENZODIAZ CONF/QNT SP     ,38250816,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,AETNA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,CIGNA,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,WELLMED,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA,MGD,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O BJ PROTEIN QUAL UR        ,38250817,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA CHOICE PLUS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,AETNA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,CIGNA,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,WELLMED,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA,MGD,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250818,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA CHOICE PLUS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,AETNA,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,CIGNA,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,TRICARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,UNITED HEALTHCARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,UNITED HEALTHCARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,VA,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,VA TRICARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,WELLMED,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,HUMANA,MGD,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
S/O HEPARIN ANTI XA LMWH      ,38250819,CDM,305,RC,,,,,,Inpatient,,,716.5,716.5,HUMANA CHOICE PLUS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
HEPARIN ANTI-XA UNFRC         ,38250820,CDM,305,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,AETNA,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,BCBS,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,CIGNA,COM,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,TRICARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,UNITED HEALTHCARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,UNITED HEALTHCARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,VA,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,VA TRICARE,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,WELLMED,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,HUMANA,MGD,188.5,,,,,,,per diem,188.5,188.5,"Per diem rate, code is bundled with other services"
S/O RETICULIN IGA TITER       ,38250821,CDM,302,RC,,,,,,Inpatient,,,188.5,188.5,HUMANA CHOICE PLUS,MGD,188.5,,,,,,,case rate,188.5,188.5,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,AETNA,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,BCBS,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,CIGNA,COM,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,TRICARE,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,UNITED HEALTHCARE,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,UNITED HEALTHCARE,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,VA,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,VA TRICARE,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,WELLMED,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,HUMANA,MGD,194.92,,,,,,,per diem,194.92,194.92,"Per diem rate, code is bundled with other services"
S/O ENDOMYSIAL AB IGA IFA     ,38250822,CDM,302,RC,,,,,,Inpatient,,,194.92,194.92,HUMANA CHOICE PLUS,MGD,194.92,,,,,,,case rate,194.92,194.92,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O STRIAT MUSC IGG TITER     ,38250823,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,AETNA,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,BCBS,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,CIGNA,COM,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,TRICARE,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,UNITED HEALTHCARE,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,UNITED HEALTHCARE,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,VA,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,VA TRICARE,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,WELLMED,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,HUMANA,MGD,116.74,,,,,,,per diem,116.74,116.74,"Per diem rate, code is bundled with other services"
S/O MYOCARDIAL IGG TITER      ,38250824,CDM,302,RC,,,,,,Inpatient,,,116.74,116.74,HUMANA CHOICE PLUS,MGD,116.74,,,,,,,case rate,116.74,116.74,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,AETNA,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,BCBS,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,CIGNA,COM,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,TRICARE,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,UNITED HEALTHCARE,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,UNITED HEALTHCARE,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,VA,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,VA TRICARE,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,WELLMED,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,HUMANA,MGD,520.51,,,,,,,per diem,520.51,520.51,"Per diem rate, code is bundled with other services"
S/O YO AB TITER               ,38250825,CDM,302,RC,,,,,,Inpatient,,,520.51,520.51,HUMANA CHOICE PLUS,MGD,520.51,,,,,,,case rate,520.51,520.51,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,AETNA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,BCBS,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,CIGNA,COM,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,UNITED HEALTHCARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,VA TRICARE,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,WELLMED,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA,MGD,117.81,,,,,,,per diem,117.81,117.81,"Per diem rate, code is bundled with other services"
S/O SMOOTH MUSC IGG TITER     ,38250826,CDM,302,RC,,,,,,Inpatient,,,117.81,117.81,HUMANA CHOICE PLUS,MGD,117.81,,,,,,,case rate,117.81,117.81,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,AETNA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,BCBS,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,CIGNA,COM,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,UNITED HEALTHCARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,VA,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,VA TRICARE,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,WELLMED,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA,MGD,133.88,,,,,,,per diem,133.88,133.88,"Per diem rate, code is bundled with other services"
S/O ANCA TITER                ,38250827,CDM,302,RC,,,,,,Inpatient,,,133.88,133.88,HUMANA CHOICE PLUS,MGD,133.88,,,,,,,case rate,133.88,133.88,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,AETNA,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,BCBS,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,CIGNA,COM,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,TRICARE,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,UNITED HEALTHCARE,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,UNITED HEALTHCARE,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,VA,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,VA TRICARE,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,WELLMED,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,HUMANA,MGD,759.34,,,,,,,per diem,759.34,759.34,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250828,CDM,302,RC,,,,,,Inpatient,,,759.34,759.34,HUMANA CHOICE PLUS,MGD,759.34,,,,,,,case rate,759.34,759.34,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O DSDNA IGG IFA             ,38250829,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O SCLER CENTROMERE IFA      ,38250830,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,AETNA,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,BCBS,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,CIGNA,COM,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,TRICARE,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,UNITED HEALTHCARE,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,UNITED HEALTHCARE,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,VA,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,VA TRICARE,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,WELLMED,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,HUMANA,MGD,390.92,,,,,,,per diem,390.92,390.92,"Per diem rate, code is bundled with other services"
S/O NMDA AB IGG TITER         ,38250831,CDM,302,RC,,,,,,Inpatient,,,390.92,390.92,HUMANA CHOICE PLUS,MGD,390.92,,,,,,,case rate,390.92,390.92,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,AETNA,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,BCBS,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,CIGNA,COM,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,TRICARE,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,UNITED HEALTHCARE,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,UNITED HEALTHCARE,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,VA,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,VA TRICARE,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,WELLMED,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,HUMANA,MGD,637.25,,,,,,,per diem,637.25,637.25,"Per diem rate, code is bundled with other services"
S/O AQUPRIN-4 AB TTR RFLX     ,38250832,CDM,302,RC,,,,,,Inpatient,,,637.25,637.25,HUMANA CHOICE PLUS,MGD,637.25,,,,,,,case rate,637.25,637.25,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,AETNA,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,BCBS,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,CIGNA,COM,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,TRICARE,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,UNITED HEALTHCARE,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,UNITED HEALTHCARE,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,VA,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,VA TRICARE,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,WELLMED,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,HUMANA,MGD,679.01,,,,,,,per diem,679.01,679.01,"Per diem rate, code is bundled with other services"
S/O AFB ISOLATION REFLEX      ,38250833,CDM,306,RC,,,,,,Inpatient,,,679.01,679.01,HUMANA CHOICE PLUS,MGD,679.01,,,,,,,case rate,679.01,679.01,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O FACTOR XIII 1:1 MIX       ,38250834,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,AETNA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,BCBS,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,CIGNA,COM,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,UNITED HEALTHCARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,VA,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,VA TRICARE,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,WELLMED,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA,MGD,74.97,,,,,,,per diem,74.97,74.97,"Per diem rate, code is bundled with other services"
S/O FACTOR V ACTIVITY         ,38250835,CDM,305,RC,,,,,,Inpatient,,,74.97,74.97,HUMANA CHOICE PLUS,MGD,74.97,,,,,,,case rate,74.97,74.97,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSAY PT 1:1 MI     ,38250836,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PT TOTAL     ,38250837,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PT SUBS PLSM FRAC         ,38250838,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,AETNA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,CIGNA,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,VA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,VA TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,WELLMED,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA,MGD,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O PTT-D 1:1 MIX RFLX        ,38250839,CDM,305,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA CHOICE PLUS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1:1MIX     ,38250840,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,AETNA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,BCBS,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,CIGNA,COM,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,UNITED HEALTHCARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,VA TRICARE,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,WELLMED,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA,MGD,36.41,,,,,,,per diem,36.41,36.41,"Per diem rate, code is bundled with other services"
S/O INHIB ASSY PTT 1HR        ,38250841,CDM,305,RC,,,,,,Inpatient,,,36.41,36.41,HUMANA CHOICE PLUS,MGD,36.41,,,,,,,case rate,36.41,36.41,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,AETNA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,BCBS,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,CIGNA,COM,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,UNITED HEALTHCARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,VA,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,VA TRICARE,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,WELLMED,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA,MGD,141.37,,,,,,,per diem,141.37,141.37,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D 1:1      ,38250842,CDM,305,RC,,,,,,Inpatient,,,141.37,141.37,HUMANA CHOICE PLUS,MGD,141.37,,,,,,,case rate,141.37,141.37,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O MIXING STUDY PTT TTL      ,38250843,CDM,305,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O PTT SUBS PLSM FRC         ,38250844,CDM,305,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGM        ,38250845,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,AETNA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,CIGNA,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,VA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,VA TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,WELLMED,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA,MGD,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGG        ,38250846,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA CHOICE PLUS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,AETNA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,CIGNA,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,VA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,VA TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,WELLMED,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA,MGD,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250847,CDM,302,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA CHOICE PLUS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250848,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,AETNA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,BCBS,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,CIGNA,COM,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,UNITED HEALTHCARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,VA TRICARE,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,WELLMED,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA,MGD,108.17,,,,,,,per diem,108.17,108.17,"Per diem rate, code is bundled with other services"
S/O CARDIOLIPIN AB IGA        ,38250849,CDM,302,RC,,,,,,Inpatient,,,108.17,108.17,HUMANA CHOICE PLUS,MGD,108.17,,,,,,,case rate,108.17,108.17,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB BY ID      ,38250850,CDM,302,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O ASPERGILLIS AB CF         ,38250851,CDM,302,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O HYPERSEN PNEUM I          ,38250852,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,AETNA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,BCBS,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,CIGNA,COM,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,UNITED HEALTHCARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,VA TRICARE,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,WELLMED,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA,MGD,178.86,,,,,,,per diem,178.86,178.86,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250853,CDM,301,RC,,,,,,Inpatient,,,178.86,178.86,HUMANA CHOICE PLUS,MGD,178.86,,,,,,,case rate,178.86,178.86,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA SRM     ,38250854,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGG IFA CSF     ,38250855,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,AETNA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,BCBS,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,CIGNA,COM,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,UNITED HEALTHCARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,VA TRICARE,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,WELLMED,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA,MGD,394.13,,,,,,,per diem,394.13,394.13,"Per diem rate, code is bundled with other services"
S/O CALIF ENC IGM IFA CSF     ,38250856,CDM,302,RC,,,,,,Inpatient,,,394.13,394.13,HUMANA CHOICE PLUS,MGD,394.13,,,,,,,case rate,394.13,394.13,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM SRM     ,38250857,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGG CSF     ,38250858,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O EAST EQ ENCPH IGM CSF     ,38250859,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O STLOUIS ENCPH IGG CSF     ,38250860,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,AETNA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,CIGNA,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,VA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,VA TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,WELLMED,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA,MGD,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMSRM     ,38250861,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA CHOICE PLUS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,AETNA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,CIGNA,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,VA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,VA TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,WELLMED,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA,MGD,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O ST LOUIS ENCPH IGMCSF     ,38250862,CDM,302,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA CHOICE PLUS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM CSF     ,38250863,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGG SRM     ,38250864,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O WEST EQ ENCPH IGM SRM     ,38250865,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,AETNA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,CIGNA,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,VA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,VA TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,WELLMED,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,HUMANA,MGD,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O B HENSELAE IGG IFA        ,38250866,CDM,302,RC,,,,,,Inpatient,,,42.84,42.84,HUMANA CHOICE PLUS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGG IFA        ,38250867,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O B QUINTANA IGM IFA        ,38250868,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,AETNA,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,BCBS,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,CIGNA,COM,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,TRICARE,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,UNITED HEALTHCARE,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,UNITED HEALTHCARE,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,VA,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,VA TRICARE,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,WELLMED,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,HUMANA,MGD,358.79,,,,,,,per diem,358.79,358.79,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FUNCT HCCL      ,38250869,CDM,305,RC,,,,,,Inpatient,,,358.79,358.79,HUMANA CHOICE PLUS,MGD,358.79,,,,,,,case rate,358.79,358.79,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,AETNA,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,BCBS,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,CIGNA,COM,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,TRICARE,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,UNITED HEALTHCARE,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,UNITED HEALTHCARE,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,VA,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,VA TRICARE,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,WELLMED,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,HUMANA,MGD,328.8,,,,,,,per diem,328.8,328.8,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38250870,CDM,305,RC,,,,,,Inpatient,,,328.8,328.8,HUMANA CHOICE PLUS,MGD,328.8,,,,,,,case rate,328.8,328.8,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,AETNA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,CIGNA,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,VA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,VA TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,WELLMED,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA,MGD,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
S/O PROTEIN S FREE AG         ,38250871,CDM,305,RC,,,,,,Inpatient,,,65.33,65.33,HUMANA CHOICE PLUS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,AETNA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,BCBS,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,CIGNA,COM,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,UNITED HEALTHCARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,VA,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,VA TRICARE,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,WELLMED,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA,MGD,86.75,,,,,,,per diem,86.75,86.75,"Per diem rate, code is bundled with other services"
S/O MTB DNA PROBE REFLEX      ,38250872,CDM,306,RC,,,,,,Inpatient,,,86.75,86.75,HUMANA CHOICE PLUS,MGD,86.75,,,,,,,case rate,86.75,86.75,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250873,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,AETNA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,CIGNA,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,VA TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,WELLMED,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA,MGD,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
S/O PHOSPHORUS URINE          ,38250874,CDM,301,RC,,,,,,Inpatient,,,19.28,19.28,HUMANA CHOICE PLUS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,AETNA,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,BCBS,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,CIGNA,COM,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,TRICARE,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,UNITED HEALTHCARE,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,UNITED HEALTHCARE,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,VA,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,VA TRICARE,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,WELLMED,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,HUMANA,MGD,146.73,,,,,,,per diem,146.73,146.73,"Per diem rate, code is bundled with other services"
S/O URN URIC ACID RANDOM      ,38250875,CDM,301,RC,,,,,,Inpatient,,,146.73,146.73,HUMANA CHOICE PLUS,MGD,146.73,,,,,,,case rate,146.73,146.73,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38250876,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,AETNA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,CIGNA,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,VA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,VA TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,WELLMED,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA,MGD,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
S/O URIC ACID BODY FLUID      ,38250877,CDM,301,RC,,,,,,Inpatient,,,20.35,20.35,HUMANA CHOICE PLUS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,AETNA,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,BCBS,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,CIGNA,COM,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,TRICARE,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,UNITED HEALTHCARE,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,UNITED HEALTHCARE,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,VA,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,VA TRICARE,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,WELLMED,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,HUMANA,MGD,368.42,,,,,,,per diem,368.42,368.42,"Per diem rate, code is bundled with other services"
S/O FACTOR X ACTIVITY         ,38250878,CDM,305,RC,,,,,,Inpatient,,,368.42,368.42,HUMANA CHOICE PLUS,MGD,368.42,,,,,,,case rate,368.42,368.42,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,AETNA,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,CIGNA,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,TRICARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,UNITED HEALTHCARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,UNITED HEALTHCARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,VA,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,VA TRICARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,WELLMED,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,HUMANA,MGD,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O PARVOVIRUS B19 AB         ,38250879,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,HUMANA CHOICE PLUS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
S/O FACTOR VII ACTIVITY       ,38250880,CDM,305,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,AETNA,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,BCBS,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,CIGNA,COM,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,TRICARE,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,UNITED HEALTHCARE,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,UNITED HEALTHCARE,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,VA,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,VA TRICARE,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,WELLMED,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,HUMANA,MGD,257.04,,,,,,,per diem,257.04,257.04,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES AB CF         ,38250881,CDM,302,RC,,,,,,Inpatient,,,257.04,257.04,HUMANA CHOICE PLUS,MGD,257.04,,,,,,,case rate,257.04,257.04,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,AETNA,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,BCBS,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,CIGNA,COM,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,TRICARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,UNITED HEALTHCARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,UNITED HEALTHCARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,VA,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,VA TRICARE,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,WELLMED,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,HUMANA,MGD,101.75,,,,,,,per diem,101.75,101.75,"Per diem rate, code is bundled with other services"
S/O BLASTOMYCES CF ID         ,38250882,CDM,302,RC,,,,,,Inpatient,,,101.75,101.75,HUMANA CHOICE PLUS,MGD,101.75,,,,,,,case rate,101.75,101.75,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250883,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O HISTOPLASMA AB CF&ID      ,38250884,CDM,302,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,AETNA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,CIGNA,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,VA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,VA TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,WELLMED,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA,MGD,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB SRM/PLSM CONF/QNT     ,38250885,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA CHOICE PLUS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,AETNA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,BCBS,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,CIGNA,COM,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,UNITED HEALTHCARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,VA,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,VA TRICARE,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,WELLMED,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA,MGD,511.94,,,,,,,per diem,511.94,511.94,"Per diem rate, code is bundled with other services"
S/O GHB UR CONF/QUNT          ,38250886,CDM,301,RC,,,,,,Inpatient,,,511.94,511.94,HUMANA CHOICE PLUS,MGD,511.94,,,,,,,case rate,511.94,511.94,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,AETNA,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,BCBS,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,CIGNA,COM,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,TRICARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,UNITED HEALTHCARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,UNITED HEALTHCARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,VA,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,VA TRICARE,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,WELLMED,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,HUMANA,MGD,531.22,,,,,,,per diem,531.22,531.22,"Per diem rate, code is bundled with other services"
S/O SULFONYLUR HYPOGLY UR     ,38250887,CDM,301,RC,,,,,,Inpatient,,,531.22,531.22,HUMANA CHOICE PLUS,MGD,531.22,,,,,,,case rate,531.22,531.22,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG ASPIRIN          ,38250888,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EA AGENT         ,38250889,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET AGG EPI EA           ,38250890,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250891,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250892,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,AETNA,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,BCBS,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,CIGNA,COM,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,TRICARE,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,UNITED HEALTHCARE,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,UNITED HEALTHCARE,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,VA,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,VA TRICARE,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,WELLMED,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,HUMANA,MGD,1190.95,,,,,,,per diem,1190.95,1190.95,"Per diem rate, code is bundled with other services"
S/O PLATELET AGGREGATION      ,38250893,CDM,305,RC,,,,,,Inpatient,,,1190.95,1190.95,HUMANA CHOICE PLUS,MGD,1190.95,,,,,,,case rate,1190.95,1190.95,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250894,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250895,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38250896,CDM,305,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
UA QL/SEMIQT RED SUB          ,38250897,CDM,307,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,AETNA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,CIGNA,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,VA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,VA TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,WELLMED,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA,MGD,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O NEURON SPECIF ENOLASE     ,38250898,CDM,302,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA CHOICE PLUS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
S/O MESOMARK                  ,38250899,CDM,302,RC,,,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,AETNA,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,CIGNA,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,TRICARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,UNITED HEALTHCARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,UNITED HEALTHCARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,VA,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,VA TRICARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,WELLMED,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,HUMANA,MGD,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM               ,38250900,CDM,302,RC,,,,,,Inpatient,,,119.95,119.95,HUMANA CHOICE PLUS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,AETNA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,CIGNA,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,VA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,VA TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,WELLMED,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA,MGD,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGM CSF           ,38250901,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA CHOICE PLUS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 AB IGG CSF        ,38250902,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,AETNA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,CIGNA,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,VA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,VA TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,WELLMED,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA,MGD,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O HSV1/2 IGG/IGM W RFLX     ,38250903,CDM,302,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA CHOICE PLUS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 IGG               ,38250904,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O TORCH AB IGG              ,38250905,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,AETNA,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,CIGNA,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,TRICARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,UNITED HEALTHCARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,UNITED HEALTHCARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,VA,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,VA TRICARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,WELLMED,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,HUMANA,MGD,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SPECIAL SERUM STUDIES     ,38250906,CDM,302,RC,,,,,,Inpatient,,,193.85,193.85,HUMANA CHOICE PLUS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O KAPPA/LAMBDA QNT UR       ,38250907,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250908,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38250909,CDM,390,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,AETNA,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,BCBS,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,CIGNA,COM,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,TRICARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,UNITED HEALTHCARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,UNITED HEALTHCARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,VA,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,VA TRICARE,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,WELLMED,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,HUMANA,MGD,285.96,,,,,,,per diem,285.96,285.96,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38250910,CDM,302,RC,,,,,,Inpatient,,,285.96,285.96,HUMANA CHOICE PLUS,MGD,285.96,,,,,,,case rate,285.96,285.96,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38250911,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O HU TITER/WEST BLT         ,38250912,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,AETNA,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,BCBS,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,CIGNA,COM,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,TRICARE,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,UNITED HEALTHCARE,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,UNITED HEALTHCARE,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,VA,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,VA TRICARE,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,WELLMED,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,HUMANA,MGD,709,,,,,,,per diem,709,709,"Per diem rate, code is bundled with other services"
S/O HSV 1/2 DNA PCR           ,38250913,CDM,306,RC,,,,,,Inpatient,,,709,709,HUMANA CHOICE PLUS,MGD,709,,,,,,,case rate,709,709,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,AETNA,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,BCBS,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,CIGNA,COM,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,TRICARE,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,UNITED HEALTHCARE,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,UNITED HEALTHCARE,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,VA,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,VA TRICARE,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,WELLMED,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,HUMANA,MGD,857.87,,,,,,,per diem,857.87,857.87,"Per diem rate, code is bundled with other services"
S/O HSV BY PCR                ,38250914,CDM,306,RC,,,,,,Inpatient,,,857.87,857.87,HUMANA CHOICE PLUS,MGD,857.87,,,,,,,case rate,857.87,857.87,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,AETNA,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,BCBS,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,CIGNA,COM,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,TRICARE,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,UNITED HEALTHCARE,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,UNITED HEALTHCARE,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,VA,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,VA TRICARE,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,WELLMED,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,HUMANA,MGD,738.99,,,,,,,per diem,738.99,738.99,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250915,CDM,306,RC,,,,,,Inpatient,,,738.99,738.99,HUMANA CHOICE PLUS,MGD,738.99,,,,,,,case rate,738.99,738.99,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,AETNA,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,BCBS,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,CIGNA,COM,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,TRICARE,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,UNITED HEALTHCARE,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,UNITED HEALTHCARE,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,VA,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,VA TRICARE,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,WELLMED,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,HUMANA,MGD,737.92,,,,,,,per diem,737.92,737.92,"Per diem rate, code is bundled with other services"
S/O HERPES BY PCR CSF         ,38250916,CDM,306,RC,,,,,,Inpatient,,,737.92,737.92,HUMANA CHOICE PLUS,MGD,737.92,,,,,,,case rate,737.92,737.92,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250917,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O APS AB PANEL              ,38250918,CDM,302,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38250919,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,AETNA,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,CIGNA,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,TRICARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,UNITED HEALTHCARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,UNITED HEALTHCARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,VA,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,VA TRICARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,WELLMED,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,HUMANA,MGD,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250920,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,HUMANA CHOICE PLUS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,AETNA,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,BCBS,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,CIGNA,COM,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,TRICARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,UNITED HEALTHCARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,UNITED HEALTHCARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,VA,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,VA TRICARE,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,WELLMED,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,HUMANA,MGD,192.78,,,,,,,per diem,192.78,192.78,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG I&II          ,38250921,CDM,302,RC,,,,,,Inpatient,,,192.78,192.78,HUMANA CHOICE PLUS,MGD,192.78,,,,,,,case rate,192.78,192.78,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O Q FEVER IGG PHASE I       ,38250922,CDM,302,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,AETNA,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,CIGNA,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,TRICARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,UNITED HEALTHCARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,UNITED HEALTHCARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,VA,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,VA TRICARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,WELLMED,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,HUMANA,MGD,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGG CSF      ,38250923,CDM,302,RC,,,,,,Inpatient,,,264.54,264.54,HUMANA CHOICE PLUS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,AETNA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,CIGNA,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,VA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,VA TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,WELLMED,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA,MGD,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O METHADON SRM/PLSM QNT     ,38250924,CDM,301,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA CHOICE PLUS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,AETNA,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,BCBS,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,CIGNA,COM,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,TRICARE,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,UNITED HEALTHCARE,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,UNITED HEALTHCARE,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,VA,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,VA TRICARE,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,WELLMED,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,HUMANA,MGD,175.64,,,,,,,per diem,175.64,175.64,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,38250925,CDM,309,RC,,,,,,Inpatient,,,175.64,175.64,HUMANA CHOICE PLUS,MGD,175.64,,,,,,,case rate,175.64,175.64,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O DIRECT ANTIGLOBUL UBS     ,38250926,CDM,309,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,AETNA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,CIGNA,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,VA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,VA TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,WELLMED,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA,MGD,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT COMPLEM     ,38250927,CDM,309,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA CHOICE PLUS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,AETNA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,CIGNA,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,VA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,VA TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,WELLMED,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA,MGD,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O COOMBS DIRECT             ,38250928,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA CHOICE PLUS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O AG RBC NON ABO/RH EA      ,38250929,CDM,309,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING PATIENT     ,38250930,CDM,309,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING RARE PT     ,38250931,CDM,309,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O RBC EXTEND PHENO          ,38250932,CDM,309,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,AETNA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,CIGNA,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,VA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,VA TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,WELLMED,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA,MGD,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O RBC AB ELUTION            ,38250933,CDM,309,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA CHOICE PLUS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,AETNA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,BCBS,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,CIGNA,COM,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,UNITED HEALTHCARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,VA,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,VA TRICARE,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,WELLMED,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,HUMANA,MGD,443.39,,,,,,,per diem,443.39,443.39,"Per diem rate, code is bundled with other services"
S/O ADSORPTION ALLO           ,38250934,CDM,302,RC,,,,,,Inpatient,,,443.39,443.39,HUMANA CHOICE PLUS,MGD,443.39,,,,,,,case rate,443.39,443.39,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,AETNA,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,BCBS,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,CIGNA,COM,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,TRICARE,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,UNITED HEALTHCARE,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,UNITED HEALTHCARE,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,VA,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,VA TRICARE,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,WELLMED,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,HUMANA,MGD,221.7,,,,,,,per diem,221.7,221.7,"Per diem rate, code is bundled with other services"
S/O RBC AG TYPING DONOR       ,38250935,CDM,309,RC,,,,,,Inpatient,,,221.7,221.7,HUMANA CHOICE PLUS,MGD,221.7,,,,,,,case rate,221.7,221.7,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,AETNA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,CIGNA,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,WELLMED,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA,MGD,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ACT                           ,38250936,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA CHOICE PLUS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,AETNA,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,BCBS,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,CIGNA,COM,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,TRICARE,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,UNITED HEALTHCARE,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,UNITED HEALTHCARE,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,VA,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,VA TRICARE,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,WELLMED,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,HUMANA,MGD,365.21,,,,,,,per diem,365.21,365.21,"Per diem rate, code is bundled with other services"
RHOD IMMUNE GLOB 300MCG       ,38250937,CDM,636,RC,,,,,,Inpatient,1,EA,365.21,365.21,HUMANA CHOICE PLUS,MGD,365.21,,,,,,,case rate,365.21,365.21,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
CRYOPRECIPITATE EA            ,38250938,CDM,390,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,AETNA,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,BCBS,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,CIGNA,COM,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,TRICARE,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,UNITED HEALTHCARE,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,UNITED HEALTHCARE,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,VA,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,VA TRICARE,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,WELLMED,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,HUMANA,MGD,674.73,,,,,,,per diem,674.73,674.73,"Per diem rate, code is bundled with other services"
FETAL FIBRONECTIN             ,38250939,CDM,301,RC,,,,,,Inpatient,,,674.73,674.73,HUMANA CHOICE PLUS,MGD,674.73,,,,,,,case rate,674.73,674.73,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
FFP 1 UNIT                    ,38250940,CDM,390,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,AETNA,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,BCBS,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,CIGNA,COM,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,TRICARE,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,UNITED HEALTHCARE,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,UNITED HEALTHCARE,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,VA,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,VA TRICARE,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,WELLMED,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,HUMANA,MGD,309.7,,,,,,,per diem,309.7,309.7,"Per diem rate, code is bundled with other services"
FFP 8-24 HR EA UNIT           ,38250941,CDM,390,RC,,,,,,Inpatient,,,309.7,309.7,HUMANA CHOICE PLUS,MGD,309.7,,,,,,,case rate,309.7,309.7,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,AETNA,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,BCBS,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,CIGNA,COM,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,TRICARE,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,UNITED HEALTHCARE,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,UNITED HEALTHCARE,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,VA,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,VA TRICARE,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,WELLMED,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,HUMANA,MGD,76.61,,,,,,,per diem,76.61,76.61,"Per diem rate, code is bundled with other services"
FIBRINOLYSINS INT/RPT         ,38250942,CDM,305,RC,,,,,,Inpatient,,,76.61,76.61,HUMANA CHOICE PLUS,MGD,76.61,,,,,,,case rate,76.61,76.61,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY DEVICE       ,38250943,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,AETNA,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,CIGNA,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,TRICARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,UNITED HEALTHCARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,UNITED HEALTHCARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,VA,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,VA TRICARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,WELLMED,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,HUMANA,MGD,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
HGB F KLEIHAUER-BETKE         ,38250944,CDM,305,RC,,,,,,Inpatient,,,287.03,287.03,HUMANA CHOICE PLUS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,AETNA,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,BCBS,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,CIGNA,COM,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,TRICARE,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,UNITED HEALTHCARE,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,UNITED HEALTHCARE,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,VA,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,VA TRICARE,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,WELLMED,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,HUMANA,MGD,250.67,,,,,,,per diem,250.67,250.67,"Per diem rate, code is bundled with other services"
IA HIV1 AG W HIV1&HIV2 AB     ,38250945,CDM,302,RC,,,,,,Inpatient,,,250.67,250.67,HUMANA CHOICE PLUS,MGD,250.67,,,,,,,case rate,250.67,250.67,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
AMNIOTIC PROT QL AMNISURE     ,38250946,CDM,301,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,AETNA,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,BCBS,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,CIGNA,COM,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,TRICARE,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,UNITED HEALTHCARE,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,UNITED HEALTHCARE,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,VA,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,VA TRICARE,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,WELLMED,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,HUMANA,MGD,960.69,,,,,,,per diem,960.69,960.69,"Per diem rate, code is bundled with other services"
PLATELETS PHER EA             ,38250947,CDM,390,RC,,,,,,Inpatient,,,960.69,960.69,HUMANA CHOICE PLUS,MGD,960.69,,,,,,,case rate,960.69,960.69,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,AETNA,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,BCBS,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,CIGNA,COM,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,TRICARE,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,UNITED HEALTHCARE,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,UNITED HEALTHCARE,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,VA,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,VA TRICARE,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,WELLMED,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,HUMANA,MGD,2320.86,,,,,,,per diem,2320.86,2320.86,"Per diem rate, code is bundled with other services"
PLT PHERESIS L/R IRRAD        ,38250948,CDM,390,RC,,,,,,Inpatient,,,2320.86,2320.86,HUMANA CHOICE PLUS,MGD,2320.86,,,,,,,case rate,2320.86,2320.86,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,AETNA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,CIGNA,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,VA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,VA TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,WELLMED,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA,MGD,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
PREG URINE VISUAL             ,38250949,CDM,307,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA CHOICE PLUS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,AETNA,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,BCBS,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,CIGNA,COM,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,TRICARE,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,UNITED HEALTHCARE,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,UNITED HEALTHCARE,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,VA,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,VA TRICARE,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,WELLMED,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,HUMANA,MGD,130.26,,,,,,,per diem,130.26,130.26,"Per diem rate, code is bundled with other services"
RBC L/R EA AUTO               ,38250950,CDM,390,RC,,,,,,Inpatient,,,130.26,130.26,HUMANA CHOICE PLUS,MGD,130.26,,,,,,,case rate,130.26,130.26,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,AETNA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,CIGNA,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,VA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,VA TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,WELLMED,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA,MGD,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
RED CELLS EA AUTO             ,38250951,CDM,390,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA CHOICE PLUS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,AETNA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,CIGNA,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,VA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,VA TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,WELLMED,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA,MGD,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
RED CELLS PACKED EA           ,38250952,CDM,390,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA CHOICE PLUS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,AETNA,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,CIGNA,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,TRICARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,UNITED HEALTHCARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,UNITED HEALTHCARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,VA,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,VA TRICARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,WELLMED,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,HUMANA,MGD,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
RED CELLS WASHED EA           ,38250953,CDM,390,RC,,,,,,Inpatient,,,353.43,353.43,HUMANA CHOICE PLUS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,AETNA,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,BCBS,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,CIGNA,COM,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,TRICARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,UNITED HEALTHCARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,UNITED HEALTHCARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,VA,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,VA TRICARE,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,WELLMED,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,HUMANA,MGD,397.34,,,,,,,per diem,397.34,397.34,"Per diem rate, code is bundled with other services"
WHOLE BLOOD EA                ,38250954,CDM,390,RC,,,,,,Inpatient,,,397.34,397.34,HUMANA CHOICE PLUS,MGD,397.34,,,,,,,case rate,397.34,397.34,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,AETNA,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,BCBS,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,CIGNA,COM,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,TRICARE,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,UNITED HEALTHCARE,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,UNITED HEALTHCARE,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,VA,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,VA TRICARE,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,WELLMED,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,HUMANA,MGD,583.7,,,,,,,per diem,583.7,583.7,"Per diem rate, code is bundled with other services"
WHOLE BLOOD L/R IRRAD EA      ,38250955,CDM,390,RC,,,,,,Inpatient,,,583.7,583.7,HUMANA CHOICE PLUS,MGD,583.7,,,,,,,case rate,583.7,583.7,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,AETNA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,CIGNA,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,WELLMED,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA,MGD,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38250956,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA CHOICE PLUS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,AETNA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,BCBS,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,CIGNA,COM,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,UNITED HEALTHCARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,VA,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,VA TRICARE,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,WELLMED,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA,MGD,96.39,,,,,,,per diem,96.39,96.39,"Per diem rate, code is bundled with other services"
S/O LIPOPROTEIN A             ,38250957,CDM,301,RC,,,,,,Inpatient,,,96.39,96.39,HUMANA CHOICE PLUS,MGD,96.39,,,,,,,case rate,96.39,96.39,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EBV EA IGG                ,38250958,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,AETNA,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,BCBS,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,CIGNA,COM,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,TRICARE,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,UNITED HEALTHCARE,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,UNITED HEALTHCARE,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,VA,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,VA TRICARE,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,WELLMED,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,HUMANA,MGD,3754.93,,,,,,,per diem,3754.93,3754.93,"Per diem rate, code is bundled with other services"
S/O CF MUTATION PNL           ,38250959,CDM,301,RC,,,,,,Inpatient,,,3754.93,3754.93,HUMANA CHOICE PLUS,MGD,3754.93,,,,,,,case rate,3754.93,3754.93,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,AETNA,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,BCBS,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,CIGNA,COM,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,TRICARE,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,UNITED HEALTHCARE,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,UNITED HEALTHCARE,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,VA,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,VA TRICARE,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,WELLMED,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,HUMANA,MGD,170.29,,,,,,,per diem,170.29,170.29,"Per diem rate, code is bundled with other services"
S/O NICOTINE META S/P QNT     ,38250960,CDM,301,RC,,,,,,Inpatient,,,170.29,170.29,HUMANA CHOICE PLUS,MGD,170.29,,,,,,,case rate,170.29,170.29,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,AETNA,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,CIGNA,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,TRICARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,UNITED HEALTHCARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,UNITED HEALTHCARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,VA,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,VA TRICARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,WELLMED,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,HUMANA,MGD,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
S/O ENTEROVIRUS BY PCR        ,38250961,CDM,306,RC,,,,,,Inpatient,,,402.7,402.7,HUMANA CHOICE PLUS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,AETNA,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,BCBS,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,CIGNA,COM,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,TRICARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,UNITED HEALTHCARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,UNITED HEALTHCARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,VA,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,VA TRICARE,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,WELLMED,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,HUMANA,MGD,287.03,,,,,,,per diem,287.03,287.03,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM SRM      ,38250962,CDM,302,RC,,,,,,Inpatient,,,287.03,287.03,HUMANA CHOICE PLUS,MGD,287.03,,,,,,,case rate,287.03,287.03,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,AETNA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,CIGNA,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,VA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,VA TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,WELLMED,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA,MGD,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
S/O WEST NILE AB IGM CSF      ,38250963,CDM,302,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA CHOICE PLUS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,AETNA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,BCBS,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,CIGNA,COM,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,UNITED HEALTHCARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,VA TRICARE,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,WELLMED,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA,MGD,126.38,,,,,,,per diem,126.38,126.38,"Per diem rate, code is bundled with other services"
S/O INSULIN ANTIBODY          ,38250964,CDM,302,RC,,,,,,Inpatient,,,126.38,126.38,HUMANA CHOICE PLUS,MGD,126.38,,,,,,,case rate,126.38,126.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,AETNA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,CIGNA,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,VA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,VA TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,WELLMED,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA,MGD,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
S/O ACYLCARN QUANT PLASMA     ,38250965,CDM,301,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA CHOICE PLUS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,AETNA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,CIGNA,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,VA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,VA TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,WELLMED,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,HUMANA,MGD,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
S/O CARNITINE TOTAL           ,38250966,CDM,301,RC,,,,,,Inpatient,,,79.25,79.25,HUMANA CHOICE PLUS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,AETNA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,CIGNA,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,WELLMED,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA,MGD,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O MYCOPHEN AC & MET         ,38250967,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA CHOICE PLUS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,AETNA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,BCBS,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,CIGNA,COM,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,UNITED HEALTHCARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,VA TRICARE,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,WELLMED,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA,MGD,111.38,,,,,,,per diem,111.38,111.38,"Per diem rate, code is bundled with other services"
S/O PROPOXYPH CONF/QNT UR     ,38250968,CDM,301,RC,,,,,,Inpatient,,,111.38,111.38,HUMANA CHOICE PLUS,MGD,111.38,,,,,,,case rate,111.38,111.38,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O SELENIUM SRM/PLASM        ,38250969,CDM,301,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,AETNA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,BCBS,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,CIGNA,COM,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,UNITED HEALTHCARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,VA TRICARE,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,WELLMED,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA,MGD,51.41,,,,,,,per diem,51.41,51.41,"Per diem rate, code is bundled with other services"
S/O ALLERGY FEATHER MIX       ,38250970,CDM,302,RC,,,,,,Inpatient,,,51.41,51.41,HUMANA CHOICE PLUS,MGD,51.41,,,,,,,case rate,51.41,51.41,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,AETNA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,CIGNA,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,VA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,VA TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,WELLMED,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA,MGD,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB SERUM CF      ,38250971,CDM,302,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA CHOICE PLUS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG PAPER WASP IGG     ,38250972,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET WHT IGG     ,38250973,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG HORNET YEL IGG     ,38250974,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
S/O ALLERG YEL JACKET IGG     ,38250975,CDM,302,RC,,,,,,Inpatient,,,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,AETNA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,BCBS,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,CIGNA,COM,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,UNITED HEALTHCARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,VA TRICARE,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,WELLMED,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA,MGD,121.02,,,,,,,per diem,121.02,121.02,"Per diem rate, code is bundled with other services"
S/O C1 ESTERASE INHIB FNC     ,38250976,CDM,302,RC,,,,,,Inpatient,,,121.02,121.02,HUMANA CHOICE PLUS,MGD,121.02,,,,,,,case rate,121.02,121.02,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O CAFFEINE SERUM/PLASMA     ,38250977,CDM,301,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O DNASE B ANTIBODY          ,38250978,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,AETNA,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,BCBS,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,CIGNA,COM,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,TRICARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,UNITED HEALTHCARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,UNITED HEALTHCARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,VA,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,VA TRICARE,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,WELLMED,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,HUMANA,MGD,131.73,,,,,,,per diem,131.73,131.73,"Per diem rate, code is bundled with other services"
S/O HEP DELTA AG ELISA        ,38250979,CDM,306,RC,,,,,,Inpatient,,,131.73,131.73,HUMANA CHOICE PLUS,MGD,131.73,,,,,,,case rate,131.73,131.73,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,AETNA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,CIGNA,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,VA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,VA TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,WELLMED,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA,MGD,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN ANTIGEN      ,38250980,CDM,305,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA CHOICE PLUS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,AETNA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,CIGNA,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,VA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,VA TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,WELLMED,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,HUMANA,MGD,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT BLOOD      ,38250981,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,HUMANA CHOICE PLUS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,AETNA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,BCBS,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,CIGNA,COM,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,UNITED HEALTHCARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,VA,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,VA TRICARE,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,WELLMED,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,HUMANA,MGD,598.69,,,,,,,per diem,598.69,598.69,"Per diem rate, code is bundled with other services"
S/O BK VIRUS QUANT URINE      ,38250982,CDM,306,RC,,,,,,Inpatient,,,598.69,598.69,HUMANA CHOICE PLUS,MGD,598.69,,,,,,,case rate,598.69,598.69,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,AETNA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,CIGNA,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,VA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,VA TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,WELLMED,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA,MGD,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O BILE ACIDS TOTAL          ,38250983,CDM,301,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA CHOICE PLUS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,AETNA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,CIGNA,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,WELLMED,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA,MGD,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEXAGONAL PHOSPHOLIP      ,38250984,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA CHOICE PLUS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,AETNA,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,CIGNA,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,TRICARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,UNITED HEALTHCARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,UNITED HEALTHCARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,VA,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,VA TRICARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,WELLMED,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,HUMANA,MGD,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
S/O MYCOPLASMA PNEUM PCR      ,38250985,CDM,306,RC,,,,,,Inpatient,,,176.72,176.72,HUMANA CHOICE PLUS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O INHIBIN A DIMER           ,38250986,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O HOMOVANILLIC ACID UR      ,38250987,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,AETNA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,BCBS,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,CIGNA,COM,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,UNITED HEALTHCARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,VA,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,VA TRICARE,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,WELLMED,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA,MGD,137.09,,,,,,,per diem,137.09,137.09,"Per diem rate, code is bundled with other services"
S/O ESTROGENS FRAC TMS        ,38250988,CDM,301,RC,,,,,,Inpatient,,,137.09,137.09,HUMANA CHOICE PLUS,MGD,137.09,,,,,,,case rate,137.09,137.09,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,AETNA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,CIGNA,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,WELLMED,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA,MGD,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O ADAMTS13 ACTIVITY         ,38250989,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA CHOICE PLUS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O THALLIUM WHOLE BLOOD      ,38250990,CDM,301,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,AETNA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,CIGNA,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,VA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,VA TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,WELLMED,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA,MGD,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O THALLIUM URINE            ,38250991,CDM,301,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA CHOICE PLUS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,AETNA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,CIGNA,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,VA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,VA TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,WELLMED,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,HUMANA,MGD,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
S/O ALLERG PHOMABETAE IGG     ,38250992,CDM,302,RC,,,,,,Inpatient,,,47.12,47.12,HUMANA CHOICE PLUS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O LIPID ASSOC SIALIC AC     ,38250993,CDM,301,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O HERPESVIRUS 6 QNT PCR     ,38250994,CDM,306,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ALLRG TRICHO RUBR IGG     ,38250995,CDM,302,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O ZONISAMIDE                ,38250996,CDM,301,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,AETNA,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,BCBS,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,CIGNA,COM,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,TRICARE,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,UNITED HEALTHCARE,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,UNITED HEALTHCARE,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,VA,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,VA TRICARE,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,WELLMED,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,HUMANA,MGD,366.28,,,,,,,per diem,366.28,366.28,"Per diem rate, code is bundled with other services"
S/O CHLAM PNEUMONIAE PCR      ,38250997,CDM,306,RC,,,,,,Inpatient,,,366.28,366.28,HUMANA CHOICE PLUS,MGD,366.28,,,,,,,case rate,366.28,366.28,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O BOR BURG IGG WEST CSF     ,38250998,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,AETNA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,CIGNA,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,WELLMED,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA,MGD,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGM WEST BLOT      ,38250999,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA CHOICE PLUS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,AETNA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,CIGNA,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,VA TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,WELLMED,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA,MGD,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O B BURG IGG WEST BLOT      ,38251000,CDM,302,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA CHOICE PLUS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,AETNA,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,BCBS,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,CIGNA,COM,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,TRICARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,UNITED HEALTHCARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,UNITED HEALTHCARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,VA,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,VA TRICARE,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,WELLMED,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,HUMANA,MGD,155.3,,,,,,,per diem,155.3,155.3,"Per diem rate, code is bundled with other services"
S/O BORRELIA SPECIES PCR      ,38251001,CDM,306,RC,,,,,,Inpatient,,,155.3,155.3,HUMANA CHOICE PLUS,MGD,155.3,,,,,,,case rate,155.3,155.3,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O HEP B SURF AG CONF        ,38251002,CDM,306,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O VITAMIN B2 RIBOFLAVIN     ,38251003,CDM,301,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,AETNA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,CIGNA,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,VA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,VA TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,WELLMED,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,HUMANA,MGD,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
"S/O 1,5 ANHYDROGLU QN S/P     ",38251004,CDM,301,RC,,,,,,Inpatient,,,47.12,47.12,HUMANA CHOICE PLUS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META S/P       ,38251005,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O MEPERIDINE META URINE     ,38251006,CDM,301,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,AETNA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,CIGNA,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,WELLMED,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA,MGD,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR QNT PCR      ,38251007,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA CHOICE PLUS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,AETNA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,CIGNA,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,WELLMED,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA,MGD,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O ADENOVIRUS QNT PCR        ,38251008,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA CHOICE PLUS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,AETNA,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,BCBS,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,CIGNA,COM,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,TRICARE,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,UNITED HEALTHCARE,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,UNITED HEALTHCARE,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,VA,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,VA TRICARE,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,WELLMED,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,HUMANA,MGD,972.47,,,,,,,per diem,972.47,972.47,"Per diem rate, code is bundled with other services"
S/O HEROIN SRM/PLASM CONF     ,38251009,CDM,301,RC,,,,,,Inpatient,,,972.47,972.47,HUMANA CHOICE PLUS,MGD,972.47,,,,,,,case rate,972.47,972.47,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O FACT VIII BETHESD QNT     ,38251010,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,AETNA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,CIGNA,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,VA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,VA TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,WELLMED,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA,MGD,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
S/O LIPOPRO ASSOC PHOS A2     ,38251011,CDM,301,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA CHOICE PLUS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,AETNA,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,CIGNA,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,TRICARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,UNITED HEALTHCARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,UNITED HEALTHCARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,VA,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,VA TRICARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,WELLMED,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,HUMANA,MGD,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
IA INFLUENZA A OR B QL EA     ,38251012,CDM,306,RC,,,,,,Inpatient,,,362,362,HUMANA CHOICE PLUS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,AETNA,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,BCBS,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,CIGNA,COM,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,TRICARE,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,UNITED HEALTHCARE,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,UNITED HEALTHCARE,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,VA,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,VA TRICARE,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,WELLMED,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,HUMANA,MGD,966.04,,,,,,,per diem,966.04,966.04,"Per diem rate, code is bundled with other services"
IMMUNOASSAY STREP A           ,38251013,CDM,306,RC,,,,,,Inpatient,,,966.04,966.04,HUMANA CHOICE PLUS,MGD,966.04,,,,,,,case rate,966.04,966.04,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O HGB ELECTRO INTERFACE     ,38251014,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,AETNA,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,BCBS,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,CIGNA,COM,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,TRICARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,UNITED HEALTHCARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,UNITED HEALTHCARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,VA,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,VA TRICARE,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,WELLMED,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,HUMANA,MGD,382.35,,,,,,,per diem,382.35,382.35,"Per diem rate, code is bundled with other services"
S/O FRAGILE X FMR1 W/RFLX     ,38251015,CDM,301,RC,,,,,,Inpatient,,,382.35,382.35,HUMANA CHOICE PLUS,MGD,382.35,,,,,,,case rate,382.35,382.35,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,AETNA,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,BCBS,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,CIGNA,COM,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,TRICARE,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,UNITED HEALTHCARE,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,UNITED HEALTHCARE,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,VA,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,VA TRICARE,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,WELLMED,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,HUMANA,MGD,208.85,,,,,,,per diem,208.85,208.85,"Per diem rate, code is bundled with other services"
S/O HUNTINGTON DIS PCR        ,38251016,CDM,301,RC,,,,,,Inpatient,,,208.85,208.85,HUMANA CHOICE PLUS,MGD,208.85,,,,,,,case rate,208.85,208.85,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,AETNA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,BCBS,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,CIGNA,COM,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,UNITED HEALTHCARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,VA,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,VA TRICARE,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,WELLMED,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA,MGD,93.18,,,,,,,per diem,93.18,93.18,"Per diem rate, code is bundled with other services"
S/O HUNTING DIS SOUTH BLT     ,38251017,CDM,301,RC,,,,,,Inpatient,,,93.18,93.18,HUMANA CHOICE PLUS,MGD,93.18,,,,,,,case rate,93.18,93.18,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 1 HPA1        ,38251018,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 2 HPA2        ,38251019,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 3 HPA3        ,38251020,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 4 HPA4        ,38251021,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 5 HPA5        ,38251022,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 6 HPA6        ,38251023,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O PLATELET AG 15 HPA15      ,38251024,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,AETNA,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,BCBS,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,CIGNA,COM,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,TRICARE,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,UNITED HEALTHCARE,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,UNITED HEALTHCARE,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,VA,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,VA TRICARE,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,WELLMED,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,HUMANA,MGD,296.67,,,,,,,per diem,296.67,296.67,"Per diem rate, code is bundled with other services"
S/O APOLIPOPRO E 2 CARDIO     ,38251025,CDM,301,RC,,,,,,Inpatient,,,296.67,296.67,HUMANA CHOICE PLUS,MGD,296.67,,,,,,,case rate,296.67,296.67,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,AETNA,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,CIGNA,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,TRICARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,UNITED HEALTHCARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,UNITED HEALTHCARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,VA,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,VA TRICARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,WELLMED,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,HUMANA,MGD,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O HEMOCHROMATOS 3 MUTAT     ,38251026,CDM,301,RC,,,,,,Inpatient,,,338.44,338.44,HUMANA CHOICE PLUS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,AETNA,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,CIGNA,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,TRICARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,UNITED HEALTHCARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,UNITED HEALTHCARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,VA,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,VA TRICARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,WELLMED,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,HUMANA,MGD,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O PROTHROMB G20210A MUT     ,38251027,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,HUMANA CHOICE PLUS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,AETNA,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,BCBS,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,CIGNA,COM,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,TRICARE,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,UNITED HEALTHCARE,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,UNITED HEALTHCARE,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,VA,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,VA TRICARE,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,WELLMED,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,HUMANA,MGD,8173.87,,,,,,,per diem,8173.87,8173.87,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251028,CDM,301,RC,,,,,,Inpatient,,,8173.87,8173.87,HUMANA CHOICE PLUS,MGD,8173.87,,,,,,,case rate,8173.87,8173.87,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,AETNA,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,BCBS,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,CIGNA,COM,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,TRICARE,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,UNITED HEALTHCARE,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,UNITED HEALTHCARE,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,VA,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,VA TRICARE,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,WELLMED,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,HUMANA,MGD,1074.21,,,,,,,per diem,1074.21,1074.21,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRANSLOC QNT     ,38251029,CDM,301,RC,,,,,,Inpatient,,,1074.21,1074.21,HUMANA CHOICE PLUS,MGD,1074.21,,,,,,,case rate,1074.21,1074.21,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,AETNA,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,BCBS,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,CIGNA,COM,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,TRICARE,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,UNITED HEALTHCARE,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,UNITED HEALTHCARE,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,VA,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,VA TRICARE,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,WELLMED,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,HUMANA,MGD,6686.25,,,,,,,per diem,6686.25,6686.25,"Per diem rate, code is bundled with other services"
S/O CYTOGENOMIC SNP MICRO     ,38251030,CDM,301,RC,,,,,,Inpatient,,,6686.25,6686.25,HUMANA CHOICE PLUS,MGD,6686.25,,,,,,,case rate,6686.25,6686.25,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251031,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,AETNA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,CIGNA,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,VA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,VA TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,WELLMED,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA,MGD,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251032,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA CHOICE PLUS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,AETNA,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,BCBS,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,CIGNA,COM,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,TRICARE,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,UNITED HEALTHCARE,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,UNITED HEALTHCARE,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,VA,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,VA TRICARE,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,WELLMED,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,HUMANA,MGD,114.6,,,,,,,per diem,114.6,114.6,"Per diem rate, code is bundled with other services"
S/O ANGELMAN/P-WILLI SYND     ,38251033,CDM,301,RC,,,,,,Inpatient,,,114.6,114.6,HUMANA CHOICE PLUS,MGD,114.6,,,,,,,case rate,114.6,114.6,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,AETNA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,BCBS,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,CIGNA,COM,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,UNITED HEALTHCARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,VA,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,VA TRICARE,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,WELLMED,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA,MGD,212.06,,,,,,,per diem,212.06,212.06,"Per diem rate, code is bundled with other services"
S/O NPM1 MUTATON PCR FRAG     ,38251034,CDM,301,RC,,,,,,Inpatient,,,212.06,212.06,HUMANA CHOICE PLUS,MGD,212.06,,,,,,,case rate,212.06,212.06,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,AETNA,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,BCBS,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,CIGNA,COM,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,TRICARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,UNITED HEALTHCARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,UNITED HEALTHCARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,VA,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,VA TRICARE,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,WELLMED,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,HUMANA,MGD,338.44,,,,,,,per diem,338.44,338.44,"Per diem rate, code is bundled with other services"
S/O GIARDIA LAMBLIA IFA       ,38251035,CDM,302,RC,,,,,,Inpatient,,,338.44,338.44,HUMANA CHOICE PLUS,MGD,338.44,,,,,,,case rate,338.44,338.44,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O FACTOR V LEIDEN R506Q     ,38251036,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,AETNA,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,BCBS,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,CIGNA,COM,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,TRICARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,UNITED HEALTHCARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,UNITED HEALTHCARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,VA,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,VA TRICARE,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,WELLMED,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,HUMANA,MGD,264.54,,,,,,,per diem,264.54,264.54,"Per diem rate, code is bundled with other services"
S/O PYRUVIC ACID              ,38251037,CDM,301,RC,,,,,,Inpatient,,,264.54,264.54,HUMANA CHOICE PLUS,MGD,264.54,,,,,,,case rate,264.54,264.54,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O OSMOTIC FRAGIL ERYTHR     ,38251038,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,AETNA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,CIGNA,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,VA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,VA TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,WELLMED,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA,MGD,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O PYRUVATE KINASE           ,38251039,CDM,301,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA CHOICE PLUS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,AETNA,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,BCBS,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,CIGNA,COM,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,TRICARE,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,UNITED HEALTHCARE,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,UNITED HEALTHCARE,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,VA,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,VA TRICARE,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,WELLMED,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,HUMANA,MGD,463.74,,,,,,,per diem,463.74,463.74,"Per diem rate, code is bundled with other services"
S/O ORGANIC ACIDS URINE       ,38251040,CDM,301,RC,,,,,,Inpatient,,,463.74,463.74,HUMANA CHOICE PLUS,MGD,463.74,,,,,,,case rate,463.74,463.74,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,AETNA,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,CIGNA,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,TRICARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,UNITED HEALTHCARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,UNITED HEALTHCARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,VA,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,VA TRICARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,WELLMED,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,HUMANA,MGD,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
S/O AMINO ACID QUNT PLASM     ,38251041,CDM,301,RC,,,,,,Inpatient,,,1027.09,1027.09,HUMANA CHOICE PLUS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,AETNA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,BCBS,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,CIGNA,COM,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,UNITED HEALTHCARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,VA TRICARE,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,WELLMED,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA,MGD,142.44,,,,,,,per diem,142.44,142.44,"Per diem rate, code is bundled with other services"
S/O CRYOFIBRINOGEN            ,38251042,CDM,301,RC,,,,,,Inpatient,,,142.44,142.44,HUMANA CHOICE PLUS,MGD,142.44,,,,,,,case rate,142.44,142.44,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O COLD AGGLUTININS          ,38251043,CDM,302,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O HETEROPHILE AB TITER      ,38251044,CDM,302,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,AETNA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,BCBS,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,CIGNA,COM,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,UNITED HEALTHCARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,VA TRICARE,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,WELLMED,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA,MGD,56.76,,,,,,,per diem,56.76,56.76,"Per diem rate, code is bundled with other services"
S/O LEISHMANIA AB IGG         ,38251045,CDM,302,RC,,,,,,Inpatient,,,56.76,56.76,HUMANA CHOICE PLUS,MGD,56.76,,,,,,,case rate,56.76,56.76,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,AETNA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,BCBS,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,CIGNA,COM,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,UNITED HEALTHCARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,VA TRICARE,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,WELLMED,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA,MGD,343.79,,,,,,,per diem,343.79,343.79,"Per diem rate, code is bundled with other services"
S/O LISTERIA AB CSF CF        ,38251046,CDM,302,RC,,,,,,Inpatient,,,343.79,343.79,HUMANA CHOICE PLUS,MGD,343.79,,,,,,,case rate,343.79,343.79,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,AETNA,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,BCBS,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,CIGNA,COM,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,TRICARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,UNITED HEALTHCARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,UNITED HEALTHCARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,VA,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,VA TRICARE,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,WELLMED,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,HUMANA,MGD,83.54,,,,,,,per diem,83.54,83.54,"Per diem rate, code is bundled with other services"
S/O VERY LONG FATTY ACID      ,38251047,CDM,301,RC,,,,,,Inpatient,,,83.54,83.54,HUMANA CHOICE PLUS,MGD,83.54,,,,,,,case rate,83.54,83.54,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,AETNA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,BCBS,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,CIGNA,COM,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,UNITED HEALTHCARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,VA,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,VA TRICARE,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,WELLMED,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA,MGD,94.25,,,,,,,per diem,94.25,94.25,"Per diem rate, code is bundled with other services"
S/O COBALT SERUM/PLASMA       ,38251048,CDM,301,RC,,,,,,Inpatient,,,94.25,94.25,HUMANA CHOICE PLUS,MGD,94.25,,,,,,,case rate,94.25,94.25,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,AETNA,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,CIGNA,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,TRICARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,UNITED HEALTHCARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,UNITED HEALTHCARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,VA,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,VA TRICARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,WELLMED,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,HUMANA,MGD,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O GLUTATHIONE TOTAL         ,38251049,CDM,301,RC,,,,,,Inpatient,,,284.89,284.89,HUMANA CHOICE PLUS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,AETNA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,BCBS,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,CIGNA,COM,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,UNITED HEALTHCARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,VA,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,VA TRICARE,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,WELLMED,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA,MGD,62.12,,,,,,,per diem,62.12,62.12,"Per diem rate, code is bundled with other services"
S/O FATTY ACIDS FREE          ,38251050,CDM,301,RC,,,,,,Inpatient,,,62.12,62.12,HUMANA CHOICE PLUS,MGD,62.12,,,,,,,case rate,62.12,62.12,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,AETNA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,CIGNA,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,VA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,VA TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,WELLMED,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,HUMANA,MGD,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O CALPROTECTIN FECAL        ,38251051,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,HUMANA CHOICE PLUS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,AETNA,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,BCBS,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,CIGNA,COM,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,TRICARE,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,UNITED HEALTHCARE,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,UNITED HEALTHCARE,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,VA,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,VA TRICARE,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,WELLMED,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,HUMANA,MGD,793.61,,,,,,,per diem,793.61,793.61,"Per diem rate, code is bundled with other services"
S/O ALPHA GLOBIN SEQUENC      ,38251052,CDM,301,RC,,,,,,Inpatient,,,793.61,793.61,HUMANA CHOICE PLUS,MGD,793.61,,,,,,,case rate,793.61,793.61,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,AETNA,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,BCBS,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,CIGNA,COM,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,TRICARE,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,UNITED HEALTHCARE,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,UNITED HEALTHCARE,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,VA,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,VA TRICARE,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,WELLMED,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,HUMANA,MGD,834.31,,,,,,,per diem,834.31,834.31,"Per diem rate, code is bundled with other services"
S/O ALPHA THALASSEM 7 DEL     ,38251053,CDM,301,RC,,,,,,Inpatient,,,834.31,834.31,HUMANA CHOICE PLUS,MGD,834.31,,,,,,,case rate,834.31,834.31,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O APOLIPOPROTEIN B MUT      ,38251054,CDM,301,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,AETNA,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,BCBS,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,CIGNA,COM,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,TRICARE,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,UNITED HEALTHCARE,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,UNITED HEALTHCARE,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,VA,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,VA TRICARE,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,WELLMED,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,HUMANA,MGD,1918.16,,,,,,,per diem,1918.16,1918.16,"Per diem rate, code is bundled with other services"
S/O TPMT GENOTYPE             ,38251055,CDM,301,RC,,,,,,Inpatient,,,1918.16,1918.16,HUMANA CHOICE PLUS,MGD,1918.16,,,,,,,case rate,1918.16,1918.16,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,AETNA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,CIGNA,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,VA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,VA TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,WELLMED,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA,MGD,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
S/O T-CELL CLONALITY PCR      ,38251056,CDM,301,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA CHOICE PLUS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,AETNA,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,CIGNA,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,TRICARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,UNITED HEALTHCARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,UNITED HEALTHCARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,VA,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,VA TRICARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,WELLMED,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,HUMANA,MGD,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
S/O CMV ANTI VIRAL SEQ        ,38251057,CDM,306,RC,,,,,,Inpatient,,,911.42,911.42,HUMANA CHOICE PLUS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,AETNA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,BCBS,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,CIGNA,COM,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,UNITED HEALTHCARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,VA,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,VA TRICARE,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,WELLMED,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA,MGD,136.02,,,,,,,per diem,136.02,136.02,"Per diem rate, code is bundled with other services"
S/O 11 DEOXYCORTISOL QNT      ,38251058,CDM,301,RC,,,,,,Inpatient,,,136.02,136.02,HUMANA CHOICE PLUS,MGD,136.02,,,,,,,case rate,136.02,136.02,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,AETNA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,BCBS,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,CIGNA,COM,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,UNITED HEALTHCARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,VA,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,VA TRICARE,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,WELLMED,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,HUMANA,MGD,499.09,,,,,,,per diem,499.09,499.09,"Per diem rate, code is bundled with other services"
S/O ANGIOTENSIN II PLASMA     ,38251059,CDM,301,RC,,,,,,Inpatient,,,499.09,499.09,HUMANA CHOICE PLUS,MGD,499.09,,,,,,,case rate,499.09,499.09,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY CHEDDAR IGG       ,38251060,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O ALLERGY WHOLE EGG IGG     ,38251061,CDM,302,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,AETNA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,BCBS,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,CIGNA,COM,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,UNITED HEALTHCARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,VA,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,VA TRICARE,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,WELLMED,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA,MGD,311.66,,,,,,,per diem,311.66,311.66,"Per diem rate, code is bundled with other services"
S/O KIT D816V MUTATON PCR     ,38251062,CDM,301,RC,,,,,,Inpatient,,,311.66,311.66,HUMANA CHOICE PLUS,MGD,311.66,,,,,,,case rate,311.66,311.66,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,AETNA,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,BCBS,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,CIGNA,COM,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,TRICARE,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,UNITED HEALTHCARE,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,UNITED HEALTHCARE,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,VA,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,VA TRICARE,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,WELLMED,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,HUMANA,MGD,2613.52,,,,,,,per diem,2613.52,2613.52,"Per diem rate, code is bundled with other services"
S/O CYTOCHROME P450 2C19      ,38251063,CDM,301,RC,,,,,,Inpatient,,,2613.52,2613.52,HUMANA CHOICE PLUS,MGD,2613.52,,,,,,,case rate,2613.52,2613.52,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,AETNA,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,BCBS,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,CIGNA,COM,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,TRICARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,UNITED HEALTHCARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,UNITED HEALTHCARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,VA,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,VA TRICARE,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,WELLMED,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,HUMANA,MGD,362,,,,,,,per diem,362,362,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 T315I MUT QN     ,38251064,CDM,301,RC,,,,,,Inpatient,,,362,362,HUMANA CHOICE PLUS,MGD,362,,,,,,,case rate,362,362,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,AETNA,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,BCBS,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,CIGNA,COM,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,TRICARE,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,UNITED HEALTHCARE,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,UNITED HEALTHCARE,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,VA,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,VA TRICARE,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,WELLMED,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,HUMANA,MGD,821.46,,,,,,,per diem,821.46,821.46,"Per diem rate, code is bundled with other services"
S/O BTD 5 MUTATIONS           ,38251065,CDM,301,RC,,,,,,Inpatient,,,821.46,821.46,HUMANA CHOICE PLUS,MGD,821.46,,,,,,,case rate,821.46,821.46,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,AETNA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,BCBS,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,CIGNA,COM,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,UNITED HEALTHCARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,VA,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,VA TRICARE,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,WELLMED,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,HUMANA,MGD,248.47,,,,,,,per diem,248.47,248.47,"Per diem rate, code is bundled with other services"
S/O JAKQ EXON12 MUT PCR       ,38251066,CDM,301,RC,,,,,,Inpatient,,,248.47,248.47,HUMANA CHOICE PLUS,MGD,248.47,,,,,,,case rate,248.47,248.47,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,AETNA,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,BCBS,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,CIGNA,COM,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,TRICARE,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,UNITED HEALTHCARE,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,UNITED HEALTHCARE,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,VA,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,VA TRICARE,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,WELLMED,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,HUMANA,MGD,414.48,,,,,,,per diem,414.48,414.48,"Per diem rate, code is bundled with other services"
S/O KIT MUTATION IN AML       ,38251067,CDM,301,RC,,,,,,Inpatient,,,414.48,414.48,HUMANA CHOICE PLUS,MGD,414.48,,,,,,,case rate,414.48,414.48,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGG      ,38251068,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ANAPLASMA HGA AB IGM      ,38251069,CDM,302,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251070,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251071,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251072,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251073,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O SALMONELLA TYPHI AB       ,38251074,CDM,302,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,AETNA,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,BCBS,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,CIGNA,COM,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,TRICARE,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,UNITED HEALTHCARE,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,UNITED HEALTHCARE,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,VA,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,VA TRICARE,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,WELLMED,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,HUMANA,MGD,1383.73,,,,,,,per diem,1383.73,1383.73,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251075,CDM,301,RC,,,,,,Inpatient,,,1383.73,1383.73,HUMANA CHOICE PLUS,MGD,1383.73,,,,,,,case rate,1383.73,1383.73,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O FLT3 MUTATION PCR         ,38251076,CDM,301,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 5         ,38251077,CDM,302,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,AETNA,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,BCBS,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,CIGNA,COM,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,TRICARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,UNITED HEALTHCARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,UNITED HEALTHCARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,VA,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,VA TRICARE,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,WELLMED,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,HUMANA,MGD,160.65,,,,,,,per diem,160.65,160.65,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251078,CDM,311,RC,,,,,,Inpatient,,,160.65,160.65,HUMANA CHOICE PLUS,MGD,160.65,,,,,,,case rate,160.65,160.65,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CHR FISH INTERPH          ,38251079,CDM,311,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
S/O HEAVY METALS4 BLD         ,38251080,CDM,301,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,AETNA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,CIGNA,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,VA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,VA TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,WELLMED,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA,MGD,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251081,CDM,311,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA CHOICE PLUS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
S/O PML-RARA TRN FISH         ,38251082,CDM,311,RC,,,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,AETNA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,CIGNA,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,WELLMED,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA,MGD,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251083,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA CHOICE PLUS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,AETNA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,CIGNA,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,WELLMED,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA,MGD,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251084,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA CHOICE PLUS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251085,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251086,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251087,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251088,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
S/O PNH PANEL RBC/WBC         ,38251089,CDM,302,RC,,,,,,Inpatient,,,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O URINE SUPERSAT            ,38251090,CDM,301,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGG     ,38251091,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O EHRLICHIA CHAF AB IGM     ,38251092,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251093,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251094,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251095,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251096,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O LYMPHOCYT AG MITO         ,38251097,CDM,302,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,AETNA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,CIGNA,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,VA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,VA TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,WELLMED,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA,MGD,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
S/O HIV PHENOSENSE GT         ,38251098,CDM,306,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA CHOICE PLUS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,AETNA,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,CIGNA,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,TRICARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,UNITED HEALTHCARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,UNITED HEALTHCARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,VA,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,VA TRICARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,WELLMED,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,HUMANA,MGD,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251099,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,HUMANA CHOICE PLUS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,AETNA,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,BCBS,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,CIGNA,COM,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,TRICARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,UNITED HEALTHCARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,UNITED HEALTHCARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,VA,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,VA TRICARE,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,WELLMED,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,HUMANA,MGD,162.79,,,,,,,per diem,162.79,162.79,"Per diem rate, code is bundled with other services"
S/O WARFARIN SENS 3           ,38251100,CDM,301,RC,,,,,,Inpatient,,,162.79,162.79,HUMANA CHOICE PLUS,MGD,162.79,,,,,,,case rate,162.79,162.79,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O INSULIN FREE/TOTAL        ,38251103,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,AETNA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,CIGNA,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,VA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,VA TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,WELLMED,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA,MGD,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251104,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA CHOICE PLUS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,AETNA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,BCBS,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,CIGNA,COM,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,UNITED HEALTHCARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,VA,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,VA TRICARE,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,WELLMED,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA,MGD,431.61,,,,,,,per diem,431.61,431.61,"Per diem rate, code is bundled with other services"
S/O EWSR1 GENE FISH           ,38251105,CDM,312,RC,,,,,,Inpatient,,,431.61,431.61,HUMANA CHOICE PLUS,MGD,431.61,,,,,,,case rate,431.61,431.61,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,AETNA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,CIGNA,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,WELLMED,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA,MGD,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251106,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA CHOICE PLUS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,AETNA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,CIGNA,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,WELLMED,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA,MGD,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251107,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA CHOICE PLUS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,AETNA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,BCBS,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,CIGNA,COM,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,UNITED HEALTHCARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,VA TRICARE,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,WELLMED,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA,MGD,337.37,,,,,,,per diem,337.37,337.37,"Per diem rate, code is bundled with other services"
S/O MISMATCH REPR IHC         ,38251108,CDM,312,RC,,,,,,Inpatient,,,337.37,337.37,HUMANA CHOICE PLUS,MGD,337.37,,,,,,,case rate,337.37,337.37,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251109,CDM,305,RC,85441,CPT,30014,HCPCS,27,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,AETNA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,BCBS,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,CIGNA,COM,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,UNITED HEALTHCARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,VA TRICARE,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,WELLMED,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA,MGD,25.7,,,,,,,per diem,25.7,25.7,"Per diem rate, code is bundled with other services"
S/O HEINZ BODY STAIN          ,38251110,CDM,305,RC,,,,,,Inpatient,,,25.7,25.7,HUMANA CHOICE PLUS,MGD,25.7,,,,,,,case rate,25.7,25.7,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O VARICELLAZOST DFA WRF     ,38251111,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,AETNA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,CIGNA,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,WELLMED,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA,MGD,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251112,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA CHOICE PLUS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,AETNA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,BCBS,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,CIGNA,COM,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,UNITED HEALTHCARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,VA TRICARE,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,WELLMED,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA,MGD,251.69,,,,,,,per diem,251.69,251.69,"Per diem rate, code is bundled with other services"
S/O PNH HIGH SENS RBC         ,38251113,CDM,302,RC,,,,,,Inpatient,,,251.69,251.69,HUMANA CHOICE PLUS,MGD,251.69,,,,,,,case rate,251.69,251.69,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,AETNA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,CIGNA,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,WELLMED,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA,MGD,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O HEX PHOSPHOLIPID RFLX     ,38251114,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA CHOICE PLUS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O PLATELET NEUTRAL RFLX     ,38251115,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O PTT-D HEPARIN RFLX        ,38251116,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O MATERNAL SRM SCREEN       ,38251117,CDM,302,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,AETNA,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,BCBS,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,CIGNA,COM,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,TRICARE,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,UNITED HEALTHCARE,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,UNITED HEALTHCARE,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,VA,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,VA TRICARE,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,WELLMED,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,HUMANA,MGD,1069.93,,,,,,,per diem,1069.93,1069.93,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251118,CDM,301,RC,,,,,,Inpatient,,,1069.93,1069.93,HUMANA CHOICE PLUS,MGD,1069.93,,,,,,,case rate,1069.93,1069.93,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,AETNA,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,BCBS,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,CIGNA,COM,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,TRICARE,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,UNITED HEALTHCARE,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,UNITED HEALTHCARE,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,VA,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,VA TRICARE,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,WELLMED,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,HUMANA,MGD,278.46,,,,,,,per diem,278.46,278.46,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251119,CDM,310,RC,,,,,,Inpatient,,,278.46,278.46,HUMANA CHOICE PLUS,MGD,278.46,,,,,,,case rate,278.46,278.46,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O KRAS MUTATION             ,38251120,CDM,301,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251121,CDM,301,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O MSI BY PCR                ,38251122,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,AETNA,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,CIGNA,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,TRICARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,UNITED HEALTHCARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,UNITED HEALTHCARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,VA,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,VA TRICARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,WELLMED,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,HUMANA,MGD,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251123,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,HUMANA CHOICE PLUS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 W/RFLX        ,38251124,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,AETNA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,CIGNA,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,VA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,VA TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,WELLMED,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA,MGD,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
S/O MLH1 PROMOTER METHYL      ,38251125,CDM,301,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA CHOICE PLUS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,AETNA,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,BCBS,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,CIGNA,COM,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,TRICARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,UNITED HEALTHCARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,UNITED HEALTHCARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,VA,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,VA TRICARE,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,WELLMED,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,HUMANA,MGD,892.14,,,,,,,per diem,892.14,892.14,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251126,CDM,301,RC,,,,,,Inpatient,,,892.14,892.14,HUMANA CHOICE PLUS,MGD,892.14,,,,,,,case rate,892.14,892.14,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
S/O BRAF COD600 PYRO          ,38251127,CDM,310,RC,,,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,AETNA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,CIGNA,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,VA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,VA TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,WELLMED,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA,MGD,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251128,CDM,301,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA CHOICE PLUS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,AETNA,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,CIGNA,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,TRICARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,UNITED HEALTHCARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,UNITED HEALTHCARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,VA,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,VA TRICARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,WELLMED,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,HUMANA,MGD,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 QL WRFLX         ,38251129,CDM,301,RC,,,,,,Inpatient,,,750.77,750.77,HUMANA CHOICE PLUS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MAJOR QUANT      ,38251130,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O BCR-ABL1 MINOR QUANT      ,38251131,CDM,301,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251132,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251133,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251134,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251135,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251136,CDM,311,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O ANEUPLOIDY FISH           ,38251137,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,AETNA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,CIGNA,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,VA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,VA TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,WELLMED,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,HUMANA,MGD,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251138,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,HUMANA CHOICE PLUS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,AETNA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,BCBS,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,CIGNA,COM,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,UNITED HEALTHCARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,VA,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,VA TRICARE,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,WELLMED,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,HUMANA,MGD,494.8,,,,,,,per diem,494.8,494.8,"Per diem rate, code is bundled with other services"
S/O B-CELL SCRN PCR           ,38251139,CDM,301,RC,,,,,,Inpatient,,,494.8,494.8,HUMANA CHOICE PLUS,MGD,494.8,,,,,,,case rate,494.8,494.8,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251140,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251141,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251142,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251143,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,AETNA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,BCBS,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,CIGNA,COM,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,UNITED HEALTHCARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,VA TRICARE,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,WELLMED,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA,MGD,455.18,,,,,,,per diem,455.18,455.18,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251144,CDM,301,RC,,,,,,Inpatient,,,455.18,455.18,HUMANA CHOICE PLUS,MGD,455.18,,,,,,,case rate,455.18,455.18,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,AETNA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,BCBS,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,CIGNA,COM,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,UNITED HEALTHCARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,VA,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,VA TRICARE,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,WELLMED,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA,MGD,423.05,,,,,,,per diem,423.05,423.05,"Per diem rate, code is bundled with other services"
S/O MITOCHROND DISORD         ,38251145,CDM,301,RC,,,,,,Inpatient,,,423.05,423.05,HUMANA CHOICE PLUS,MGD,423.05,,,,,,,case rate,423.05,423.05,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
S/O THIOPURIN METABOL         ,38251146,CDM,301,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251147,CDM,311,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,AETNA,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,BCBS,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,CIGNA,COM,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,TRICARE,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,UNITED HEALTHCARE,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,UNITED HEALTHCARE,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,VA,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,VA TRICARE,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,WELLMED,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,HUMANA,MGD,957.47,,,,,,,per diem,957.47,957.47,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD W/RFLX        ,38251148,CDM,311,RC,,,,,,Inpatient,,,957.47,957.47,HUMANA CHOICE PLUS,MGD,957.47,,,,,,,case rate,957.47,957.47,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,AETNA,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,BCBS,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,CIGNA,COM,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,TRICARE,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,UNITED HEALTHCARE,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,UNITED HEALTHCARE,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,VA,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,VA TRICARE,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,WELLMED,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,HUMANA,MGD,6685.18,,,,,,,per diem,6685.18,6685.18,"Per diem rate, code is bundled with other services"
S/O CHROM P BLD GEN M ARR     ,38251149,CDM,301,RC,,,,,,Inpatient,,,6685.18,6685.18,HUMANA CHOICE PLUS,MGD,6685.18,,,,,,,case rate,6685.18,6685.18,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251150,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251151,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251152,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251153,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
CRYOPRECIP 5UNIT POOL         ,38251154,CDM,390,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,AETNA,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,BCBS,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,CIGNA,COM,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,TRICARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,UNITED HEALTHCARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,UNITED HEALTHCARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,VA,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,VA TRICARE,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,WELLMED,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,HUMANA,MGD,254.9,,,,,,,per diem,254.9,254.9,"Per diem rate, code is bundled with other services"
S/O THROMBO RISK WRFX         ,38251155,CDM,301,RC,,,,,,Inpatient,,,254.9,254.9,HUMANA CHOICE PLUS,MGD,254.9,,,,,,,case rate,254.9,254.9,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
S/O THROM RISK F5 R506Q       ,38251156,CDM,301,RC,,,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,AETNA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,BCBS,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,CIGNA,COM,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,UNITED HEALTHCARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,VA TRICARE,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,WELLMED,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA,MGD,54.62,,,,,,,per diem,54.62,54.62,"Per diem rate, code is bundled with other services"
S/O THROM RISK PTT-D NEUT     ,38251157,CDM,305,RC,,,,,,Inpatient,,,54.62,54.62,HUMANA CHOICE PLUS,MGD,54.62,,,,,,,case rate,54.62,54.62,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O THROM RISK PLT NEUTRL     ,38251158,CDM,305,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,AETNA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,CIGNA,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,VA TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,WELLMED,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA,MGD,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O THROM RISK HEXA PHOSP     ,38251159,CDM,305,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA CHOICE PLUS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN FIRST      ,38251160,CDM,300,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,AETNA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,BCBS,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,CIGNA,COM,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,UNITED HEALTHCARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,VA,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,VA TRICARE,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,WELLMED,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,HUMANA,MGD,213.13,,,,,,,per diem,213.13,213.13,"Per diem rate, code is bundled with other services"
S/O FETAL HEMOGLOBIN APT      ,38251161,CDM,301,RC,,,,,,Inpatient,,,213.13,213.13,HUMANA CHOICE PLUS,MGD,213.13,,,,,,,case rate,213.13,213.13,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,AETNA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,CIGNA,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,VA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,VA TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,WELLMED,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA,MGD,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
S/O HLA 1 HR                  ,38251162,CDM,301,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA CHOICE PLUS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,AETNA,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,BCBS,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,CIGNA,COM,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,TRICARE,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,UNITED HEALTHCARE,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,UNITED HEALTHCARE,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,VA,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,VA TRICARE,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,WELLMED,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,HUMANA,MGD,930.7,,,,,,,per diem,930.7,930.7,"Per diem rate, code is bundled with other services"
S/O HLA 2 HR                  ,38251163,CDM,301,RC,,,,,,Inpatient,,,930.7,930.7,HUMANA CHOICE PLUS,MGD,930.7,,,,,,,case rate,930.7,930.7,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,AETNA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,CIGNA,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,VA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,VA TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,WELLMED,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA,MGD,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODIES           ,38251164,CDM,301,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA CHOICE PLUS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,AETNA,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,BCBS,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,CIGNA,COM,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,TRICARE,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,UNITED HEALTHCARE,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,UNITED HEALTHCARE,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,VA,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,VA TRICARE,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,WELLMED,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,HUMANA,MGD,613.68,,,,,,,per diem,613.68,613.68,"Per diem rate, code is bundled with other services"
S/O HLA ANTIBODY SCREEN       ,38251165,CDM,302,RC,,,,,,Inpatient,,,613.68,613.68,HUMANA CHOICE PLUS,MGD,613.68,,,,,,,case rate,613.68,613.68,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,AETNA,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,CIGNA,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,TRICARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,UNITED HEALTHCARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,UNITED HEALTHCARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,VA,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,VA TRICARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,WELLMED,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,HUMANA,MGD,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN NONCRH     ,38251166,CDM,300,RC,,,,,,Inpatient,,,115.67,115.67,HUMANA CHOICE PLUS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,AETNA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,CIGNA,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,VA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,VA TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,WELLMED,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA,MGD,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O NEWBORN SCREEN SECOND     ,38251167,CDM,300,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA CHOICE PLUS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,AETNA,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,BCBS,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,CIGNA,COM,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,TRICARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,UNITED HEALTHCARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,UNITED HEALTHCARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,VA,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,VA TRICARE,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,WELLMED,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,HUMANA,MGD,1349.46,,,,,,,per diem,1349.46,1349.46,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD ROUTN         ,38251168,CDM,311,RC,,,,,,Inpatient,,,1349.46,1349.46,HUMANA CHOICE PLUS,MGD,1349.46,,,,,,,case rate,1349.46,1349.46,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,AETNA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,CIGNA,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,WELLMED,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA,MGD,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251169,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA CHOICE PLUS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,AETNA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,CIGNA,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,WELLMED,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA,MGD,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251170,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA CHOICE PLUS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,AETNA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,BCBS,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,CIGNA,COM,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,UNITED HEALTHCARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,VA TRICARE,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,WELLMED,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA,MGD,1253.07,,,,,,,per diem,1253.07,1253.07,"Per diem rate, code is bundled with other services"
S/O CHR ANL AMNIO FLD         ,38251171,CDM,311,RC,,,,,,Inpatient,,,1253.07,1253.07,HUMANA CHOICE PLUS,MGD,1253.07,,,,,,,case rate,1253.07,1253.07,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,AETNA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,CIGNA,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,WELLMED,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA,MGD,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SOLID TUMR        ,38251172,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA CHOICE PLUS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,AETNA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,CIGNA,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,WELLMED,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA,MGD,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O CHR ANL SKN BIOPY         ,38251173,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA CHOICE PLUS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,AETNA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,CIGNA,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,VA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,VA TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,WELLMED,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA,MGD,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251174,CDM,311,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA CHOICE PLUS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,AETNA,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,BCBS,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,CIGNA,COM,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,TRICARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,UNITED HEALTHCARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,UNITED HEALTHCARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,VA,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,VA TRICARE,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,WELLMED,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,HUMANA,MGD,152.08,,,,,,,per diem,152.08,152.08,"Per diem rate, code is bundled with other services"
SO MICRODELTN HI RES          ,38251175,CDM,311,RC,,,,,,Inpatient,,,152.08,152.08,HUMANA CHOICE PLUS,MGD,152.08,,,,,,,case rate,152.08,152.08,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,AETNA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,CIGNA,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,VA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,VA TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,WELLMED,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA,MGD,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251176,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA CHOICE PLUS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,AETNA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,CIGNA,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,VA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,VA TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,WELLMED,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA,MGD,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
S/O PANCREATIC FUNCT          ,38251177,CDM,301,RC,,,,,,Inpatient,,,124.24,124.24,HUMANA CHOICE PLUS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,AETNA,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,BCBS,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,CIGNA,COM,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,TRICARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,UNITED HEALTHCARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,UNITED HEALTHCARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,VA,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,VA TRICARE,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,WELLMED,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,HUMANA,MGD,167.08,,,,,,,per diem,167.08,167.08,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251178,CDM,311,RC,,,,,,Inpatient,,,167.08,167.08,HUMANA CHOICE PLUS,MGD,167.08,,,,,,,case rate,167.08,167.08,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,AETNA,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,BCBS,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,CIGNA,COM,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,TRICARE,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,UNITED HEALTHCARE,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,UNITED HEALTHCARE,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,VA,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,VA TRICARE,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,WELLMED,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,HUMANA,MGD,677.94,,,,,,,per diem,677.94,677.94,"Per diem rate, code is bundled with other services"
S/O CHR FISH METAPHAS         ,38251179,CDM,311,RC,,,,,,Inpatient,,,677.94,677.94,HUMANA CHOICE PLUS,MGD,677.94,,,,,,,case rate,677.94,677.94,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,AETNA,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,BCBS,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,CIGNA,COM,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,TRICARE,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,UNITED HEALTHCARE,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,UNITED HEALTHCARE,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,VA,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,VA TRICARE,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,WELLMED,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,HUMANA,MGD,3230.14,,,,,,,per diem,3230.14,3230.14,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251180,CDM,311,RC,,,,,,Inpatient,,,3230.14,3230.14,HUMANA CHOICE PLUS,MGD,3230.14,,,,,,,case rate,3230.14,3230.14,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,AETNA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,CIGNA,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,VA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,VA TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,WELLMED,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,HUMANA,MGD,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O CHR ANL BLD HI RES        ,38251181,CDM,311,RC,,,,,,Inpatient,,,80.33,80.33,HUMANA CHOICE PLUS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
TEG TEST                      ,38251182,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,AETNA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,CIGNA,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,VA TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,WELLMED,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA,MGD,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251183,CDM,305,RC,,,,,,Inpatient,,,81.4,81.4,HUMANA CHOICE PLUS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
PLATELET MAPPING              ,38251184,CDM,305,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,AETNA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,CIGNA,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,VA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,VA TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,WELLMED,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA,MGD,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
S/O FRAGILE X METHYL ANL      ,38251185,CDM,301,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA CHOICE PLUS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,AETNA,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,BCBS,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,CIGNA,COM,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,TRICARE,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,UNITED HEALTHCARE,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,UNITED HEALTHCARE,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,VA,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,VA TRICARE,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,WELLMED,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,HUMANA,MGD,498.91,,,,,,,per diem,498.91,498.91,"Per diem rate, code is bundled with other services"
RED CELLS L/R IRR EA          ,38251186,CDM,390,RC,,,,,,Inpatient,,,498.91,498.91,HUMANA CHOICE PLUS,MGD,498.91,,,,,,,case rate,498.91,498.91,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O HBSAG NEUTRALIZATION      ,38251187,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,AETNA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,BCBS,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,CIGNA,COM,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,UNITED HEALTHCARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,VA,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,VA TRICARE,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,WELLMED,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA,MGD,46.05,,,,,,,per diem,46.05,46.05,"Per diem rate, code is bundled with other services"
S/O ANTITHROMBIN III AG       ,38251188,CDM,305,RC,,,,,,Inpatient,,,46.05,46.05,HUMANA CHOICE PLUS,MGD,46.05,,,,,,,case rate,46.05,46.05,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,AETNA,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,BCBS,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,CIGNA,COM,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,TRICARE,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,UNITED HEALTHCARE,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,UNITED HEALTHCARE,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,VA,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,VA TRICARE,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,WELLMED,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,HUMANA,MGD,1634.44,,,,,,,per diem,1634.44,1634.44,"Per diem rate, code is bundled with other services"
PLATELETS PHER L/R EA         ,38251189,CDM,390,RC,,,,,,Inpatient,,,1634.44,1634.44,HUMANA CHOICE PLUS,MGD,1634.44,,,,,,,case rate,1634.44,1634.44,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,AETNA,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,BCBS,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,CIGNA,COM,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,TRICARE,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,UNITED HEALTHCARE,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,UNITED HEALTHCARE,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,VA,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,VA TRICARE,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,WELLMED,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,HUMANA,MGD,338.79,,,,,,,per diem,338.79,338.79,"Per diem rate, code is bundled with other services"
RED CELLS L/R EA              ,38251190,CDM,390,RC,,,,,,Inpatient,,,338.79,338.79,HUMANA CHOICE PLUS,MGD,338.79,,,,,,,case rate,338.79,338.79,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,AETNA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,BCBS,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,CIGNA,COM,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,UNITED HEALTHCARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,VA TRICARE,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,WELLMED,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA,MGD,128.52,,,,,,,per diem,128.52,128.52,"Per diem rate, code is bundled with other services"
S/O DEOXYCORTICOSTERON QN     ,38251191,CDM,301,RC,,,,,,Inpatient,,,128.52,128.52,HUMANA CHOICE PLUS,MGD,128.52,,,,,,,case rate,128.52,128.52,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,AETNA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,CIGNA,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,VA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,VA TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,WELLMED,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA,MGD,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O ANTI-MYELOPEROXIDASE      ,38251192,CDM,301,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA CHOICE PLUS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,AETNA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,CIGNA,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,VA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,VA TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,WELLMED,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,HUMANA,MGD,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
S/O LAMELLAR BODY COUNTS      ,38251193,CDM,301,RC,,,,,,Inpatient,,,80.33,80.33,HUMANA CHOICE PLUS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,AETNA,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,CIGNA,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,TRICARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,UNITED HEALTHCARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,UNITED HEALTHCARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,VA,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,VA TRICARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,WELLMED,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,HUMANA,MGD,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
S/O MOLEC RED CELL PHENO      ,38251194,CDM,301,RC,,,,,,Inpatient,,,1108.49,1108.49,HUMANA CHOICE PLUS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,AETNA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,CIGNA,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,VA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,VA TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,WELLMED,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA,MGD,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O RED CELL SEPARATION       ,38251195,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA CHOICE PLUS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251196,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O DRUG DEPENDENT AB         ,38251197,CDM,302,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,AETNA,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,BCBS,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,CIGNA,COM,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,TRICARE,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,UNITED HEALTHCARE,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,UNITED HEALTHCARE,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,VA,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,VA TRICARE,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,WELLMED,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,HUMANA,MGD,1071,,,,,,,per diem,1071,1071,"Per diem rate, code is bundled with other services"
S/O MOLECUL PLATELET GENO     ,38251198,CDM,301,RC,,,,,,Inpatient,,,1071,1071,HUMANA CHOICE PLUS,MGD,1071,,,,,,,case rate,1071,1071,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,AETNA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,BCBS,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,CIGNA,COM,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,UNITED HEALTHCARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,VA,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,VA TRICARE,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,WELLMED,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA,MGD,171.36,,,,,,,per diem,171.36,171.36,"Per diem rate, code is bundled with other services"
S/O HLA SEARCH                ,38251199,CDM,300,RC,,,,,,Inpatient,,,171.36,171.36,HUMANA CHOICE PLUS,MGD,171.36,,,,,,,case rate,171.36,171.36,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,AETNA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,CIGNA,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,VA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,VA TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,WELLMED,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,HUMANA,MGD,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 1         ,38251200,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,HUMANA CHOICE PLUS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,AETNA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,CIGNA,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,VA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,VA TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,WELLMED,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,HUMANA,MGD,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
S/O HLA DONOR MATCH 2         ,38251201,CDM,301,RC,,,,,,Inpatient,,,174.57,174.57,HUMANA CHOICE PLUS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,AETNA,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,CIGNA,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,TRICARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,UNITED HEALTHCARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,UNITED HEALTHCARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,VA,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,VA TRICARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,WELLMED,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,HUMANA,MGD,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
S/O REDUCED VOL PLATELETS     ,38251202,CDM,390,RC,,,,,,Inpatient,,,134.95,134.95,HUMANA CHOICE PLUS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,AETNA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,BCBS,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,CIGNA,COM,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,UNITED HEALTHCARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,VA TRICARE,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,WELLMED,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA,MGD,186.35,,,,,,,per diem,186.35,186.35,"Per diem rate, code is bundled with other services"
S/O EPSTEIN BARR PCR BLD      ,38251203,CDM,306,RC,,,,,,Inpatient,,,186.35,186.35,HUMANA CHOICE PLUS,MGD,186.35,,,,,,,case rate,186.35,186.35,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251204,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 6         ,38251205,CDM,302,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,AETNA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,BCBS,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,CIGNA,COM,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,UNITED HEALTHCARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,VA TRICARE,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,WELLMED,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA,MGD,88.89,,,,,,,per diem,88.89,88.89,"Per diem rate, code is bundled with other services"
S/O NCAPS AB PANEL            ,38251206,CDM,302,RC,,,,,,Inpatient,,,88.89,88.89,HUMANA CHOICE PLUS,MGD,88.89,,,,,,,case rate,88.89,88.89,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O HIV-2 AB DIFFERENTIAT     ,38251207,CDM,302,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,AETNA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,CIGNA,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,VA TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,WELLMED,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA,MGD,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
S/O TISS CLT SKIN/OTHER       ,38251208,CDM,311,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA CHOICE PLUS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251209,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O AFB SUSCEPT REFLX         ,38251210,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,AETNA,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,BCBS,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,CIGNA,COM,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,TRICARE,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,UNITED HEALTHCARE,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,UNITED HEALTHCARE,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,VA,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,VA TRICARE,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,WELLMED,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,HUMANA,MGD,490.52,,,,,,,per diem,490.52,490.52,"Per diem rate, code is bundled with other services"
S/O MTB DNA SEQUENC RFLX      ,38251211,CDM,306,RC,,,,,,Inpatient,,,490.52,490.52,HUMANA CHOICE PLUS,MGD,490.52,,,,,,,case rate,490.52,490.52,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O MTB CPLX SPC/AMP PRBE     ,38251212,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,AETNA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,BCBS,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,CIGNA,COM,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,UNITED HEALTHCARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,VA,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,VA TRICARE,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,WELLMED,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA,MGD,23.56,,,,,,,per diem,23.56,23.56,"Per diem rate, code is bundled with other services"
S/O AFB ID BY MALDI REFLX     ,38251213,CDM,306,RC,,,,,,Inpatient,,,23.56,23.56,HUMANA CHOICE PLUS,MGD,23.56,,,,,,,case rate,23.56,23.56,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,AETNA,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,CIGNA,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,TRICARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,UNITED HEALTHCARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,UNITED HEALTHCARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,VA,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,VA TRICARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,WELLMED,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,HUMANA,MGD,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
S/O ROS1 BY FISH              ,38251214,CDM,312,RC,,,,,,Inpatient,,,659.74,659.74,HUMANA CHOICE PLUS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,AETNA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,CIGNA,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,WELLMED,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA,MGD,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251215,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA CHOICE PLUS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,AETNA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,BCBS,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,CIGNA,COM,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,UNITED HEALTHCARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,VA TRICARE,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,WELLMED,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA,MGD,323.44,,,,,,,per diem,323.44,323.44,"Per diem rate, code is bundled with other services"
S/O MYELOPROL PNL FISH        ,38251216,CDM,311,RC,,,,,,Inpatient,,,323.44,323.44,HUMANA CHOICE PLUS,MGD,323.44,,,,,,,case rate,323.44,323.44,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,AETNA,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,CIGNA,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,TRICARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,UNITED HEALTHCARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,UNITED HEALTHCARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,VA,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,VA TRICARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,WELLMED,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,HUMANA,MGD,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251217,CDM,310,RC,,,,,,Inpatient,,,526.93,526.93,HUMANA CHOICE PLUS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,AETNA,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,BCBS,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,CIGNA,COM,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,TRICARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,UNITED HEALTHCARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,UNITED HEALTHCARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,VA,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,VA TRICARE,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,WELLMED,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,HUMANA,MGD,526.93,,,,,,,per diem,526.93,526.93,"Per diem rate, code is bundled with other services"
S/O NRAS MUT PYROSEQ          ,38251218,CDM,301,RC,,,,,,Inpatient,,,526.93,526.93,HUMANA CHOICE PLUS,MGD,526.93,,,,,,,case rate,526.93,526.93,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251219,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251220,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251221,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251222,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251223,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251224,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
S/O THYROID TRANS/MUT         ,38251225,CDM,301,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,AETNA,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,CIGNA,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,TRICARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,UNITED HEALTHCARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,UNITED HEALTHCARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,VA,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,VA TRICARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,WELLMED,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,HUMANA,MGD,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251226,CDM,310,RC,,,,,,Inpatient,,,736.85,736.85,HUMANA CHOICE PLUS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,AETNA,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,BCBS,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,CIGNA,COM,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,TRICARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,UNITED HEALTHCARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,UNITED HEALTHCARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,VA,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,VA TRICARE,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,WELLMED,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,HUMANA,MGD,736.85,,,,,,,per diem,736.85,736.85,"Per diem rate, code is bundled with other services"
S/O HRAS MUT DET PYRO         ,38251227,CDM,301,RC,,,,,,Inpatient,,,736.85,736.85,HUMANA CHOICE PLUS,MGD,736.85,,,,,,,case rate,736.85,736.85,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,AETNA,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,BCBS,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,CIGNA,COM,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,TRICARE,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,UNITED HEALTHCARE,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,UNITED HEALTHCARE,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,VA,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,VA TRICARE,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,WELLMED,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,HUMANA,MGD,698.29,,,,,,,per diem,698.29,698.29,"Per diem rate, code is bundled with other services"
S/O CYST FIBR CFTR 165VAR     ,38251228,CDM,301,RC,,,,,,Inpatient,,,698.29,698.29,HUMANA CHOICE PLUS,MGD,698.29,,,,,,,case rate,698.29,698.29,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251229,CDM,310,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251230,CDM,301,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
S/O LUNG CANCER PANEL         ,38251231,CDM,312,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,AETNA,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,BCBS,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,CIGNA,COM,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,TRICARE,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,UNITED HEALTHCARE,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,UNITED HEALTHCARE,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,VA,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,VA TRICARE,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,WELLMED,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,HUMANA,MGD,7666.22,,,,,,,per diem,7666.22,7666.22,"Per diem rate, code is bundled with other services"
"S/O BRCA1 & 2 SEQ,DEL/DUP     ",38251232,CDM,301,RC,,,,,,Inpatient,,,7666.22,7666.22,HUMANA CHOICE PLUS,MGD,7666.22,,,,,,,case rate,7666.22,7666.22,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
S/O EVEROLIMUS BY TMS         ,38251233,CDM,301,RC,,,,,,Inpatient,,,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,AETNA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,CIGNA,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,WELLMED,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA,MGD,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR STREP                ,38251244,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA CHOICE PLUS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,AETNA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,CIGNA,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,WELLMED,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA,MGD,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR YERSINIA             ,38251245,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA CHOICE PLUS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,AETNA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,CIGNA,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,WELLMED,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA,MGD,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCRN H PYLORI            ,38251246,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA CHOICE PLUS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,AETNA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,BCBS,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,CIGNA,COM,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,UNITED HEALTHCARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,VA TRICARE,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,WELLMED,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA,MGD,247.4,,,,,,,per diem,247.4,247.4,"Per diem rate, code is bundled with other services"
CULT SCR MRSA                 ,38251247,CDM,306,RC,,,,,,Inpatient,,,247.4,247.4,HUMANA CHOICE PLUS,MGD,247.4,,,,,,,case rate,247.4,247.4,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CORYNEBACT DIPHT CULT     ,38251248,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,AETNA,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,BCBS,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,CIGNA,COM,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,TRICARE,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,UNITED HEALTHCARE,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,UNITED HEALTHCARE,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,VA,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,VA TRICARE,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,WELLMED,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,HUMANA,MGD,658.67,,,,,,,per diem,658.67,658.67,"Per diem rate, code is bundled with other services"
S/O LEGIONELLA SPECIES        ,38251249,CDM,306,RC,,,,,,Inpatient,,,658.67,658.67,HUMANA CHOICE PLUS,MGD,658.67,,,,,,,case rate,658.67,658.67,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,AETNA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,CIGNA,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,VA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,VA TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,WELLMED,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA,MGD,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251250,CDM,306,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA CHOICE PLUS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN LEGIONELLA      ,38251251,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O CULT SCRN B PERTUSSIS     ,38251252,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251253,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR LEGIONELLA       ,38251254,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR MRSA             ,38251255,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCR STREP            ,38251256,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCREEN VRE           ,38251257,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN GC              ,38251258,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN PERTUSSIS       ,38251259,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,AETNA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,BCBS,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,CIGNA,COM,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,UNITED HEALTHCARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,VA TRICARE,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,WELLMED,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA,MGD,255.97,,,,,,,per diem,255.97,255.97,"Per diem rate, code is bundled with other services"
S/O CULT SCRN STREP GRP A     ,38251260,CDM,306,RC,,,,,,Inpatient,,,255.97,255.97,HUMANA CHOICE PLUS,MGD,255.97,,,,,,,case rate,255.97,255.97,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,AETNA,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,BCBS,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,CIGNA,COM,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,TRICARE,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,UNITED HEALTHCARE,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,UNITED HEALTHCARE,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,VA,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,VA TRICARE,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,WELLMED,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,HUMANA,MGD,238.83,,,,,,,per diem,238.83,238.83,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC OTHER QN     ,38251261,CDM,306,RC,,,,,,Inpatient,,,238.83,238.83,HUMANA CHOICE PLUS,MGD,238.83,,,,,,,case rate,238.83,238.83,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,AETNA,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,CIGNA,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,TRICARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,UNITED HEALTHCARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,UNITED HEALTHCARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,VA,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,VA TRICARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,WELLMED,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,HUMANA,MGD,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
SMEAR CRYPTOSPORIDIUM         ,38251262,CDM,306,RC,,,,,,Inpatient,,,197.06,197.06,HUMANA CHOICE PLUS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,AETNA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,CIGNA,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,VA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,VA TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,WELLMED,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA,MGD,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251263,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA CHOICE PLUS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,AETNA,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,BCBS,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,CIGNA,COM,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,TRICARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,UNITED HEALTHCARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,UNITED HEALTHCARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,VA,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,VA TRICARE,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,WELLMED,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,HUMANA,MGD,193.85,,,,,,,per diem,193.85,193.85,"Per diem rate, code is bundled with other services"
S/O SMEAR ACID FAST           ,38251264,CDM,306,RC,,,,,,Inpatient,,,193.85,193.85,HUMANA CHOICE PLUS,MGD,193.85,,,,,,,case rate,193.85,193.85,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA I                ,38251265,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,AETNA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,BCBS,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,CIGNA,COM,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,UNITED HEALTHCARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,VA,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,VA TRICARE,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,WELLMED,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA,MGD,78.18,,,,,,,per diem,78.18,78.18,"Per diem rate, code is bundled with other services"
IMMUNO SHIGA II               ,38251266,CDM,306,RC,,,,,,Inpatient,,,78.18,78.18,HUMANA CHOICE PLUS,MGD,78.18,,,,,,,case rate,78.18,78.18,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,AETNA,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,BCBS,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,CIGNA,COM,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,TRICARE,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,UNITED HEALTHCARE,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,UNITED HEALTHCARE,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,VA,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,VA TRICARE,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,WELLMED,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,HUMANA,MGD,66.26,,,,,,,per diem,66.26,66.26,"Per diem rate, code is bundled with other services"
S/O CDIFF QK TOX A/B          ,38251267,CDM,306,RC,,,,,,Inpatient,,,66.26,66.26,HUMANA CHOICE PLUS,MGD,66.26,,,,,,,case rate,66.26,66.26,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,AETNA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,BCBS,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,CIGNA,COM,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,UNITED HEALTHCARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,VA,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,VA TRICARE,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,WELLMED,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA,MGD,282.74,,,,,,,per diem,282.74,282.74,"Per diem rate, code is bundled with other services"
SUSCEPT MIC PER PLATE         ,38251268,CDM,306,RC,,,,,,Inpatient,,,282.74,282.74,HUMANA CHOICE PLUS,MGD,282.74,,,,,,,case rate,282.74,282.74,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC NONFER     ,38251269,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSC STREPT     ,38251270,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,AETNA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,BCBS,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,CIGNA,COM,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,UNITED HEALTHCARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,VA TRICARE,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,WELLMED,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA,MGD,39.63,,,,,,,per diem,39.63,39.63,"Per diem rate, code is bundled with other services"
S/O ANTIMICROBIAL SUSCEPT     ,38251271,CDM,306,RC,,,,,,Inpatient,,,39.63,39.63,HUMANA CHOICE PLUS,MGD,39.63,,,,,,,case rate,39.63,39.63,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,AETNA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,BCBS,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,CIGNA,COM,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,UNITED HEALTHCARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,VA,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,VA TRICARE,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,WELLMED,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA,MGD,140.3,,,,,,,per diem,140.3,140.3,"Per diem rate, code is bundled with other services"
S/O ANTIMICRO SUSCEPT MAI     ,38251272,CDM,306,RC,,,,,,Inpatient,,,140.3,140.3,HUMANA CHOICE PLUS,MGD,140.3,,,,,,,case rate,140.3,140.3,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251273,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,AETNA,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,BCBS,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,CIGNA,COM,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,TRICARE,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,UNITED HEALTHCARE,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,UNITED HEALTHCARE,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,VA,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,VA TRICARE,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,WELLMED,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,HUMANA,MGD,387.7,,,,,,,per diem,387.7,387.7,"Per diem rate, code is bundled with other services"
S/O AFB RIF/EMB COMBO         ,38251274,CDM,306,RC,,,,,,Inpatient,,,387.7,387.7,HUMANA CHOICE PLUS,MGD,387.7,,,,,,,case rate,387.7,387.7,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251275,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC YEAST           ,38251276,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251277,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251278,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,AETNA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,BCBS,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,CIGNA,COM,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,UNITED HEALTHCARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,VA TRICARE,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,WELLMED,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA,MGD,488.38,,,,,,,per diem,488.38,488.38,"Per diem rate, code is bundled with other services"
S/O 5CF MIC YEAST             ,38251279,CDM,306,RC,,,,,,Inpatient,,,488.38,488.38,HUMANA CHOICE PLUS,MGD,488.38,,,,,,,case rate,488.38,488.38,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,AETNA,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,BCBS,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,CIGNA,COM,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,TRICARE,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,UNITED HEALTHCARE,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,UNITED HEALTHCARE,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,VA,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,VA TRICARE,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,WELLMED,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,HUMANA,MGD,155.83,,,,,,,per diem,155.83,155.83,"Per diem rate, code is bundled with other services"
S/O SUSCEPT MIC PER PLATE     ,38251280,CDM,306,RC,,,,,,Inpatient,,,155.83,155.83,HUMANA CHOICE PLUS,MGD,155.83,,,,,,,case rate,155.83,155.83,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,AETNA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,CIGNA,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,VA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,VA TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,WELLMED,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA,MGD,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
S/O FLU MIC YEAST             ,38251281,CDM,306,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA CHOICE PLUS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,AETNA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,CIGNA,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,WELLMED,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA,MGD,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O NJH-NTM3/5 ADDSGL MIC     ,38251283,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA CHOICE PLUS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,AETNA,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,BCBS,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,CIGNA,COM,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,TRICARE,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,UNITED HEALTHCARE,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,UNITED HEALTHCARE,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,VA,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,VA TRICARE,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,WELLMED,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,HUMANA,MGD,1043.15,,,,,,,per diem,1043.15,1043.15,"Per diem rate, code is bundled with other services"
S/O NJH-NTM4 15 DRUG MIC      ,38251284,CDM,306,RC,,,,,,Inpatient,,,1043.15,1043.15,HUMANA CHOICE PLUS,MGD,1043.15,,,,,,,case rate,1043.15,1043.15,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,AETNA,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,CIGNA,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,TRICARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,UNITED HEALTHCARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,UNITED HEALTHCARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,VA,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,VA TRICARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,WELLMED,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,HUMANA,MGD,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
S/O NJH-NTM6 20 DRUG MIC      ,38251285,CDM,306,RC,,,,,,Inpatient,,,1460.84,1460.84,HUMANA CHOICE PLUS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,AETNA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,BCBS,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,CIGNA,COM,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,UNITED HEALTHCARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,VA,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,VA TRICARE,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,WELLMED,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA,MGD,356.64,,,,,,,per diem,356.64,356.64,"Per diem rate, code is bundled with other services"
S/O NJH-RECOM                 ,38251286,CDM,306,RC,,,,,,Inpatient,,,356.64,356.64,HUMANA CHOICE PLUS,MGD,356.64,,,,,,,case rate,356.64,356.64,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,AETNA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,CIGNA,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,WELLMED,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA,MGD,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251287,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA CHOICE PLUS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,AETNA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,CIGNA,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,WELLMED,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA,MGD,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251288,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA CHOICE PLUS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,AETNA,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,BCBS,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,CIGNA,COM,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,TRICARE,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,UNITED HEALTHCARE,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,UNITED HEALTHCARE,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,VA,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,VA TRICARE,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,WELLMED,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,HUMANA,MGD,729.35,,,,,,,per diem,729.35,729.35,"Per diem rate, code is bundled with other services"
S/O NJH-AFB2 NAAT             ,38251289,CDM,306,RC,,,,,,Inpatient,,,729.35,729.35,HUMANA CHOICE PLUS,MGD,729.35,,,,,,,case rate,729.35,729.35,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,AETNA,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,BCBS,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,CIGNA,COM,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,TRICARE,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,UNITED HEALTHCARE,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,UNITED HEALTHCARE,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,VA,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,VA TRICARE,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,WELLMED,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,HUMANA,MGD,381.28,,,,,,,per diem,381.28,381.28,"Per diem rate, code is bundled with other services"
S/O NJH-MTB7 MTB CPLX ID      ,38251290,CDM,306,RC,,,,,,Inpatient,,,381.28,381.28,HUMANA CHOICE PLUS,MGD,381.28,,,,,,,case rate,381.28,381.28,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251291,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA TRACHOMATIS     ,38251292,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA AMP PROBE       ,38251293,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,AETNA,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,BCBS,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,CIGNA,COM,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,TRICARE,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,UNITED HEALTHCARE,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,UNITED HEALTHCARE,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,VA,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,VA TRICARE,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,WELLMED,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,HUMANA,MGD,103.89,,,,,,,per diem,103.89,103.89,"Per diem rate, code is bundled with other services"
S/O HOMOGENIZATION TISSUE     ,38251294,CDM,306,RC,,,,,,Inpatient,,,103.89,103.89,HUMANA CHOICE PLUS,MGD,103.89,,,,,,,case rate,103.89,103.89,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,AETNA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,CIGNA,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,VA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,VA TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,WELLMED,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA,MGD,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
IA CRYPTOCOCCUS NEOFOR QL     ,38251295,CDM,306,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA CHOICE PLUS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,AETNA,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,BCBS,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,CIGNA,COM,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,TRICARE,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,UNITED HEALTHCARE,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,UNITED HEALTHCARE,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,VA,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,VA TRICARE,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,WELLMED,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,HUMANA,MGD,330.94,,,,,,,per diem,330.94,330.94,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS OTHER         ,38251296,CDM,306,RC,,,,,,Inpatient,,,330.94,330.94,HUMANA CHOICE PLUS,MGD,330.94,,,,,,,case rate,330.94,330.94,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT SPUTUM                   ,38251297,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,AETNA,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,BCBS,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,CIGNA,COM,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,TRICARE,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,UNITED HEALTHCARE,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,UNITED HEALTHCARE,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,VA,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,VA TRICARE,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,WELLMED,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,HUMANA,MGD,542.64,,,,,,,per diem,542.64,542.64,"Per diem rate, code is bundled with other services"
CULT BODY FLUID               ,38251298,CDM,306,RC,,,,,,Inpatient,,,542.64,542.64,HUMANA CHOICE PLUS,MGD,542.64,,,,,,,case rate,542.64,542.64,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CATHETER TIP             ,38251299,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT CSF                      ,38251300,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EAR                      ,38251301,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT EYE                      ,38251302,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT GENITAL                  ,38251303,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,AETNA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,BCBS,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,CIGNA,COM,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,UNITED HEALTHCARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,VA,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,VA TRICARE,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,WELLMED,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,HUMANA,MGD,60.56,,,,,,,per diem,60.56,60.56,"Per diem rate, code is bundled with other services"
CULT THROAT                   ,38251304,CDM,306,RC,,,,,,Inpatient,,,60.56,60.56,HUMANA CHOICE PLUS,MGD,60.56,,,,,,,case rate,60.56,60.56,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT TISSUE                   ,38251305,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT UTERUS/PLACENTA          ,38251306,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH WASH           ,38251307,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULT NOSE/THROAT              ,38251308,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE NASAL PHARYN          ,38251309,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE OTHER SOURCE          ,38251310,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,AETNA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,BCBS,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,CIGNA,COM,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,UNITED HEALTHCARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,VA TRICARE,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,WELLMED,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA,MGD,546.21,,,,,,,per diem,546.21,546.21,"Per diem rate, code is bundled with other services"
CULTURE BRONCH BRUSH          ,38251311,CDM,306,RC,,,,,,Inpatient,,,546.21,546.21,HUMANA CHOICE PLUS,MGD,546.21,,,,,,,case rate,546.21,546.21,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,AETNA,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,BCBS,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,CIGNA,COM,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,TRICARE,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,UNITED HEALTHCARE,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,UNITED HEALTHCARE,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,VA,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,VA TRICARE,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,WELLMED,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,HUMANA,MGD,409.12,,,,,,,per diem,409.12,409.12,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251312,CDM,306,RC,,,,,,Inpatient,,,409.12,409.12,HUMANA CHOICE PLUS,MGD,409.12,,,,,,,case rate,409.12,409.12,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BODY FLUID           ,38251313,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT BONE MARROW          ,38251314,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT CSF                  ,38251315,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT GENITAL              ,38251316,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,AETNA,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,BCBS,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,CIGNA,COM,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,TRICARE,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,UNITED HEALTHCARE,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,UNITED HEALTHCARE,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,VA,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,VA TRICARE,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,WELLMED,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,HUMANA,MGD,296.4,,,,,,,per diem,296.4,296.4,"Per diem rate, code is bundled with other services"
S/O CULT RESPIRATORY          ,38251317,CDM,306,RC,,,,,,Inpatient,,,296.4,296.4,HUMANA CHOICE PLUS,MGD,296.4,,,,,,,case rate,296.4,296.4,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
S/O CULT WOUND                ,38251318,CDM,306,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,AETNA,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,BCBS,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,CIGNA,COM,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,TRICARE,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,UNITED HEALTHCARE,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,UNITED HEALTHCARE,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,VA,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,VA TRICARE,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,WELLMED,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,HUMANA,MGD,87.84,,,,,,,per diem,87.84,87.84,"Per diem rate, code is bundled with other services"
CULT AEROBIC ID               ,38251319,CDM,306,RC,,,,,,Inpatient,,,87.84,87.84,HUMANA CHOICE PLUS,MGD,87.84,,,,,,,case rate,87.84,87.84,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID           ,38251320,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,AETNA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,BCBS,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,CIGNA,COM,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,UNITED HEALTHCARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,VA,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,VA TRICARE,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,WELLMED,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA,MGD,147.8,,,,,,,per diem,147.8,147.8,"Per diem rate, code is bundled with other services"
S/O CULT AEROBIC ID           ,38251321,CDM,306,RC,,,,,,Inpatient,,,147.8,147.8,HUMANA CHOICE PLUS,MGD,147.8,,,,,,,case rate,147.8,147.8,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,AETNA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,CIGNA,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,VA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,VA TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,WELLMED,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA,MGD,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O NOCARDIA ACTINOMY         ,38251322,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA CHOICE PLUS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,AETNA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,BCBS,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,CIGNA,COM,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,UNITED HEALTHCARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,VA,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,VA TRICARE,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,WELLMED,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA,MGD,447.68,,,,,,,per diem,447.68,447.68,"Per diem rate, code is bundled with other services"
S/O CULTURE ANAEROBIC         ,38251323,CDM,306,RC,,,,,,Inpatient,,,447.68,447.68,HUMANA CHOICE PLUS,MGD,447.68,,,,,,,case rate,447.68,447.68,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,AETNA,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,BCBS,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,CIGNA,COM,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,TRICARE,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,UNITED HEALTHCARE,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,UNITED HEALTHCARE,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,VA,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,VA TRICARE,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,WELLMED,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,HUMANA,MGD,543,,,,,,,per diem,543,543,"Per diem rate, code is bundled with other services"
S/O CULT BLOOD                ,38251324,CDM,306,RC,,,,,,Inpatient,,,543,543,HUMANA CHOICE PLUS,MGD,543,,,,,,,case rate,543,543,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,AETNA,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,CIGNA,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,TRICARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,UNITED HEALTHCARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,UNITED HEALTHCARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,VA,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,VA TRICARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,WELLMED,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,HUMANA,MGD,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL E COLI          ,38251325,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,HUMANA CHOICE PLUS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,AETNA,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,BCBS,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,CIGNA,COM,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,TRICARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,UNITED HEALTHCARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,UNITED HEALTHCARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,VA,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,VA TRICARE,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,WELLMED,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,HUMANA,MGD,261.32,,,,,,,per diem,261.32,261.32,"Per diem rate, code is bundled with other services"
CULTURE STOOL CAMPY           ,38251326,CDM,306,RC,,,,,,Inpatient,,,261.32,261.32,HUMANA CHOICE PLUS,MGD,261.32,,,,,,,case rate,261.32,261.32,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,AETNA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,CIGNA,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,VA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,VA TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,WELLMED,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,HUMANA,MGD,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
S/O STOOL CULTURE VIBRIO      ,38251327,CDM,306,RC,,,,,,Inpatient,,,9.64,9.64,HUMANA CHOICE PLUS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT STOOL VIBRIO         ,38251328,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,AETNA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,BCBS,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,CIGNA,COM,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,UNITED HEALTHCARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,VA,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,VA TRICARE,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,WELLMED,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA,MGD,132.8,,,,,,,per diem,132.8,132.8,"Per diem rate, code is bundled with other services"
S/O CULT SCR YERSINIA         ,38251329,CDM,306,RC,,,,,,Inpatient,,,132.8,132.8,HUMANA CHOICE PLUS,MGD,132.8,,,,,,,case rate,132.8,132.8,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,AETNA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,BCBS,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,CIGNA,COM,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,UNITED HEALTHCARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,VA,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,VA TRICARE,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,WELLMED,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA,MGD,270.96,,,,,,,per diem,270.96,270.96,"Per diem rate, code is bundled with other services"
S/O CULTURE STOOL CAMPY       ,38251330,CDM,306,RC,,,,,,Inpatient,,,270.96,270.96,HUMANA CHOICE PLUS,MGD,270.96,,,,,,,case rate,270.96,270.96,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CHLAMYDIA CULTURE         ,38251331,CDM,306,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,AETNA,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,BCBS,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,CIGNA,COM,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,TRICARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,UNITED HEALTHCARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,UNITED HEALTHCARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,VA,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,VA TRICARE,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,WELLMED,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,HUMANA,MGD,232.41,,,,,,,per diem,232.41,232.41,"Per diem rate, code is bundled with other services"
S/O CULT CHLAMYDIA            ,38251332,CDM,306,RC,,,,,,Inpatient,,,232.41,232.41,HUMANA CHOICE PLUS,MGD,232.41,,,,,,,case rate,232.41,232.41,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251333,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O VIRAL CULT NON-RESP       ,38251334,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251335,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,AETNA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,CIGNA,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,WELLMED,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA,MGD,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CULTURE RESP        ,38251336,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA CHOICE PLUS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251337,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251338,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,AETNA,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,CIGNA,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,TRICARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,UNITED HEALTHCARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,UNITED HEALTHCARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,VA,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,VA TRICARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,WELLMED,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,HUMANA,MGD,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
CULT TYP STREP                ,38251339,CDM,306,RC,,,,,,Inpatient,,,34.27,34.27,HUMANA CHOICE PLUS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYP SEROLOGICAL      ,38251340,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
S/O CULT TYPING STREP         ,38251341,CDM,306,RC,,,,,,Inpatient,,,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,AETNA,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,BCBS,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,CIGNA,COM,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,TRICARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,UNITED HEALTHCARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,UNITED HEALTHCARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,VA,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,VA TRICARE,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,WELLMED,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,HUMANA,MGD,433.76,,,,,,,per diem,433.76,433.76,"Per diem rate, code is bundled with other services"
S/O CULT STOOL SALM/SHIG      ,38251342,CDM,306,RC,,,,,,Inpatient,,,433.76,433.76,HUMANA CHOICE PLUS,MGD,433.76,,,,,,,case rate,433.76,433.76,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,AETNA,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,BCBS,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,CIGNA,COM,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,TRICARE,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,UNITED HEALTHCARE,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,UNITED HEALTHCARE,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,VA,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,VA TRICARE,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,WELLMED,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,HUMANA,MGD,662.95,,,,,,,per diem,662.95,662.95,"Per diem rate, code is bundled with other services"
S/O CULT UR W/COLONY CNT      ,38251343,CDM,306,RC,,,,,,Inpatient,,,662.95,662.95,HUMANA CHOICE PLUS,MGD,662.95,,,,,,,case rate,662.95,662.95,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BARBITURATES SCRN NONCHR      ,38251344,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
BENZODIAZEPIN SCRN NONCHR     ,38251345,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
CANNABINOID SCRN NONCHR       ,38251346,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
COCAINE SCRN NONCHR           ,38251347,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHADONE SCRN NONCHR         ,38251348,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
METHAMPHETAM SCRN NONCHR      ,38251349,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OPIATES SCREEN NONCHR         ,38251350,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
OXYCODONE SCREEN NONCHR       ,38251351,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PCP SCREEN NONCHR             ,38251352,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
PROPOXYPHENE SCRN NONCHR      ,38251353,CDM,301,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,AETNA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,BCBS,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,CIGNA,COM,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,UNITED HEALTHCARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,VA,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,VA TRICARE,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,WELLMED,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA,MGD,307.38,,,,,,,per diem,307.38,307.38,"Per diem rate, code is bundled with other services"
SMEAR WET MOUNT INFECT        ,38251354,CDM,306,RC,,,,,,Inpatient,,,307.38,307.38,HUMANA CHOICE PLUS,MGD,307.38,,,,,,,case rate,307.38,307.38,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR INDIA INK           ,38251355,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,AETNA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,BCBS,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,CIGNA,COM,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,UNITED HEALTHCARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,VA,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,VA TRICARE,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,WELLMED,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA,MGD,318.09,,,,,,,per diem,318.09,318.09,"Per diem rate, code is bundled with other services"
S/O SMEAR WET MOUNT INFCT     ,38251356,CDM,306,RC,,,,,,Inpatient,,,318.09,318.09,HUMANA CHOICE PLUS,MGD,318.09,,,,,,,case rate,318.09,318.09,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,AETNA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,BCBS,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,CIGNA,COM,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,UNITED HEALTHCARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,VA,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,VA TRICARE,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,WELLMED,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA,MGD,219.56,,,,,,,per diem,219.56,219.56,"Per diem rate, code is bundled with other services"
S/O SMEAR GRAM/GEIMSA         ,38251357,CDM,306,RC,,,,,,Inpatient,,,219.56,219.56,HUMANA CHOICE PLUS,MGD,219.56,,,,,,,case rate,219.56,219.56,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALO RAPID CULT     ,38251358,CDM,306,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,AETNA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,CIGNA,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,WELLMED,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA,MGD,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O VIRUS SHELL VIAL ID       ,38251359,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA CHOICE PLUS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,AETNA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,CIGNA,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,WELLMED,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA,MGD,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU2         ,38251360,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA CHOICE PLUS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,AETNA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,CIGNA,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,WELLMED,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA,MGD,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251361,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA CHOICE PLUS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,AETNA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,BCBS,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,CIGNA,COM,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,UNITED HEALTHCARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,VA,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,VA TRICARE,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,WELLMED,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA,MGD,82.47,,,,,,,per diem,82.47,82.47,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU3         ,38251362,CDM,306,RC,,,,,,Inpatient,,,82.47,82.47,HUMANA CHOICE PLUS,MGD,82.47,,,,,,,case rate,82.47,82.47,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,AETNA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,CIGNA,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,WELLMED,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA,MGD,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251363,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA CHOICE PLUS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU4         ,38251364,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,AETNA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,BCBS,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,CIGNA,COM,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,UNITED HEALTHCARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,VA TRICARE,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,WELLMED,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA,MGD,118.88,,,,,,,per diem,118.88,118.88,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251365,CDM,306,RC,,,,,,Inpatient,,,118.88,118.88,HUMANA CHOICE PLUS,MGD,118.88,,,,,,,case rate,118.88,118.88,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
S/O SHELL VL EA VIRU5         ,38251366,CDM,306,RC,,,,,,Inpatient,,,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
S/O RESP VIRUS RAPID CULT     ,38251367,CDM,306,RC,,,,,,Inpatient,,,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O V CULT NONRESP CMV        ,38251368,CDM,306,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,AETNA,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,BCBS,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,CIGNA,COM,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,TRICARE,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,UNITED HEALTHCARE,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,UNITED HEALTHCARE,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,VA,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,VA TRICARE,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,WELLMED,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,HUMANA,MGD,266.68,,,,,,,per diem,266.68,266.68,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251369,CDM,306,RC,,,,,,Inpatient,,,266.68,266.68,HUMANA CHOICE PLUS,MGD,266.68,,,,,,,case rate,266.68,266.68,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,AETNA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,BCBS,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,CIGNA,COM,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,UNITED HEALTHCARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,VA,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,VA TRICARE,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,WELLMED,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA,MGD,72.83,,,,,,,per diem,72.83,72.83,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251370,CDM,306,RC,,,,,,Inpatient,,,72.83,72.83,HUMANA CHOICE PLUS,MGD,72.83,,,,,,,case rate,72.83,72.83,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251371,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,AETNA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,CIGNA,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,VA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,VA TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,WELLMED,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA,MGD,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251372,CDM,302,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA CHOICE PLUS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,AETNA,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,BCBS,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,CIGNA,COM,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,TRICARE,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,UNITED HEALTHCARE,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,UNITED HEALTHCARE,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,VA,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,VA TRICARE,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,WELLMED,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,HUMANA,MGD,154.22,,,,,,,per diem,154.22,154.22,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QL            ,38251373,CDM,302,RC,,,,,,Inpatient,,,154.22,154.22,HUMANA CHOICE PLUS,MGD,154.22,,,,,,,case rate,154.22,154.22,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251374,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,AETNA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,CIGNA,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,VA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,VA TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,WELLMED,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA,MGD,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
SYPHIL VDRL/RPR QN            ,38251375,CDM,302,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA CHOICE PLUS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,AETNA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,BCBS,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,CIGNA,COM,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,UNITED HEALTHCARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,VA,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,VA TRICARE,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,WELLMED,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA,MGD,49.27,,,,,,,per diem,49.27,49.27,"Per diem rate, code is bundled with other services"
S/O ACID FAST BACTERIA ID     ,38251376,CDM,306,RC,,,,,,Inpatient,,,49.27,49.27,HUMANA CHOICE PLUS,MGD,49.27,,,,,,,case rate,49.27,49.27,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,AETNA,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,BCBS,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,CIGNA,COM,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,TRICARE,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,UNITED HEALTHCARE,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,UNITED HEALTHCARE,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,VA,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,VA TRICARE,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,WELLMED,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,HUMANA,MGD,419.83,,,,,,,per diem,419.83,419.83,"Per diem rate, code is bundled with other services"
S/O CULTURE AFB/TB/MYCO       ,38251377,CDM,306,RC,,,,,,Inpatient,,,419.83,419.83,HUMANA CHOICE PLUS,MGD,419.83,,,,,,,case rate,419.83,419.83,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,AETNA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,CIGNA,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,VA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,VA TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,WELLMED,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA,MGD,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O AMPHETAMINES MECONIUM     ,38251378,CDM,301,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA CHOICE PLUS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,AETNA,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,BCBS,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,CIGNA,COM,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,TRICARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,UNITED HEALTHCARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,UNITED HEALTHCARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,VA,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,VA TRICARE,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,WELLMED,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,HUMANA,MGD,115.67,,,,,,,per diem,115.67,115.67,"Per diem rate, code is bundled with other services"
CULT ANAEROBIC ID             ,38251379,CDM,306,RC,,,,,,Inpatient,,,115.67,115.67,HUMANA CHOICE PLUS,MGD,115.67,,,,,,,case rate,115.67,115.67,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,AETNA,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,BCBS,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,CIGNA,COM,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,TRICARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,UNITED HEALTHCARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,UNITED HEALTHCARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,VA,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,VA TRICARE,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,WELLMED,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,HUMANA,MGD,119.95,,,,,,,per diem,119.95,119.95,"Per diem rate, code is bundled with other services"
S/O CULT ANAEROBIC ID         ,38251380,CDM,306,RC,,,,,,Inpatient,,,119.95,119.95,HUMANA CHOICE PLUS,MGD,119.95,,,,,,,case rate,119.95,119.95,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
S/O BARBITUATES MECONIUM      ,38251381,CDM,301,RC,,,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O CANNABINOIDS MECONIUM     ,38251382,CDM,301,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,AETNA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,BCBS,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,CIGNA,COM,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,UNITED HEALTHCARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,VA TRICARE,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,WELLMED,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA,MGD,55.69,,,,,,,per diem,55.69,55.69,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251383,CDM,301,RC,,,,,,Inpatient,,,55.69,55.69,HUMANA CHOICE PLUS,MGD,55.69,,,,,,,case rate,55.69,55.69,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,AETNA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,BCBS,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,CIGNA,COM,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,UNITED HEALTHCARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,VA,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,VA TRICARE,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,WELLMED,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA,MGD,68.54,,,,,,,per diem,68.54,68.54,"Per diem rate, code is bundled with other services"
S/O COCAINE MECONIUM          ,38251384,CDM,301,RC,,,,,,Inpatient,,,68.54,68.54,HUMANA CHOICE PLUS,MGD,68.54,,,,,,,case rate,68.54,68.54,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,AETNA,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,BCBS,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,CIGNA,COM,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,TRICARE,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,UNITED HEALTHCARE,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,UNITED HEALTHCARE,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,VA,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,VA TRICARE,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,WELLMED,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,HUMANA,MGD,608.33,,,,,,,per diem,608.33,608.33,"Per diem rate, code is bundled with other services"
COCCIDIOIDES AB IGM           ,38251385,CDM,302,RC,,,,,,Inpatient,,,608.33,608.33,HUMANA CHOICE PLUS,MGD,608.33,,,,,,,case rate,608.33,608.33,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,AETNA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,BCBS,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,CIGNA,COM,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,UNITED HEALTHCARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,VA TRICARE,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,WELLMED,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA,MGD,85.68,,,,,,,per diem,85.68,85.68,"Per diem rate, code is bundled with other services"
S/O COCCI IMM AB IMMUNDIF     ,38251386,CDM,302,RC,,,,,,Inpatient,,,85.68,85.68,HUMANA CHOICE PLUS,MGD,85.68,,,,,,,case rate,85.68,85.68,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,AETNA,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,BCBS,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,CIGNA,COM,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,TRICARE,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,UNITED HEALTHCARE,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,UNITED HEALTHCARE,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,VA,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,VA TRICARE,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,WELLMED,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,HUMANA,MGD,761.48,,,,,,,per diem,761.48,761.48,"Per diem rate, code is bundled with other services"
S/O COCCIDIOIDES AB CF        ,38251387,CDM,302,RC,,,,,,Inpatient,,,761.48,761.48,HUMANA CHOICE PLUS,MGD,761.48,,,,,,,case rate,761.48,761.48,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,AETNA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,BCBS,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,CIGNA,COM,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,UNITED HEALTHCARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,VA,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,VA TRICARE,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,WELLMED,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA,MGD,71.76,,,,,,,per diem,71.76,71.76,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID YEAST      ,38251388,CDM,306,RC,,,,,,Inpatient,,,71.76,71.76,HUMANA CHOICE PLUS,MGD,71.76,,,,,,,case rate,71.76,71.76,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,AETNA,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,BCBS,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,CIGNA,COM,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,TRICARE,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,UNITED HEALTHCARE,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,UNITED HEALTHCARE,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,VA,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,VA TRICARE,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,WELLMED,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,HUMANA,MGD,20.21,,,,,,,per diem,20.21,20.21,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251389,CDM,306,RC,,,,,,Inpatient,,,20.21,20.21,HUMANA CHOICE PLUS,MGD,20.21,,,,,,,case rate,20.21,20.21,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251390,CDM,306,RC,,,,,,Inpatient,,,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,AETNA,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,BCBS,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,CIGNA,COM,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,TRICARE,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,UNITED HEALTHCARE,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,UNITED HEALTHCARE,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,VA,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,VA TRICARE,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,WELLMED,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,HUMANA,MGD,144.74,,,,,,,per diem,144.74,144.74,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251391,CDM,306,RC,,,,,,Inpatient,,,144.74,144.74,HUMANA CHOICE PLUS,MGD,144.74,,,,,,,case rate,144.74,144.74,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O PERTUS DNA/BP BPP         ,38251392,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,AETNA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,CIGNA,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,VA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,VA TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,WELLMED,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA,MGD,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251393,CDM,306,RC,,,,,,Inpatient,,,164.93,164.93,HUMANA CHOICE PLUS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,AETNA,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,BCBS,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,CIGNA,COM,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,TRICARE,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,UNITED HEALTHCARE,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,UNITED HEALTHCARE,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,VA,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,VA TRICARE,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,WELLMED,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,HUMANA,MGD,158.52,,,,,,,per diem,158.52,158.52,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251394,CDM,306,RC,,,,,,Inpatient,,,158.52,158.52,HUMANA CHOICE PLUS,MGD,158.52,,,,,,,case rate,158.52,158.52,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251395,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA PCR         ,38251396,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,AETNA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,CIGNA,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,VA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,VA TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,WELLMED,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,HUMANA,MGD,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251397,CDM,301,RC,,,,,,Inpatient,,,92.11,92.11,HUMANA CHOICE PLUS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,AETNA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,BCBS,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,CIGNA,COM,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,UNITED HEALTHCARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,VA,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,VA TRICARE,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,WELLMED,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA,MGD,63.19,,,,,,,per diem,63.19,63.19,"Per diem rate, code is bundled with other services"
S/O PHENCYCLIDIN MECONIUM     ,38251398,CDM,301,RC,,,,,,Inpatient,,,63.19,63.19,HUMANA CHOICE PLUS,MGD,63.19,,,,,,,case rate,63.19,63.19,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,AETNA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,CIGNA,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,WELLMED,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA,MGD,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
OVA & PARASITES               ,38251399,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA CHOICE PLUS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,AETNA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,BCBS,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,CIGNA,COM,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,UNITED HEALTHCARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,VA,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,VA TRICARE,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,WELLMED,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA,MGD,76.04,,,,,,,per diem,76.04,76.04,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES           ,38251400,CDM,306,RC,,,,,,Inpatient,,,76.04,76.04,HUMANA CHOICE PLUS,MGD,76.04,,,,,,,case rate,76.04,76.04,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,AETNA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,BCBS,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,CIGNA,COM,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,UNITED HEALTHCARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,VA,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,VA TRICARE,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,WELLMED,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA,MGD,66.4,,,,,,,per diem,66.4,66.4,"Per diem rate, code is bundled with other services"
S/O OVA & PARASITES HCCL      ,38251401,CDM,306,RC,,,,,,Inpatient,,,66.4,66.4,HUMANA CHOICE PLUS,MGD,66.4,,,,,,,case rate,66.4,66.4,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,AETNA,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,BCBS,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,CIGNA,COM,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,TRICARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,UNITED HEALTHCARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,UNITED HEALTHCARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,VA,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,VA TRICARE,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,WELLMED,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,HUMANA,MGD,284.89,,,,,,,per diem,284.89,284.89,"Per diem rate, code is bundled with other services"
S/O TISS EXAM FUNG/ECTOPR     ,38251402,CDM,306,RC,,,,,,Inpatient,,,284.89,284.89,HUMANA CHOICE PLUS,MGD,284.89,,,,,,,case rate,284.89,284.89,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,AETNA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,BCBS,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,CIGNA,COM,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,UNITED HEALTHCARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,VA TRICARE,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,WELLMED,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA,MGD,57.83,,,,,,,per diem,57.83,57.83,"Per diem rate, code is bundled with other services"
S/O ELECTROLYTE FECAL         ,38251403,CDM,301,RC,,,,,,Inpatient,,,57.83,57.83,HUMANA CHOICE PLUS,MGD,57.83,,,,,,,case rate,57.83,57.83,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,AETNA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,BCBS,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,CIGNA,COM,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,UNITED HEALTHCARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,VA,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,VA TRICARE,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,WELLMED,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA,MGD,172.43,,,,,,,per diem,172.43,172.43,"Per diem rate, code is bundled with other services"
S/O CYTOMEGALOVIRUS PCR       ,38251404,CDM,306,RC,,,,,,Inpatient,,,172.43,172.43,HUMANA CHOICE PLUS,MGD,172.43,,,,,,,case rate,172.43,172.43,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
S/O OPIATES MECONIUM          ,38251405,CDM,301,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
S/O BENZODIAZEP MECONIUM      ,38251406,CDM,301,RC,,,,,,Inpatient,,,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,AETNA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,BCBS,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,CIGNA,COM,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,UNITED HEALTHCARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,VA TRICARE,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,WELLMED,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA,MGD,37.49,,,,,,,per diem,37.49,37.49,"Per diem rate, code is bundled with other services"
S/O PARASIT STAIN MAF         ,38251407,CDM,306,RC,,,,,,Inpatient,,,37.49,37.49,HUMANA CHOICE PLUS,MGD,37.49,,,,,,,case rate,37.49,37.49,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O MICROSPORIDIA STN         ,38251408,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251409,CDM,306,RC,,,,,,Inpatient,,,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,AETNA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,BCBS,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,CIGNA,COM,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,UNITED HEALTHCARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,VA,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,VA TRICARE,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,WELLMED,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA,MGD,84.61,,,,,,,per diem,84.61,84.61,"Per diem rate, code is bundled with other services"
S/O CONCENTRATION ANY         ,38251410,CDM,306,RC,,,,,,Inpatient,,,84.61,84.61,HUMANA CHOICE PLUS,MGD,84.61,,,,,,,case rate,84.61,84.61,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,AETNA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,BCBS,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,CIGNA,COM,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,UNITED HEALTHCARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,VA TRICARE,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,WELLMED,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA,MGD,26.78,,,,,,,per diem,26.78,26.78,"Per diem rate, code is bundled with other services"
S/O SUSCEPT B-LACTAM EA       ,38251411,CDM,306,RC,,,,,,Inpatient,,,26.78,26.78,HUMANA CHOICE PLUS,MGD,26.78,,,,,,,case rate,26.78,26.78,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,AETNA,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,BCBS,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,CIGNA,COM,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,TRICARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,UNITED HEALTHCARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,UNITED HEALTHCARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,VA,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,VA TRICARE,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,WELLMED,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,HUMANA,MGD,353.43,,,,,,,per diem,353.43,353.43,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS BLOOD         ,38251412,CDM,306,RC,,,,,,Inpatient,,,353.43,353.43,HUMANA CHOICE PLUS,MGD,353.43,,,,,,,case rate,353.43,353.43,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,AETNA,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,CIGNA,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,TRICARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,UNITED HEALTHCARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,UNITED HEALTHCARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,VA,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,VA TRICARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,WELLMED,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,HUMANA,MGD,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
S/O AFB 10 DRUG PLUS          ,38251413,CDM,306,RC,,,,,,Inpatient,,,472.31,472.31,HUMANA CHOICE PLUS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,AETNA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,BCBS,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,CIGNA,COM,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,UNITED HEALTHCARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,VA,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,VA TRICARE,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,WELLMED,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,HUMANA,MGD,42.84,,,,,,,per diem,42.84,42.84,"Per diem rate, code is bundled with other services"
S/O SUSCEPT AGAR              ,38251414,CDM,306,RC,,,,,,Inpatient,,,42.84,42.84,HUMANA CHOICE PLUS,MGD,42.84,,,,,,,case rate,42.84,42.84,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,AETNA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,BCBS,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,CIGNA,COM,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,UNITED HEALTHCARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,VA TRICARE,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,WELLMED,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA,MGD,449.82,,,,,,,per diem,449.82,449.82,"Per diem rate, code is bundled with other services"
S/O NJH-NTM10 10 MIC          ,38251415,CDM,306,RC,,,,,,Inpatient,,,449.82,449.82,HUMANA CHOICE PLUS,MGD,449.82,,,,,,,case rate,449.82,449.82,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,AETNA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,BCBS,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,CIGNA,COM,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,UNITED HEALTHCARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,VA,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,VA TRICARE,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,WELLMED,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA,MGD,156.37,,,,,,,per diem,156.37,156.37,"Per diem rate, code is bundled with other services"
VERIGENE ID BY DNA            ,38251416,CDM,306,RC,,,,,,Inpatient,,,156.37,156.37,HUMANA CHOICE PLUS,MGD,156.37,,,,,,,case rate,156.37,156.37,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,AETNA,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,BCBS,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,CIGNA,COM,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,TRICARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,UNITED HEALTHCARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,UNITED HEALTHCARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,VA,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,VA TRICARE,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,WELLMED,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,HUMANA,MGD,242.05,,,,,,,per diem,242.05,242.05,"Per diem rate, code is bundled with other services"
S/O COCCI IMMITIS ID DNA      ,38251417,CDM,306,RC,,,,,,Inpatient,,,242.05,242.05,HUMANA CHOICE PLUS,MGD,242.05,,,,,,,case rate,242.05,242.05,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,AETNA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,BCBS,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,CIGNA,COM,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,UNITED HEALTHCARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,VA,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,VA TRICARE,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,WELLMED,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA,MGD,215.27,,,,,,,per diem,215.27,215.27,"Per diem rate, code is bundled with other services"
S/O AFB ID MTB DNA PROBE      ,38251418,CDM,306,RC,,,,,,Inpatient,,,215.27,215.27,HUMANA CHOICE PLUS,MGD,215.27,,,,,,,case rate,215.27,215.27,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,AETNA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,CIGNA,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,WELLMED,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA,MGD,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MAI DNA PROBE      ,38251419,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA CHOICE PLUS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,AETNA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,BCBS,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,CIGNA,COM,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,UNITED HEALTHCARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,VA TRICARE,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,WELLMED,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA,MGD,166.01,,,,,,,per diem,166.01,166.01,"Per diem rate, code is bundled with other services"
S/O AFB ID MYCO SPECI DNA     ,38251420,CDM,306,RC,,,,,,Inpatient,,,166.01,166.01,HUMANA CHOICE PLUS,MGD,166.01,,,,,,,case rate,166.01,166.01,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,AETNA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,CIGNA,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,WELLMED,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA,MGD,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM NEG         ,38251421,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA CHOICE PLUS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,AETNA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,CIGNA,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,WELLMED,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA,MGD,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O CULT TYP ID DIRT ORG      ,38251422,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA CHOICE PLUS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,AETNA,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,BCBS,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,CIGNA,COM,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,TRICARE,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,UNITED HEALTHCARE,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,UNITED HEALTHCARE,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,VA,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,VA TRICARE,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,WELLMED,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,HUMANA,MGD,70.2,,,,,,,per diem,70.2,70.2,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251423,CDM,306,RC,,,,,,Inpatient,,,70.2,70.2,HUMANA CHOICE PLUS,MGD,70.2,,,,,,,case rate,70.2,70.2,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,AETNA,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,BCBS,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,CIGNA,COM,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,TRICARE,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,UNITED HEALTHCARE,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,UNITED HEALTHCARE,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,VA,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,VA TRICARE,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,WELLMED,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,HUMANA,MGD,72.91,,,,,,,per diem,72.91,72.91,"Per diem rate, code is bundled with other services"
S/O VERIGENE GRAM POS         ,38251424,CDM,306,RC,,,,,,Inpatient,,,72.91,72.91,HUMANA CHOICE PLUS,MGD,72.91,,,,,,,case rate,72.91,72.91,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,AETNA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,BCBS,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,CIGNA,COM,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,UNITED HEALTHCARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,VA,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,VA TRICARE,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,WELLMED,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA,MGD,29.99,,,,,,,per diem,29.99,29.99,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251425,CDM,306,RC,,,,,,Inpatient,,,29.99,29.99,HUMANA CHOICE PLUS,MGD,29.99,,,,,,,case rate,29.99,29.99,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,AETNA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,CIGNA,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,VA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,VA TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,WELLMED,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,HUMANA,MGD,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O CULT TYPE IF HSV          ,38251426,CDM,306,RC,,,,,,Inpatient,,,102.82,102.82,HUMANA CHOICE PLUS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
S/O RHEUTAMOID FACTOR BLD     ,38251427,CDM,302,RC,,,,,,Inpatient,,,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,AETNA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,BCBS,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,CIGNA,COM,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,UNITED HEALTHCARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,VA TRICARE,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,WELLMED,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA,MGD,161.72,,,,,,,per diem,161.72,161.72,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251428,CDM,306,RC,,,,,,Inpatient,,,161.72,161.72,HUMANA CHOICE PLUS,MGD,161.72,,,,,,,case rate,161.72,161.72,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251429,CDM,306,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,AETNA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,CIGNA,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,VA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,VA TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,WELLMED,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA,MGD,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251430,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA CHOICE PLUS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,AETNA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,CIGNA,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,VA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,VA TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,WELLMED,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,HUMANA,MGD,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT NRESP DEFIF     ,38251431,CDM,306,RC,,,,,,Inpatient,,,110.31,110.31,HUMANA CHOICE PLUS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,AETNA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,CIGNA,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,WELLMED,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA,MGD,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE DFA           ,38251432,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA CHOICE PLUS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,AETNA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,CIGNA,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,WELLMED,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA,MGD,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O VIRAL CLT RESP DEF IF     ,38251433,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA CHOICE PLUS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,AETNA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,BCBS,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,CIGNA,COM,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,UNITED HEALTHCARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,VA TRICARE,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,WELLMED,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA,MGD,143.51,,,,,,,per diem,143.51,143.51,"Per diem rate, code is bundled with other services"
S/O HSV CULTURE               ,38251434,CDM,306,RC,,,,,,Inpatient,,,143.51,143.51,HUMANA CHOICE PLUS,MGD,143.51,,,,,,,case rate,143.51,143.51,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
S/O V CULT NRESP CMV DFID     ,38251435,CDM,306,RC,,,,,,Inpatient,,,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,AETNA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,CIGNA,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,VA TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,WELLMED,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA,MGD,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251436,CDM,306,RC,,,,,,Inpatient,,,144.59,144.59,HUMANA CHOICE PLUS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,AETNA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,BCBS,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,CIGNA,COM,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,UNITED HEALTHCARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,VA,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,VA TRICARE,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,WELLMED,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA,MGD,91.04,,,,,,,per diem,91.04,91.04,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251437,CDM,306,RC,,,,,,Inpatient,,,91.04,91.04,HUMANA CHOICE PLUS,MGD,91.04,,,,,,,case rate,91.04,91.04,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,AETNA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,BCBS,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,CIGNA,COM,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,UNITED HEALTHCARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,VA,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,VA TRICARE,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,WELLMED,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA,MGD,158.51,,,,,,,per diem,158.51,158.51,"Per diem rate, code is bundled with other services"
S/O SHIGA TOXIN TEST          ,38251438,CDM,306,RC,,,,,,Inpatient,,,158.51,158.51,HUMANA CHOICE PLUS,MGD,158.51,,,,,,,case rate,158.51,158.51,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,AETNA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,BCBS,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,CIGNA,COM,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,UNITED HEALTHCARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,VA,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,VA TRICARE,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,WELLMED,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA,MGD,305.24,,,,,,,per diem,305.24,305.24,"Per diem rate, code is bundled with other services"
S/O CLOS DIF TOX AMP PROB     ,38251439,CDM,306,RC,,,,,,Inpatient,,,305.24,305.24,HUMANA CHOICE PLUS,MGD,305.24,,,,,,,case rate,305.24,305.24,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O OCCULT BLOOD FECES QL     ,38251440,CDM,301,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O METHADONE MECONIUM        ,38251441,CDM,301,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,AETNA,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,BCBS,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,CIGNA,COM,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,TRICARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,UNITED HEALTHCARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,UNITED HEALTHCARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,VA,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,VA TRICARE,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,WELLMED,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,HUMANA,MGD,321.3,,,,,,,per diem,321.3,321.3,"Per diem rate, code is bundled with other services"
ASO SCREEN                    ,38251442,CDM,302,RC,,,,,,Inpatient,,,321.3,321.3,HUMANA CHOICE PLUS,MGD,321.3,,,,,,,case rate,321.3,321.3,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
CULT FUNGUS ID MOLD           ,38251443,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,AETNA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,CIGNA,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,VA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,VA TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,WELLMED,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA,MGD,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
IA ROTAVIRUS QL               ,38251444,CDM,306,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA CHOICE PLUS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,AETNA,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,BCBS,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,CIGNA,COM,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,TRICARE,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,UNITED HEALTHCARE,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,UNITED HEALTHCARE,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,VA,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,VA TRICARE,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,WELLMED,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,HUMANA,MGD,280.6,,,,,,,per diem,280.6,280.6,"Per diem rate, code is bundled with other services"
MACRO EXAM ARTHROPOD          ,38251445,CDM,306,RC,,,,,,Inpatient,,,280.6,280.6,HUMANA CHOICE PLUS,MGD,280.6,,,,,,,case rate,280.6,280.6,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O LEGIONELL SPEC QL PCR     ,38251446,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
S/O PHOSPHATIDYLGLYCEROL      ,38251447,CDM,301,RC,,,,,,Inpatient,,,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,AETNA,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,BCBS,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,CIGNA,COM,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,TRICARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,UNITED HEALTHCARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,UNITED HEALTHCARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,VA,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,VA TRICARE,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,WELLMED,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,HUMANA,MGD,95.32,,,,,,,per diem,95.32,95.32,"Per diem rate, code is bundled with other services"
S/O CHYLOMICRON SCRN BF       ,38251448,CDM,301,RC,,,,,,Inpatient,,,95.32,95.32,HUMANA CHOICE PLUS,MGD,95.32,,,,,,,case rate,95.32,95.32,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O CULT AETOBIC ID SEQ       ,38251449,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,AETNA,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,CIGNA,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,TRICARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,UNITED HEALTHCARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,UNITED HEALTHCARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,VA,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,VA TRICARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,WELLMED,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,HUMANA,MGD,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O AFB ID BY SEQUENCING      ,38251450,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,HUMANA CHOICE PLUS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,AETNA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,BCBS,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,CIGNA,COM,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,UNITED HEALTHCARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,VA,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,VA TRICARE,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,WELLMED,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,HUMANA,MGD,200.28,,,,,,,per diem,200.28,200.28,"Per diem rate, code is bundled with other services"
S/O 14-3-3 PROTEIN CSF        ,38251451,CDM,301,RC,,,,,,Inpatient,,,200.28,200.28,HUMANA CHOICE PLUS,MGD,200.28,,,,,,,case rate,200.28,200.28,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,AETNA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,CIGNA,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,WELLMED,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA,MGD,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251452,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA CHOICE PLUS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,AETNA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,CIGNA,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,WELLMED,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA,MGD,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251453,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA CHOICE PLUS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,AETNA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,BCBS,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,CIGNA,COM,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,UNITED HEALTHCARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,VA TRICARE,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,WELLMED,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA,MGD,125.31,,,,,,,per diem,125.31,125.31,"Per diem rate, code is bundled with other services"
S/O LYMPHOCY SUBSET 4         ,38251454,CDM,302,RC,,,,,,Inpatient,,,125.31,125.31,HUMANA CHOICE PLUS,MGD,125.31,,,,,,,case rate,125.31,125.31,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,AETNA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,CIGNA,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,VA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,VA TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,WELLMED,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA,MGD,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251455,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA CHOICE PLUS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,AETNA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,BCBS,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,CIGNA,COM,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,UNITED HEALTHCARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,VA,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,VA TRICARE,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,WELLMED,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA,MGD,50.34,,,,,,,per diem,50.34,50.34,"Per diem rate, code is bundled with other services"
S/O HSV DFA W/REFLEX          ,38251456,CDM,306,RC,,,,,,Inpatient,,,50.34,50.34,HUMANA CHOICE PLUS,MGD,50.34,,,,,,,case rate,50.34,50.34,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
S/O CG TMA                    ,38251457,CDM,306,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251458,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251459,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O VAG PATH DNA DP           ,38251460,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251461,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251462,CDM,306,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,AETNA,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,BCBS,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,CIGNA,COM,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,TRICARE,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,UNITED HEALTHCARE,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,UNITED HEALTHCARE,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,VA,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,VA TRICARE,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,WELLMED,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,HUMANA,MGD,424.12,,,,,,,per diem,424.12,424.12,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251463,CDM,306,RC,,,,,,Inpatient,,,424.12,424.12,HUMANA CHOICE PLUS,MGD,424.12,,,,,,,case rate,424.12,424.12,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
S/O RESP VIR DFA WRFX         ,38251464,CDM,306,RC,,,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,AETNA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,BCBS,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,CIGNA,COM,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,UNITED HEALTHCARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,VA,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,VA TRICARE,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,WELLMED,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,HUMANA,MGD,102.82,,,,,,,per diem,102.82,102.82,"Per diem rate, code is bundled with other services"
S/O L/S RATIO                 ,38251465,CDM,301,RC,,,,,,Inpatient,,,102.82,102.82,HUMANA CHOICE PLUS,MGD,102.82,,,,,,,case rate,102.82,102.82,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF POLYVL MULT ORG AG     ,38251466,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
S/O VIRUS ISOLATION HSV       ,38251467,CDM,306,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,AETNA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,BCBS,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,CIGNA,COM,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,UNITED HEALTHCARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,VA,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,VA TRICARE,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,WELLMED,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA,MGD,69.62,,,,,,,per diem,69.62,69.62,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251468,CDM,306,RC,,,,,,Inpatient,,,69.62,69.62,HUMANA CHOICE PLUS,MGD,69.62,,,,,,,case rate,69.62,69.62,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,AETNA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,BCBS,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,CIGNA,COM,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,UNITED HEALTHCARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,VA TRICARE,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,WELLMED,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA,MGD,148.87,,,,,,,per diem,148.87,148.87,"Per diem rate, code is bundled with other services"
S/O NEISSERIA AMP PROBE       ,38251469,CDM,306,RC,,,,,,Inpatient,,,148.87,148.87,HUMANA CHOICE PLUS,MGD,148.87,,,,,,,case rate,148.87,148.87,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,AETNA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,BCBS,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,CIGNA,COM,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,UNITED HEALTHCARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,VA,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,VA TRICARE,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,WELLMED,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA,MGD,35.34,,,,,,,per diem,35.34,35.34,"Per diem rate, code is bundled with other services"
S/O PERTUSSIS DFA             ,38251470,CDM,306,RC,,,,,,Inpatient,,,35.34,35.34,HUMANA CHOICE PLUS,MGD,35.34,,,,,,,case rate,35.34,35.34,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251471,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AZOLE MIC MOLD            ,38251472,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,AETNA,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,CIGNA,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,TRICARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,UNITED HEALTHCARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,UNITED HEALTHCARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,VA,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,VA TRICARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,WELLMED,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,HUMANA,MGD,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC YEAST        ,38251473,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,HUMANA CHOICE PLUS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251474,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,AETNA,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,BCBS,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,CIGNA,COM,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,TRICARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,UNITED HEALTHCARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,UNITED HEALTHCARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,VA,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,VA TRICARE,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,WELLMED,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,HUMANA,MGD,185.28,,,,,,,per diem,185.28,185.28,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251475,CDM,306,RC,,,,,,Inpatient,,,185.28,185.28,HUMANA CHOICE PLUS,MGD,185.28,,,,,,,case rate,185.28,185.28,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O AMB/CAND MIC MOLD         ,38251476,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251477,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 2 DRUGS          ,38251478,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251479,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 3 DRUGS          ,38251480,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251481,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 4 DRUGS          ,38251482,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251483,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,AETNA,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,BCBS,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,CIGNA,COM,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,TRICARE,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,UNITED HEALTHCARE,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,UNITED HEALTHCARE,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,VA,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,VA TRICARE,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,WELLMED,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,HUMANA,MGD,212.8,,,,,,,per diem,212.8,212.8,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 5 DRUGS          ,38251484,CDM,306,RC,,,,,,Inpatient,,,212.8,212.8,HUMANA CHOICE PLUS,MGD,212.8,,,,,,,case rate,212.8,212.8,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251485,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC 6 DRUGS          ,38251486,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,AETNA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,BCBS,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,CIGNA,COM,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,UNITED HEALTHCARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,VA,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,VA TRICARE,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,WELLMED,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA,MGD,77.11,,,,,,,per diem,77.11,77.11,"Per diem rate, code is bundled with other services"
S/O CULT FUNGUS ID MOLD       ,38251487,CDM,306,RC,,,,,,Inpatient,,,77.11,77.11,HUMANA CHOICE PLUS,MGD,77.11,,,,,,,case rate,77.11,77.11,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,AETNA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,BCBS,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,CIGNA,COM,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,UNITED HEALTHCARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,VA TRICARE,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,WELLMED,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA,MGD,214.2,,,,,,,per diem,214.2,214.2,"Per diem rate, code is bundled with other services"
S/O MOLD MIC SINGLE DRUG      ,38251488,CDM,306,RC,,,,,,Inpatient,,,214.2,214.2,HUMANA CHOICE PLUS,MGD,214.2,,,,,,,case rate,214.2,214.2,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,AETNA,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,BCBS,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,CIGNA,COM,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,TRICARE,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,UNITED HEALTHCARE,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,UNITED HEALTHCARE,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,VA,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,VA TRICARE,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,WELLMED,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,HUMANA,MGD,1822.84,,,,,,,per diem,1822.84,1822.84,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251489,CDM,306,RC,,,,,,Inpatient,,,1822.84,1822.84,HUMANA CHOICE PLUS,MGD,1822.84,,,,,,,case rate,1822.84,1822.84,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,AETNA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,CIGNA,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,VA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,VA TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,WELLMED,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA,MGD,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251490,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA CHOICE PLUS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,AETNA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,BCBS,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,CIGNA,COM,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,UNITED HEALTHCARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,VA,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,VA TRICARE,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,WELLMED,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA,MGD,153.15,,,,,,,per diem,153.15,153.15,"Per diem rate, code is bundled with other services"
S/O RESP MULTI PNL NP         ,38251491,CDM,306,RC,,,,,,Inpatient,,,153.15,153.15,HUMANA CHOICE PLUS,MGD,153.15,,,,,,,case rate,153.15,153.15,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,AETNA,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,BCBS,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,CIGNA,COM,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,TRICARE,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,UNITED HEALTHCARE,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,UNITED HEALTHCARE,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,VA,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,VA TRICARE,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,WELLMED,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,HUMANA,MGD,38.56,,,,,,,per diem,38.56,38.56,"Per diem rate, code is bundled with other services"
S/O CULTURE TYPING OTHER      ,38251492,CDM,306,RC,,,,,,Inpatient,,,38.56,38.56,HUMANA CHOICE PLUS,MGD,38.56,,,,,,,case rate,38.56,38.56,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,AETNA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,BCBS,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,CIGNA,COM,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,UNITED HEALTHCARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,VA,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,VA TRICARE,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,WELLMED,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA,MGD,163.86,,,,,,,per diem,163.86,163.86,"Per diem rate, code is bundled with other services"
S/O IF B PERTUSSIS AG         ,38251493,CDM,306,RC,,,,,,Inpatient,,,163.86,163.86,HUMANA CHOICE PLUS,MGD,163.86,,,,,,,case rate,163.86,163.86,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,AETNA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,BCBS,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,CIGNA,COM,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,UNITED HEALTHCARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,VA,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,VA TRICARE,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,WELLMED,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA,MGD,199.21,,,,,,,per diem,199.21,199.21,"Per diem rate, code is bundled with other services"
S/O IF HERPES TYPE 2 AG       ,38251494,CDM,306,RC,,,,,,Inpatient,,,199.21,199.21,HUMANA CHOICE PLUS,MGD,199.21,,,,,,,case rate,199.21,199.21,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,AETNA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,BCBS,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,CIGNA,COM,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,UNITED HEALTHCARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,VA,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,VA TRICARE,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,WELLMED,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA,MGD,99.6,,,,,,,per diem,99.6,99.6,"Per diem rate, code is bundled with other services"
S/O IF VARICLLA-ZOSTR AG      ,38251495,CDM,306,RC,,,,,,Inpatient,,,99.6,99.6,HUMANA CHOICE PLUS,MGD,99.6,,,,,,,case rate,99.6,99.6,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,AETNA,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,BCBS,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,CIGNA,COM,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,TRICARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,UNITED HEALTHCARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,UNITED HEALTHCARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,VA,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,VA TRICARE,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,WELLMED,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,HUMANA,MGD,228.12,,,,,,,per diem,228.12,228.12,"Per diem rate, code is bundled with other services"
S/O NOCARDIA PCR ID REFLX     ,38251496,CDM,306,RC,,,,,,Inpatient,,,228.12,228.12,HUMANA CHOICE PLUS,MGD,228.12,,,,,,,case rate,228.12,228.12,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251497,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,AETNA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,CIGNA,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,VA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,VA TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,WELLMED,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA,MGD,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251498,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA CHOICE PLUS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,AETNA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,BCBS,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,CIGNA,COM,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,UNITED HEALTHCARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,VA TRICARE,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,WELLMED,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA,MGD,151.01,,,,,,,per diem,151.01,151.01,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251499,CDM,306,RC,,,,,,Inpatient,,,151.01,151.01,HUMANA CHOICE PLUS,MGD,151.01,,,,,,,case rate,151.01,151.01,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,AETNA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,BCBS,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,CIGNA,COM,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,UNITED HEALTHCARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,VA,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,VA TRICARE,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,WELLMED,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA,MGD,73.9,,,,,,,per diem,73.9,73.9,"Per diem rate, code is bundled with other services"
S/O RESP MULTIPLX N/P         ,38251500,CDM,306,RC,,,,,,Inpatient,,,73.9,73.9,HUMANA CHOICE PLUS,MGD,73.9,,,,,,,case rate,73.9,73.9,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,AETNA,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,BCBS,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,CIGNA,COM,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,TRICARE,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,UNITED HEALTHCARE,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,UNITED HEALTHCARE,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,VA,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,VA TRICARE,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,WELLMED,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,HUMANA,MGD,368.72,,,,,,,per diem,368.72,368.72,"Per diem rate, code is bundled with other services"
S/O GI PNL BIOFRE FLM ARR     ,38251501,CDM,306,RC,,,,,,Inpatient,,,368.72,368.72,HUMANA CHOICE PLUS,MGD,368.72,,,,,,,case rate,368.72,368.72,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,AETNA,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,BCBS,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,CIGNA,COM,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,TRICARE,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,UNITED HEALTHCARE,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,UNITED HEALTHCARE,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,VA,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,VA TRICARE,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,WELLMED,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,HUMANA,MGD,1141.69,,,,,,,per diem,1141.69,1141.69,"Per diem rate, code is bundled with other services"
S/O NJH-AFB4 AFB ID           ,38251502,CDM,306,RC,,,,,,Inpatient,,,1141.69,1141.69,HUMANA CHOICE PLUS,MGD,1141.69,,,,,,,case rate,1141.69,1141.69,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,AETNA,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,BCBS,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,CIGNA,COM,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,TRICARE,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,UNITED HEALTHCARE,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,UNITED HEALTHCARE,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,VA,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,VA TRICARE,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,WELLMED,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,HUMANA,MGD,27.81,,,,,,,per diem,27.81,27.81,"Per diem rate, code is bundled with other services"
VENIPUNCTURE FOR COLLECT      ,38251511,CDM,300,RC,36415,CPT,,,,Inpatient,,,27.81,27.81,HUMANA CHOICE PLUS,MGD,27.81,,,,,,,case rate,27.81,27.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,AETNA,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,BCBS,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,CIGNA,COM,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,TRICARE,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,UNITED HEALTHCARE,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,UNITED HEALTHCARE,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,VA,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,VA TRICARE,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,WELLMED,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,HUMANA,MGD,118.6,,,,,,,per diem,118.6,118.6,"Per diem rate, code is bundled with other services"
CYCLOSPORINE A                ,38251512,CDM,300,RC,80158,CPT,,,,Inpatient,,,118.6,118.6,HUMANA CHOICE PLUS,MGD,118.6,,,,,,,case rate,118.6,118.6,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,AETNA,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,BCBS,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,CIGNA,COM,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,TRICARE,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,UNITED HEALTHCARE,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,UNITED HEALTHCARE,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,VA,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,VA TRICARE,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,WELLMED,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,HUMANA,MGD,48.04,,,,,,,per diem,48.04,48.04,"Per diem rate, code is bundled with other services"
VANCOMYCIN TROUGH             ,38251513,CDM,300,RC,80202,CPT,,,,Inpatient,,,48.04,48.04,HUMANA CHOICE PLUS,MGD,48.04,,,,,,,case rate,48.04,48.04,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,AETNA,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,BCBS,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,CIGNA,COM,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,TRICARE,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,UNITED HEALTHCARE,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,UNITED HEALTHCARE,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,VA,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,VA TRICARE,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,WELLMED,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,HUMANA,MGD,74.5,,,,,,,per diem,74.5,74.5,"Per diem rate, code is bundled with other services"
AMIODARONE SERUM              ,38251514,CDM,300,RC,80299,CPT,,,,Inpatient,,,74.5,74.5,HUMANA CHOICE PLUS,MGD,74.5,,,,,,,case rate,74.5,74.5,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,AETNA,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,BCBS,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,CIGNA,COM,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,TRICARE,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,UNITED HEALTHCARE,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,UNITED HEALTHCARE,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,VA,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,VA TRICARE,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,WELLMED,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,HUMANA,MGD,123.43,,,,,,,per diem,123.43,123.43,"Per diem rate, code is bundled with other services"
"VITAMIN D, 25-HYDROXY         ",38251515,CDM,300,RC,82306,CPT,,,,Inpatient,,,123.43,123.43,HUMANA CHOICE PLUS,MGD,123.43,,,,,,,case rate,123.43,123.43,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,AETNA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,CIGNA,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,VA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,VA TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,WELLMED,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,HUMANA,MGD,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
VITAMIN B-12                  ,38251516,CDM,300,RC,82607,CPT,,,,Inpatient,,,75.17,75.17,HUMANA CHOICE PLUS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,AETNA,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,BCBS,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,CIGNA,COM,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,TRICARE,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,UNITED HEALTHCARE,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,UNITED HEALTHCARE,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,VA,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,VA TRICARE,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,WELLMED,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,HUMANA,MGD,55.57,,,,,,,per diem,55.57,55.57,"Per diem rate, code is bundled with other services"
FOLATE SERUM                  ,38251517,CDM,300,RC,82746,CPT,,,,Inpatient,,,55.57,55.57,HUMANA CHOICE PLUS,MGD,55.57,,,,,,,case rate,55.57,55.57,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,AETNA,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,BCBS,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,CIGNA,COM,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,TRICARE,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,UNITED HEALTHCARE,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,UNITED HEALTHCARE,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,VA,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,VA TRICARE,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,WELLMED,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,HUMANA,MGD,94.78,,,,,,,per diem,94.78,94.78,"Per diem rate, code is bundled with other services"
LACTIC ACID                   ,38251518,CDM,300,RC,83605,CPT,,,,Inpatient,,,94.78,94.78,HUMANA CHOICE PLUS,MGD,94.78,,,,,,,case rate,94.78,94.78,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,AETNA,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,BCBS,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,CIGNA,COM,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,TRICARE,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,UNITED HEALTHCARE,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,UNITED HEALTHCARE,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,VA,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,VA TRICARE,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,WELLMED,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,HUMANA,MGD,64.51,,,,,,,per diem,64.51,64.51,"Per diem rate, code is bundled with other services"
"TRIIODOTHYRONINE, REVERSE     ",38251519,CDM,300,RC,84482,CPT,,,,Inpatient,,,64.51,64.51,HUMANA CHOICE PLUS,MGD,64.51,,,,,,,case rate,64.51,64.51,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,AETNA,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,BCBS,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,CIGNA,COM,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,TRICARE,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,UNITED HEALTHCARE,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,UNITED HEALTHCARE,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,VA,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,VA TRICARE,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,WELLMED,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,HUMANA,MGD,42.72,,,,,,,per diem,42.72,42.72,"Per diem rate, code is bundled with other services"
AB SCREEN IGG                 ,38251520,CDM,300,RC,86850,CPT,,,,Inpatient,,,42.72,42.72,HUMANA CHOICE PLUS,MGD,42.72,,,,,,,case rate,42.72,42.72,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,AETNA,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,BCBS,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,CIGNA,COM,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,TRICARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,UNITED HEALTHCARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,UNITED HEALTHCARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,VA,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,VA TRICARE,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,WELLMED,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,HUMANA,MGD,178.45,,,,,,,per diem,178.45,178.45,"Per diem rate, code is bundled with other services"
ABO ONLY                      ,38251521,CDM,300,RC,86900,CPT,,,,Inpatient,,,178.45,178.45,HUMANA CHOICE PLUS,MGD,178.45,,,,,,,case rate,178.45,178.45,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,AETNA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,CIGNA,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,VA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,VA TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,WELLMED,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,HUMANA,MGD,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RH TYPE ONLY                  ,38251522,CDM,300,RC,86901,CPT,,,,Inpatient,,,23.26,23.26,HUMANA CHOICE PLUS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,AETNA,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,BCBS,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,CIGNA,COM,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,TRICARE,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,UNITED HEALTHCARE,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,UNITED HEALTHCARE,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,VA,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,VA TRICARE,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,WELLMED,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,HUMANA,MGD,111.76,,,,,,,per diem,111.76,111.76,"Per diem rate, code is bundled with other services"
ELECTRONIC CROSSMATCH         ,38251523,CDM,300,RC,86923,CPT,,,,Inpatient,,,111.76,111.76,HUMANA CHOICE PLUS,MGD,111.76,,,,,,,case rate,111.76,111.76,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,AETNA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,CIGNA,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,VA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,VA TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,WELLMED,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,HUMANA,MGD,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
BASIC METABOLIC PANEL         ,38251524,CDM,301,RC,80048,CPT,,,,Inpatient,,,26.65,26.65,HUMANA CHOICE PLUS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,AETNA,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,CIGNA,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,TRICARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,UNITED HEALTHCARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,UNITED HEALTHCARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,VA,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,VA TRICARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,WELLMED,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,HUMANA,MGD,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
COMP METABOLIC PANEL          ,38251525,CDM,301,RC,80053,CPT,,,,Inpatient,,,33.26,33.26,HUMANA CHOICE PLUS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,AETNA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,BCBS,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,CIGNA,COM,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,UNITED HEALTHCARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,VA,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,VA TRICARE,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,WELLMED,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,HUMANA,MGD,164.93,,,,,,,per diem,164.93,164.93,"Per diem rate, code is bundled with other services"
LIPID PROFILE                 ,38251526,CDM,301,RC,80061,CPT,,,,Inpatient,,,164.93,164.93,HUMANA CHOICE PLUS,MGD,164.93,,,,,,,case rate,164.93,164.93,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,AETNA,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,BCBS,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,CIGNA,COM,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,TRICARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,UNITED HEALTHCARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,UNITED HEALTHCARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,VA,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,VA TRICARE,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,WELLMED,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,HUMANA,MGD,35.44,,,,,,,per diem,35.44,35.44,"Per diem rate, code is bundled with other services"
RENAL PANEL                   ,38251527,CDM,301,RC,80069,CPT,,,,Inpatient,,,35.44,35.44,HUMANA CHOICE PLUS,MGD,35.44,,,,,,,case rate,35.44,35.44,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,AETNA,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,BCBS,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,CIGNA,COM,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,TRICARE,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,UNITED HEALTHCARE,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,UNITED HEALTHCARE,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,VA,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,VA TRICARE,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,WELLMED,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,HUMANA,MGD,16.12,,,,,,,per diem,16.12,16.12,"Per diem rate, code is bundled with other services"
HEPATIC FUNCTION PANEL        ,38251528,CDM,301,RC,80076,CPT,,,,Inpatient,,,16.12,16.12,HUMANA CHOICE PLUS,MGD,16.12,,,,,,,case rate,16.12,16.12,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,AETNA,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,BCBS,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,CIGNA,COM,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,TRICARE,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,UNITED HEALTHCARE,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,UNITED HEALTHCARE,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,VA,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,VA TRICARE,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,WELLMED,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,HUMANA,MGD,68.24,,,,,,,per diem,68.24,68.24,"Per diem rate, code is bundled with other services"
DIGOXIN                       ,38251529,CDM,301,RC,80162,CPT,,,,Inpatient,,,68.24,68.24,HUMANA CHOICE PLUS,MGD,68.24,,,,,,,case rate,68.24,68.24,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,AETNA,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,BCBS,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,CIGNA,COM,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,TRICARE,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,UNITED HEALTHCARE,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,UNITED HEALTHCARE,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,VA,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,VA TRICARE,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,WELLMED,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,HUMANA,MGD,233.27,,,,,,,per diem,233.27,233.27,"Per diem rate, code is bundled with other services"
PHENYTOIN TOTAL               ,38251530,CDM,301,RC,80185,CPT,,,,Inpatient,,,233.27,233.27,HUMANA CHOICE PLUS,MGD,233.27,,,,,,,case rate,233.27,233.27,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,AETNA,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,BCBS,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,CIGNA,COM,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,TRICARE,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,UNITED HEALTHCARE,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,UNITED HEALTHCARE,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,VA,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,VA TRICARE,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,WELLMED,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,HUMANA,MGD,76.82,,,,,,,per diem,76.82,76.82,"Per diem rate, code is bundled with other services"
THEOPHYLLINE                  ,38251531,CDM,301,RC,80198,CPT,,,,Inpatient,,,76.82,76.82,HUMANA CHOICE PLUS,MGD,76.82,,,,,,,case rate,76.82,76.82,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,AETNA,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,BCBS,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,CIGNA,COM,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,TRICARE,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,UNITED HEALTHCARE,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,UNITED HEALTHCARE,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,VA,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,VA TRICARE,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,WELLMED,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,HUMANA,MGD,13.46,,,,,,,per diem,13.46,13.46,"Per diem rate, code is bundled with other services"
URINALYSIS MACRO ONLY         ,38251532,CDM,301,RC,81003,CPT,,,,Inpatient,,,13.46,13.46,HUMANA CHOICE PLUS,MGD,13.46,,,,,,,case rate,13.46,13.46,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,AETNA,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,BCBS,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,CIGNA,COM,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,TRICARE,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,UNITED HEALTHCARE,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,UNITED HEALTHCARE,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,VA,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,VA TRICARE,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,WELLMED,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,HUMANA,MGD,26.89,,,,,,,per diem,26.89,26.89,"Per diem rate, code is bundled with other services"
ALBUMIN SERUM                 ,38251533,CDM,301,RC,82040,CPT,,,,Inpatient,,,26.89,26.89,HUMANA CHOICE PLUS,MGD,26.89,,,,,,,case rate,26.89,26.89,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,AETNA,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,BCBS,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,CIGNA,COM,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,TRICARE,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,UNITED HEALTHCARE,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,UNITED HEALTHCARE,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,VA,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,VA TRICARE,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,WELLMED,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,HUMANA,MGD,159.42,,,,,,,per diem,159.42,159.42,"Per diem rate, code is bundled with other services"
AMMONIA BLOOD                 ,38251534,CDM,301,RC,82140,CPT,,,,Inpatient,,,159.42,159.42,HUMANA CHOICE PLUS,MGD,159.42,,,,,,,case rate,159.42,159.42,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,AETNA,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,BCBS,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,CIGNA,COM,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,TRICARE,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,UNITED HEALTHCARE,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,UNITED HEALTHCARE,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,VA,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,VA TRICARE,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,WELLMED,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,HUMANA,MGD,178.83,,,,,,,per diem,178.83,178.83,"Per diem rate, code is bundled with other services"
AMYLASE SERUM                 ,38251535,CDM,301,RC,82150,CPT,,,,Inpatient,,,178.83,178.83,HUMANA CHOICE PLUS,MGD,178.83,,,,,,,case rate,178.83,178.83,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,AETNA,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,BCBS,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,CIGNA,COM,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,TRICARE,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,UNITED HEALTHCARE,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,UNITED HEALTHCARE,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,VA,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,VA TRICARE,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,WELLMED,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,HUMANA,MGD,50.2,,,,,,,per diem,50.2,50.2,"Per diem rate, code is bundled with other services"
BILIRUBIN TOT                 ,38251536,CDM,301,RC,82247,CPT,,,,Inpatient,,,50.2,50.2,HUMANA CHOICE PLUS,MGD,50.2,,,,,,,case rate,50.2,50.2,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,AETNA,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,BCBS,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,CIGNA,COM,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,TRICARE,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,UNITED HEALTHCARE,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,UNITED HEALTHCARE,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,VA,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,VA TRICARE,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,WELLMED,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,HUMANA,MGD,71.27,,,,,,,per diem,71.27,71.27,"Per diem rate, code is bundled with other services"
BILIRUBIN DIR                 ,38251537,CDM,301,RC,82248,CPT,,,,Inpatient,,,71.27,71.27,HUMANA CHOICE PLUS,MGD,71.27,,,,,,,case rate,71.27,71.27,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,AETNA,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,BCBS,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,CIGNA,COM,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,TRICARE,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,UNITED HEALTHCARE,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,UNITED HEALTHCARE,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,VA,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,VA TRICARE,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,WELLMED,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,HUMANA,MGD,62.48,,,,,,,per diem,62.48,62.48,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERMIN     ,38251538,CDM,301,RC,82274,CPT,,,,Inpatient,,,62.48,62.48,HUMANA CHOICE PLUS,MGD,62.48,,,,,,,case rate,62.48,62.48,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,AETNA,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,BCBS,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,CIGNA,COM,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,TRICARE,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,UNITED HEALTHCARE,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,UNITED HEALTHCARE,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,VA,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,VA TRICARE,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,WELLMED,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,HUMANA,MGD,70.3,,,,,,,per diem,70.3,70.3,"Per diem rate, code is bundled with other services"
IONIZED CALCIUM WHOLE BLD     ,38251539,CDM,301,RC,82330,CPT,,,,Inpatient,,,70.3,70.3,HUMANA CHOICE PLUS,MGD,70.3,,,,,,,case rate,70.3,70.3,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,AETNA,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,BCBS,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,CIGNA,COM,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,TRICARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,UNITED HEALTHCARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,UNITED HEALTHCARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,VA,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,VA TRICARE,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,WELLMED,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,HUMANA,MGD,41.14,,,,,,,per diem,41.14,41.14,"Per diem rate, code is bundled with other services"
CPK TOTAL                     ,38251540,CDM,301,RC,82550,CPT,,,,Inpatient,,,41.14,41.14,HUMANA CHOICE PLUS,MGD,41.14,,,,,,,case rate,41.14,41.14,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,AETNA,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,CIGNA,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,TRICARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,UNITED HEALTHCARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,UNITED HEALTHCARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,VA,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,VA TRICARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,WELLMED,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,HUMANA,MGD,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CK-MB                         ,38251541,CDM,301,RC,82553,CPT,,,,Inpatient,,,19.47,19.47,HUMANA CHOICE PLUS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,AETNA,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,BCBS,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,CIGNA,COM,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,TRICARE,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,UNITED HEALTHCARE,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,UNITED HEALTHCARE,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,VA,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,VA TRICARE,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,WELLMED,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,HUMANA,MGD,69.83,,,,,,,per diem,69.83,69.83,"Per diem rate, code is bundled with other services"
CREATININE SERU               ,38251542,CDM,301,RC,82565,CPT,,,,Inpatient,,,69.83,69.83,HUMANA CHOICE PLUS,MGD,69.83,,,,,,,case rate,69.83,69.83,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,AETNA,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,BCBS,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,CIGNA,COM,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,TRICARE,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,UNITED HEALTHCARE,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,UNITED HEALTHCARE,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,VA,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,VA TRICARE,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,WELLMED,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,HUMANA,MGD,27.13,,,,,,,per diem,27.13,27.13,"Per diem rate, code is bundled with other services"
CREAT URN RAND                ,38251543,CDM,301,RC,82570,CPT,,,,Inpatient,,,27.13,27.13,HUMANA CHOICE PLUS,MGD,27.13,,,,,,,case rate,27.13,27.13,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,AETNA,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,BCBS,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,CIGNA,COM,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,TRICARE,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,UNITED HEALTHCARE,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,UNITED HEALTHCARE,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,VA,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,VA TRICARE,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,WELLMED,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,HUMANA,MGD,70.7,,,,,,,per diem,70.7,70.7,"Per diem rate, code is bundled with other services"
FERRITIN                      ,38251544,CDM,301,RC,82728,CPT,,,,Inpatient,,,70.7,70.7,HUMANA CHOICE PLUS,MGD,70.7,,,,,,,case rate,70.7,70.7,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,AETNA,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,BCBS,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,CIGNA,COM,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,TRICARE,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,UNITED HEALTHCARE,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,UNITED HEALTHCARE,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,VA,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,VA TRICARE,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,WELLMED,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,HUMANA,MGD,68.21,,,,,,,per diem,68.21,68.21,"Per diem rate, code is bundled with other services"
"BLOOD GASES, MIXED            ",38251545,CDM,301,RC,82803,CPT,,,,Inpatient,,,68.21,68.21,HUMANA CHOICE PLUS,MGD,68.21,,,,,,,case rate,68.21,68.21,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,AETNA,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,BCBS,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,CIGNA,COM,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,TRICARE,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,UNITED HEALTHCARE,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,UNITED HEALTHCARE,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,VA,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,VA TRICARE,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,WELLMED,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,HUMANA,MGD,52.54,,,,,,,per diem,52.54,52.54,"Per diem rate, code is bundled with other services"
GGT                           ,38251546,CDM,301,RC,82977,CPT,,,,Inpatient,,,52.54,52.54,HUMANA CHOICE PLUS,MGD,52.54,,,,,,,case rate,52.54,52.54,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,AETNA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,BCBS,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,CIGNA,COM,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,UNITED HEALTHCARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,VA,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,VA TRICARE,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,WELLMED,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,HUMANA,MGD,35.31,,,,,,,per diem,35.31,35.31,"Per diem rate, code is bundled with other services"
GLYCO HGB                     ,38251547,CDM,301,RC,83036,CPT,,,,Inpatient,,,35.31,35.31,HUMANA CHOICE PLUS,MGD,35.31,,,,,,,case rate,35.31,35.31,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,AETNA,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,BCBS,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,CIGNA,COM,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,TRICARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,UNITED HEALTHCARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,UNITED HEALTHCARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,VA,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,VA TRICARE,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,WELLMED,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,HUMANA,MGD,14.99,,,,,,,per diem,14.99,14.99,"Per diem rate, code is bundled with other services"
IRON SERUM                    ,38251548,CDM,301,RC,83540,CPT,,,,Inpatient,,,14.99,14.99,HUMANA CHOICE PLUS,MGD,14.99,,,,,,,case rate,14.99,14.99,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,AETNA,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,BCBS,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,CIGNA,COM,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,TRICARE,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,UNITED HEALTHCARE,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,UNITED HEALTHCARE,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,VA,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,VA TRICARE,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,WELLMED,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,HUMANA,MGD,43.56,,,,,,,per diem,43.56,43.56,"Per diem rate, code is bundled with other services"
IRON BINDING CAPACITY         ,38251549,CDM,301,RC,83550,CPT,,,,Inpatient,,,43.56,43.56,HUMANA CHOICE PLUS,MGD,43.56,,,,,,,case rate,43.56,43.56,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,AETNA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,BCBS,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,CIGNA,COM,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,UNITED HEALTHCARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,VA,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,VA TRICARE,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,WELLMED,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,HUMANA,MGD,48.7,,,,,,,per diem,48.7,48.7,"Per diem rate, code is bundled with other services"
LDH                           ,38251550,CDM,301,RC,83615,CPT,,,,Inpatient,,,48.7,48.7,HUMANA CHOICE PLUS,MGD,48.7,,,,,,,case rate,48.7,48.7,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,AETNA,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,BCBS,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,CIGNA,COM,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,TRICARE,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,UNITED HEALTHCARE,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,UNITED HEALTHCARE,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,VA,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,VA TRICARE,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,WELLMED,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,HUMANA,MGD,41.3,,,,,,,per diem,41.3,41.3,"Per diem rate, code is bundled with other services"
LIPASE                        ,38251551,CDM,301,RC,83690,CPT,,,,Inpatient,,,41.3,41.3,HUMANA CHOICE PLUS,MGD,41.3,,,,,,,case rate,41.3,41.3,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,AETNA,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,BCBS,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,CIGNA,COM,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,TRICARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,UNITED HEALTHCARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,UNITED HEALTHCARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,VA,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,VA TRICARE,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,WELLMED,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,HUMANA,MGD,34.27,,,,,,,per diem,34.27,34.27,"Per diem rate, code is bundled with other services"
MAGNESIUM                     ,38251552,CDM,301,RC,83735,CPT,,,,Inpatient,,,34.27,34.27,HUMANA CHOICE PLUS,MGD,34.27,,,,,,,case rate,34.27,34.27,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,AETNA,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,BCBS,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,CIGNA,COM,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,TRICARE,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,UNITED HEALTHCARE,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,UNITED HEALTHCARE,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,VA,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,VA TRICARE,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,WELLMED,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,HUMANA,MGD,98.15,,,,,,,per diem,98.15,98.15,"Per diem rate, code is bundled with other services"
MYOGLOBIN                     ,38251553,CDM,301,RC,83874,CPT,,,,Inpatient,,,98.15,98.15,HUMANA CHOICE PLUS,MGD,98.15,,,,,,,case rate,98.15,98.15,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,AETNA,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,BCBS,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,CIGNA,COM,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,TRICARE,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,UNITED HEALTHCARE,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,UNITED HEALTHCARE,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,VA,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,VA TRICARE,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,WELLMED,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,HUMANA,MGD,85.59,,,,,,,per diem,85.59,85.59,"Per diem rate, code is bundled with other services"
B-TYPE NATRIURETIC PEPTID     ,38251554,CDM,301,RC,83880,CPT,,,,Inpatient,,,85.59,85.59,HUMANA CHOICE PLUS,MGD,85.59,,,,,,,case rate,85.59,85.59,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,AETNA,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,CIGNA,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,TRICARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,UNITED HEALTHCARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,UNITED HEALTHCARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,VA,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,VA TRICARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,WELLMED,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,HUMANA,MGD,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
OSMOLALITY SERUM              ,38251555,CDM,301,RC,83930,CPT,,,,Inpatient,,,34.52,34.52,HUMANA CHOICE PLUS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,AETNA,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,BCBS,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,CIGNA,COM,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,TRICARE,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,UNITED HEALTHCARE,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,UNITED HEALTHCARE,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,VA,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,VA TRICARE,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,WELLMED,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,HUMANA,MGD,34.86,,,,,,,per diem,34.86,34.86,"Per diem rate, code is bundled with other services"
OSMOLALITY URIN               ,38251556,CDM,301,RC,83935,CPT,,,,Inpatient,,,34.86,34.86,HUMANA CHOICE PLUS,MGD,34.86,,,,,,,case rate,34.86,34.86,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,AETNA,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,BCBS,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,CIGNA,COM,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,TRICARE,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,UNITED HEALTHCARE,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,UNITED HEALTHCARE,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,VA,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,VA TRICARE,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,WELLMED,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,HUMANA,MGD,171.14,,,,,,,per diem,171.14,171.14,"Per diem rate, code is bundled with other services"
INTACT PARATHYROID HORMON     ,38251557,CDM,301,RC,83970,CPT,,,,Inpatient,,,171.14,171.14,HUMANA CHOICE PLUS,MGD,171.14,,,,,,,case rate,171.14,171.14,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,AETNA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,CIGNA,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,VA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,VA TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,WELLMED,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,HUMANA,MGD,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
PHOSPHATE INORG               ,38251558,CDM,301,RC,84100,CPT,,,,Inpatient,,,25.86,25.86,HUMANA CHOICE PLUS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,AETNA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,CIGNA,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,VA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,VA TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,WELLMED,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,HUMANA,MGD,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
POTASSIUM SERUM K             ,38251559,CDM,301,RC,84132,CPT,,,,Inpatient,,,23.26,23.26,HUMANA CHOICE PLUS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,AETNA,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,BCBS,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,CIGNA,COM,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,TRICARE,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,UNITED HEALTHCARE,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,UNITED HEALTHCARE,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,VA,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,VA TRICARE,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,WELLMED,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,HUMANA,MGD,54.78,,,,,,,per diem,54.78,54.78,"Per diem rate, code is bundled with other services"
PREALBUMIN (FASTING)          ,38251560,CDM,301,RC,84134,CPT,,,,Inpatient,,,54.78,54.78,HUMANA CHOICE PLUS,MGD,54.78,,,,,,,case rate,54.78,54.78,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,AETNA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,CIGNA,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,VA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,VA TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,WELLMED,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,HUMANA,MGD,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
PROSTATE SPECIFIC ANTIGEN     ,38251561,CDM,301,RC,84153,CPT,,,,Inpatient,,,35.69,35.69,HUMANA CHOICE PLUS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,AETNA,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,BCBS,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,CIGNA,COM,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,TRICARE,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,UNITED HEALTHCARE,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,UNITED HEALTHCARE,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,VA,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,VA TRICARE,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,WELLMED,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,HUMANA,MGD,41.11,,,,,,,per diem,41.11,41.11,"Per diem rate, code is bundled with other services"
PROTEIN SERUM                 ,38251562,CDM,301,RC,84155,CPT,,,,Inpatient,,,41.11,41.11,HUMANA CHOICE PLUS,MGD,41.11,,,,,,,case rate,41.11,41.11,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,AETNA,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,BCBS,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,CIGNA,COM,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,TRICARE,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,UNITED HEALTHCARE,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,UNITED HEALTHCARE,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,VA,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,VA TRICARE,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,WELLMED,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,HUMANA,MGD,29.69,,,,,,,per diem,29.69,29.69,"Per diem rate, code is bundled with other services"
URINE RANDOM TOTAL PROTEI     ,38251563,CDM,301,RC,84156,CPT,,,,Inpatient,,,29.69,29.69,HUMANA CHOICE PLUS,MGD,29.69,,,,,,,case rate,29.69,29.69,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,AETNA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,BCBS,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,CIGNA,COM,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,UNITED HEALTHCARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,VA,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,VA TRICARE,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,WELLMED,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,HUMANA,MGD,65.33,,,,,,,per diem,65.33,65.33,"Per diem rate, code is bundled with other services"
PROTEIN ELECTROPH FRAC/QT     ,38251564,CDM,301,RC,84165,CPT,,,,Inpatient,,,65.33,65.33,HUMANA CHOICE PLUS,MGD,65.33,,,,,,,case rate,65.33,65.33,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,AETNA,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,BCBS,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,CIGNA,COM,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,TRICARE,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,UNITED HEALTHCARE,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,UNITED HEALTHCARE,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,VA,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,VA TRICARE,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,WELLMED,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,HUMANA,MGD,146,,,,,,,per diem,146,146,"Per diem rate, code is bundled with other services"
VITAMIN B1 WHOLE BLOOD        ,38251565,CDM,301,RC,84425,CPT,,,,Inpatient,,,146,146,HUMANA CHOICE PLUS,MGD,146,,,,,,,case rate,146,146,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,AETNA,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,BCBS,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,CIGNA,COM,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,TRICARE,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,UNITED HEALTHCARE,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,UNITED HEALTHCARE,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,VA,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,VA TRICARE,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,WELLMED,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,HUMANA,MGD,48.47,,,,,,,per diem,48.47,48.47,"Per diem rate, code is bundled with other services"
T4                            ,38251566,CDM,301,RC,84436,CPT,,,,Inpatient,,,48.47,48.47,HUMANA CHOICE PLUS,MGD,48.47,,,,,,,case rate,48.47,48.47,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,AETNA,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,CIGNA,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,TRICARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,UNITED HEALTHCARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,UNITED HEALTHCARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,VA,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,VA TRICARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,WELLMED,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,HUMANA,MGD,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
THYROXINE FREE (FREE T4)      ,38251567,CDM,301,RC,84439,CPT,,,,Inpatient,,,107.1,107.1,HUMANA CHOICE PLUS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,AETNA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,CIGNA,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,VA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,VA TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,WELLMED,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,HUMANA,MGD,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
TSH                           ,38251568,CDM,301,RC,84443,CPT,,,,Inpatient,,,52.92,52.92,HUMANA CHOICE PLUS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,AETNA,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,BCBS,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,CIGNA,COM,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,TRICARE,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,UNITED HEALTHCARE,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,UNITED HEALTHCARE,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,VA,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,VA TRICARE,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,WELLMED,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,HUMANA,MGD,43.21,,,,,,,per diem,43.21,43.21,"Per diem rate, code is bundled with other services"
AST                           ,38251569,CDM,301,RC,84450,CPT,,,,Inpatient,,,43.21,43.21,HUMANA CHOICE PLUS,MGD,43.21,,,,,,,case rate,43.21,43.21,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,AETNA,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,BCBS,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,CIGNA,COM,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,TRICARE,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,UNITED HEALTHCARE,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,UNITED HEALTHCARE,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,VA,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,VA TRICARE,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,WELLMED,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,HUMANA,MGD,42.76,,,,,,,per diem,42.76,42.76,"Per diem rate, code is bundled with other services"
ALT                           ,38251570,CDM,301,RC,84460,CPT,,,,Inpatient,,,42.76,42.76,HUMANA CHOICE PLUS,MGD,42.76,,,,,,,case rate,42.76,42.76,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,AETNA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,CIGNA,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,VA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,VA TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,WELLMED,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,HUMANA,MGD,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
TROPONIN-I                    ,38251571,CDM,301,RC,84484,CPT,,,,Inpatient,,,25.86,25.86,HUMANA CHOICE PLUS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,AETNA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,BCBS,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,CIGNA,COM,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,UNITED HEALTHCARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,VA,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,VA TRICARE,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,WELLMED,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,HUMANA,MGD,63.27,,,,,,,per diem,63.27,63.27,"Per diem rate, code is bundled with other services"
URIC ACID SERUM               ,38251572,CDM,301,RC,84550,CPT,,,,Inpatient,,,63.27,63.27,HUMANA CHOICE PLUS,MGD,63.27,,,,,,,case rate,63.27,63.27,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,AETNA,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,BCBS,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,CIGNA,COM,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,TRICARE,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,UNITED HEALTHCARE,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,UNITED HEALTHCARE,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,VA,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,VA TRICARE,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,WELLMED,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,HUMANA,MGD,43.31,,,,,,,per diem,43.31,43.31,"Per diem rate, code is bundled with other services"
C REACTIVE PROTEIN            ,38251573,CDM,302,RC,86140,CPT,,,,Inpatient,,,43.31,43.31,HUMANA CHOICE PLUS,MGD,43.31,,,,,,,case rate,43.31,43.31,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,AETNA,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,CIGNA,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,TRICARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,UNITED HEALTHCARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,UNITED HEALTHCARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,VA,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,VA TRICARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,WELLMED,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,HUMANA,MGD,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
HCT                           ,38251575,CDM,305,RC,85014,CPT,,,,Inpatient,,,13.42,13.42,HUMANA CHOICE PLUS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,AETNA,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,BCBS,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,CIGNA,COM,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,TRICARE,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,UNITED HEALTHCARE,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,UNITED HEALTHCARE,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,VA,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,VA TRICARE,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,WELLMED,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,HUMANA,MGD,81.11,,,,,,,per diem,81.11,81.11,"Per diem rate, code is bundled with other services"
HGB                           ,38251576,CDM,305,RC,85018,CPT,,,,Inpatient,,,81.11,81.11,HUMANA CHOICE PLUS,MGD,81.11,,,,,,,case rate,81.11,81.11,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,AETNA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,BCBS,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,CIGNA,COM,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,UNITED HEALTHCARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,VA,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,VA TRICARE,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,WELLMED,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,HUMANA,MGD,24.48,,,,,,,per diem,24.48,24.48,"Per diem rate, code is bundled with other services"
CBC W/AUTO DIFF               ,38251577,CDM,305,RC,85025,CPT,,,,Inpatient,,,24.48,24.48,HUMANA CHOICE PLUS,MGD,24.48,,,,,,,case rate,24.48,24.48,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,AETNA,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,BCBS,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,CIGNA,COM,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,TRICARE,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,UNITED HEALTHCARE,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,UNITED HEALTHCARE,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,VA,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,VA TRICARE,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,WELLMED,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,HUMANA,MGD,37.96,,,,,,,per diem,37.96,37.96,"Per diem rate, code is bundled with other services"
AUTOMATED CBC                 ,38251578,CDM,305,RC,85027,CPT,,,,Inpatient,,,37.96,37.96,HUMANA CHOICE PLUS,MGD,37.96,,,,,,,case rate,37.96,37.96,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,AETNA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,BCBS,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,CIGNA,COM,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,UNITED HEALTHCARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,VA,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,VA TRICARE,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,WELLMED,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,HUMANA,MGD,35.69,,,,,,,per diem,35.69,35.69,"Per diem rate, code is bundled with other services"
RETIC AUTO W/CELL PARAMS      ,38251579,CDM,305,RC,85046,CPT,,,,Inpatient,,,35.69,35.69,HUMANA CHOICE PLUS,MGD,35.69,,,,,,,case rate,35.69,35.69,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,AETNA,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,BCBS,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,CIGNA,COM,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,TRICARE,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,UNITED HEALTHCARE,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,UNITED HEALTHCARE,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,VA,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,VA TRICARE,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,WELLMED,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,HUMANA,MGD,41.42,,,,,,,per diem,41.42,41.42,"Per diem rate, code is bundled with other services"
D-DIMER ELISA                 ,38251580,CDM,305,RC,85379,CPT,,,,Inpatient,,,41.42,41.42,HUMANA CHOICE PLUS,MGD,41.42,,,,,,,case rate,41.42,41.42,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,AETNA,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,CIGNA,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,TRICARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,UNITED HEALTHCARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,UNITED HEALTHCARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,VA,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,VA TRICARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,WELLMED,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,HUMANA,MGD,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
PROTHROMBIN TIME              ,38251581,CDM,305,RC,85610,CPT,,,,Inpatient,,,31.85,31.85,HUMANA CHOICE PLUS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,AETNA,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,BCBS,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,CIGNA,COM,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,TRICARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,UNITED HEALTHCARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,UNITED HEALTHCARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,VA,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,VA TRICARE,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,WELLMED,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,HUMANA,MGD,6.49,,,,,,,per diem,6.49,6.49,"Per diem rate, code is bundled with other services"
SED RATE                      ,38251582,CDM,305,RC,85652,CPT,,,,Inpatient,,,6.49,6.49,HUMANA CHOICE PLUS,MGD,6.49,,,,,,,case rate,6.49,6.49,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,AETNA,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,BCBS,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,CIGNA,COM,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,TRICARE,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,UNITED HEALTHCARE,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,UNITED HEALTHCARE,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,VA,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,VA TRICARE,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,WELLMED,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,HUMANA,MGD,42.56,,,,,,,per diem,42.56,42.56,"Per diem rate, code is bundled with other services"
APTT                          ,38251583,CDM,305,RC,85730,CPT,,,,Inpatient,,,42.56,42.56,HUMANA CHOICE PLUS,MGD,42.56,,,,,,,case rate,42.56,42.56,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,AETNA,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,BCBS,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,CIGNA,COM,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,TRICARE,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,UNITED HEALTHCARE,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,UNITED HEALTHCARE,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,VA,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,VA TRICARE,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,WELLMED,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,HUMANA,MGD,71.8,,,,,,,per diem,71.8,71.8,"Per diem rate, code is bundled with other services"
BLOOD CULTURE                 ,38251584,CDM,306,RC,87040,CPT,,,,Inpatient,,,71.8,71.8,HUMANA CHOICE PLUS,MGD,71.8,,,,,,,case rate,71.8,71.8,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,AETNA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,BCBS,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,CIGNA,COM,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,UNITED HEALTHCARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,VA,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,VA TRICARE,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,WELLMED,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,HUMANA,MGD,47.12,,,,,,,per diem,47.12,47.12,"Per diem rate, code is bundled with other services"
STOOL CULTURE                 ,38251585,CDM,306,RC,87045,CPT,,,,Inpatient,,,47.12,47.12,HUMANA CHOICE PLUS,MGD,47.12,,,,,,,case rate,47.12,47.12,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,AETNA,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,BCBS,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,CIGNA,COM,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,TRICARE,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,UNITED HEALTHCARE,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,UNITED HEALTHCARE,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,VA,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,VA TRICARE,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,WELLMED,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,HUMANA,MGD,45.23,,,,,,,per diem,45.23,45.23,"Per diem rate, code is bundled with other services"
"CAMPYLOBACTER, ADD BILL       ",38251586,CDM,306,RC,87046,CPT,,,,Inpatient,,,45.23,45.23,HUMANA CHOICE PLUS,MGD,45.23,,,,,,,case rate,45.23,45.23,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,AETNA,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,BCBS,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,CIGNA,COM,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,TRICARE,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,UNITED HEALTHCARE,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,UNITED HEALTHCARE,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,VA,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,VA TRICARE,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,WELLMED,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,HUMANA,MGD,211.44,,,,,,,per diem,211.44,211.44,"Per diem rate, code is bundled with other services"
"WOUND CULTURE,AEROBIC         ",38251587,CDM,306,RC,87070,CPT,,,,Inpatient,,,211.44,211.44,HUMANA CHOICE PLUS,MGD,211.44,,,,,,,case rate,211.44,211.44,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,AETNA,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,BCBS,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,CIGNA,COM,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,TRICARE,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,UNITED HEALTHCARE,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,UNITED HEALTHCARE,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,VA,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,VA TRICARE,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,WELLMED,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,HUMANA,MGD,38.28,,,,,,,per diem,38.28,38.28,"Per diem rate, code is bundled with other services"
DEF ID CULTURE AEROBIC        ,38251588,CDM,306,RC,87077,CPT,,,,Inpatient,,,38.28,38.28,HUMANA CHOICE PLUS,MGD,38.28,,,,,,,case rate,38.28,38.28,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,AETNA,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,BCBS,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,CIGNA,COM,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,TRICARE,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,UNITED HEALTHCARE,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,UNITED HEALTHCARE,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,VA,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,VA TRICARE,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,WELLMED,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,HUMANA,MGD,78.12,,,,,,,per diem,78.12,78.12,"Per diem rate, code is bundled with other services"
URINE CULTURE                 ,38251589,CDM,306,RC,87086,CPT,,,,Inpatient,,,78.12,78.12,HUMANA CHOICE PLUS,MGD,78.12,,,,,,,case rate,78.12,78.12,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,AETNA,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,BCBS,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,CIGNA,COM,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,TRICARE,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,UNITED HEALTHCARE,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,UNITED HEALTHCARE,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,VA,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,VA TRICARE,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,WELLMED,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,HUMANA,MGD,39.87,,,,,,,per diem,39.87,39.87,"Per diem rate, code is bundled with other services"
CULTURE IMMUNOLOGIC-LATX      ,38251590,CDM,306,RC,87147,CPT,,,,Inpatient,,,39.87,39.87,HUMANA CHOICE PLUS,MGD,39.87,,,,,,,case rate,39.87,39.87,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,AETNA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,CIGNA,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,VA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,VA TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,WELLMED,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,HUMANA,MGD,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
MIC SENSITIVITY               ,38251591,CDM,306,RC,87186,CPT,,,,Inpatient,,,40.95,40.95,HUMANA CHOICE PLUS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,AETNA,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,BCBS,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,CIGNA,COM,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,TRICARE,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,UNITED HEALTHCARE,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,UNITED HEALTHCARE,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,VA,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,VA TRICARE,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,WELLMED,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,HUMANA,MGD,58.87,,,,,,,per diem,58.87,58.87,"Per diem rate, code is bundled with other services"
GRAM STAIN SMEAR              ,38251592,CDM,306,RC,87205,CPT,,,,Inpatient,,,58.87,58.87,HUMANA CHOICE PLUS,MGD,58.87,,,,,,,case rate,58.87,58.87,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,AETNA,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,BCBS,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,CIGNA,COM,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,TRICARE,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,UNITED HEALTHCARE,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,UNITED HEALTHCARE,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,VA,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,VA TRICARE,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,WELLMED,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,HUMANA,MGD,366.06,,,,,,,per diem,366.06,366.06,"Per diem rate, code is bundled with other services"
CLOSTRIDIUM DIFF TOXIN AM     ,38251593,CDM,306,RC,87493,CPT,,,,Inpatient,,,366.06,366.06,HUMANA CHOICE PLUS,MGD,366.06,,,,,,,case rate,366.06,366.06,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,AETNA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,BCBS,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,CIGNA,COM,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,UNITED HEALTHCARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,VA,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,VA TRICARE,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,WELLMED,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,HUMANA,MGD,9.99,,,,,,,per diem,9.99,9.99,"Per diem rate, code is bundled with other services"
URINALYSIS AND MICROSCOPI     ,38251594,CDM,307,RC,81001,CPT,,,,Inpatient,,,9.99,9.99,HUMANA CHOICE PLUS,MGD,9.99,,,,,,,case rate,9.99,9.99,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,AETNA,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,BCBS,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,CIGNA,COM,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,TRICARE,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,UNITED HEALTHCARE,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,UNITED HEALTHCARE,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,VA,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,VA TRICARE,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,WELLMED,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,HUMANA,MGD,217.04,,,,,,,per diem,217.04,217.04,"Per diem rate, code is bundled with other services"
TACROLIMUS (FK506)            ,38251595,CDM,300,RC,,,,,,Inpatient,,,217.04,217.04,HUMANA CHOICE PLUS,MGD,217.04,,,,,,,case rate,217.04,217.04,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,AETNA,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,BCBS,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,CIGNA,COM,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,TRICARE,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,UNITED HEALTHCARE,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,UNITED HEALTHCARE,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,VA,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,VA TRICARE,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,WELLMED,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,HUMANA,MGD,151.39,,,,,,,per diem,151.39,151.39,"Per diem rate, code is bundled with other services"
"INFLUENZA A, PCR              ",38251597,CDM,306,RC,87502,CPT,,,,Inpatient,,,151.39,151.39,HUMANA CHOICE PLUS,MGD,151.39,,,,,,,case rate,151.39,151.39,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,AETNA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,BCBS,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,CIGNA,COM,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,UNITED HEALTHCARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,VA,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,VA TRICARE,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,WELLMED,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,HUMANA,MGD,54.6,,,,,,,per diem,54.6,54.6,"Per diem rate, code is bundled with other services"
COAGULATION SCREEN            ,38251600,CDM,301,RC,85601,CPT,,,,Inpatient,,,54.6,54.6,HUMANA CHOICE PLUS,MGD,54.6,,,,,,,case rate,54.6,54.6,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,AETNA,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,BCBS,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,CIGNA,COM,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,TRICARE,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,UNITED HEALTHCARE,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,UNITED HEALTHCARE,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,VA,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,VA TRICARE,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,WELLMED,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,HUMANA,MGD,678.1,,,,,,,per diem,678.1,678.1,"Per diem rate, code is bundled with other services"
LEUKO REDUCED RED CELLS       ,38251601,CDM,301,RC,,,,,,Inpatient,,,678.1,678.1,HUMANA CHOICE PLUS,MGD,678.1,,,,,,,case rate,678.1,678.1,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,AETNA,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,BCBS,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,CIGNA,COM,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,TRICARE,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,UNITED HEALTHCARE,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,UNITED HEALTHCARE,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,VA,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,VA TRICARE,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,WELLMED,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,HUMANA,MGD,80.59,,,,,,,per diem,80.59,80.59,"Per diem rate, code is bundled with other services"
IMMUNIOFIXATION URINE         ,38251602,CDM,301,RC,,,,,,Inpatient,,,80.59,80.59,HUMANA CHOICE PLUS,MGD,80.59,,,,,,,case rate,80.59,80.59,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,AETNA,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,BCBS,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,CIGNA,COM,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,TRICARE,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,UNITED HEALTHCARE,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,UNITED HEALTHCARE,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,VA,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,VA TRICARE,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,WELLMED,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,HUMANA,MGD,144.47,,,,,,,per diem,144.47,144.47,"Per diem rate, code is bundled with other services"
ELECTROLYTE URINE SPOT        ,38251603,CDM,301,RC,,,,,,Inpatient,,,144.47,144.47,HUMANA CHOICE PLUS,MGD,144.47,,,,,,,case rate,144.47,144.47,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,AETNA,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,BCBS,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,CIGNA,COM,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,TRICARE,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,UNITED HEALTHCARE,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,UNITED HEALTHCARE,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,VA,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,VA TRICARE,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,WELLMED,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,HUMANA,MGD,17.49,,,,,,,per diem,17.49,17.49,"Per diem rate, code is bundled with other services"
GLUCOSE POCT                  ,38251604,CDM,301,RC,,,,,,Inpatient,,,17.49,17.49,HUMANA CHOICE PLUS,MGD,17.49,,,,,,,case rate,17.49,17.49,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,AETNA,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,BCBS,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,CIGNA,COM,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,TRICARE,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,UNITED HEALTHCARE,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,UNITED HEALTHCARE,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,VA,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,VA TRICARE,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,WELLMED,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,HUMANA,MGD,26.21,,,,,,,per diem,26.21,26.21,"Per diem rate, code is bundled with other services"
LACTATE DEHYDROGENASE         ,38251605,CDM,301,RC,,,,,,Inpatient,,,26.21,26.21,HUMANA CHOICE PLUS,MGD,26.21,,,,,,,case rate,26.21,26.21,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,AETNA,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,BCBS,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,CIGNA,COM,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,TRICARE,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,UNITED HEALTHCARE,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,UNITED HEALTHCARE,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,VA,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,VA TRICARE,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,WELLMED,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,HUMANA,MGD,69.81,,,,,,,per diem,69.81,69.81,"Per diem rate, code is bundled with other services"
TYPE SCREEN                   ,38251606,CDM,301,RC,,,,,,Inpatient,,,69.81,69.81,HUMANA CHOICE PLUS,MGD,69.81,,,,,,,case rate,69.81,69.81,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,AETNA,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,BCBS,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,CIGNA,COM,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,TRICARE,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,UNITED HEALTHCARE,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,UNITED HEALTHCARE,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,VA,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,VA TRICARE,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,WELLMED,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,HUMANA,MGD,24.54,,,,,,,per diem,24.54,24.54,"Per diem rate, code is bundled with other services"
DAT POLYSPECIFIC              ,38251607,CDM,301,RC,,,,,,Inpatient,,,24.54,24.54,HUMANA CHOICE PLUS,MGD,24.54,,,,,,,case rate,24.54,24.54,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,AETNA,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,BCBS,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,CIGNA,COM,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,TRICARE,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,UNITED HEALTHCARE,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,UNITED HEALTHCARE,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,VA,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,VA TRICARE,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,WELLMED,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,HUMANA,MGD,457.46,,,,,,,per diem,457.46,457.46,"Per diem rate, code is bundled with other services"
ANA TITER ENA PANEL           ,38251611,CDM,301,RC,,,,,,Inpatient,,,457.46,457.46,HUMANA CHOICE PLUS,MGD,457.46,,,,,,,case rate,457.46,457.46,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,AETNA,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,BCBS,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,CIGNA,COM,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,TRICARE,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,UNITED HEALTHCARE,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,UNITED HEALTHCARE,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,VA,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,VA TRICARE,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,WELLMED,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,HUMANA,MGD,148.47,,,,,,,per diem,148.47,148.47,"Per diem rate, code is bundled with other services"
METANEPHRINES PLASMA          ,38251612,CDM,301,RC,,,,,,Inpatient,,,148.47,148.47,HUMANA CHOICE PLUS,MGD,148.47,,,,,,,case rate,148.47,148.47,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,AETNA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,CIGNA,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,VA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,VA TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,WELLMED,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,HUMANA,MGD,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ANCA                          ,38251614,CDM,301,RC,,,,,,Inpatient,,,51.45,51.45,HUMANA CHOICE PLUS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,AETNA,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,CIGNA,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,TRICARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,UNITED HEALTHCARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,UNITED HEALTHCARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,VA,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,VA TRICARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,WELLMED,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,HUMANA,MGD,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
EOSINOPHIL TOTAL              ,38251615,CDM,302,RC,,,,,,Inpatient,,,48.51,48.51,HUMANA CHOICE PLUS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,AETNA,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,BCBS,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,CIGNA,COM,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,TRICARE,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,UNITED HEALTHCARE,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,UNITED HEALTHCARE,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,VA,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,VA TRICARE,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,WELLMED,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,HUMANA,MGD,47.05,,,,,,,per diem,47.05,47.05,"Per diem rate, code is bundled with other services"
PH BLOOD I-STAT               ,38251618,CDM,301,RC,,,,,,Inpatient,,,47.05,47.05,HUMANA CHOICE PLUS,MGD,47.05,,,,,,,case rate,47.05,47.05,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,AETNA,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,BCBS,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,CIGNA,COM,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,TRICARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,UNITED HEALTHCARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,UNITED HEALTHCARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,VA,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,VA TRICARE,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,WELLMED,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,HUMANA,MGD,131.41,,,,,,,per diem,131.41,131.41,"Per diem rate, code is bundled with other services"
HAEMOPHILUS INFLUENZAE B      ,38251619,CDM,302,RC,86684,CPT,,,,Inpatient,,,131.41,131.41,HUMANA CHOICE PLUS,MGD,131.41,,,,,,,case rate,131.41,131.41,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,AETNA,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,BCBS,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,CIGNA,COM,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,TRICARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,UNITED HEALTHCARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,UNITED HEALTHCARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,VA,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,VA TRICARE,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,WELLMED,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,HUMANA,MGD,81.62,,,,,,,per diem,81.62,81.62,"Per diem rate, code is bundled with other services"
INFLUENZAE B ANTIGEN DFA      ,38251620,CDM,306,RC,87275,CPT,,,,Inpatient,,,81.62,81.62,HUMANA CHOICE PLUS,MGD,81.62,,,,,,,case rate,81.62,81.62,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,AETNA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,BCBS,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,CIGNA,COM,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,UNITED HEALTHCARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,VA,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,VA TRICARE,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,WELLMED,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,HUMANA,MGD,58.95,,,,,,,per diem,58.95,58.95,"Per diem rate, code is bundled with other services"
INFLUENZAE A ANTIGEN DFA      ,38251621,CDM,306,RC,87276,CPT,,,,Inpatient,,,58.95,58.95,HUMANA CHOICE PLUS,MGD,58.95,,,,,,,case rate,58.95,58.95,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,AETNA,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,BCBS,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,CIGNA,COM,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,TRICARE,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,UNITED HEALTHCARE,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,UNITED HEALTHCARE,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,VA,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,VA TRICARE,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,WELLMED,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,HUMANA,MGD,438.01,,,,,,,per diem,438.01,438.01,"Per diem rate, code is bundled with other services"
FETAL LUNG MATURITY ASSESS    ,38251623,CDM,301,RC,83661,CPT,,,,Inpatient,,,438.01,438.01,HUMANA CHOICE PLUS,MGD,438.01,,,,,,,case rate,438.01,438.01,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,AETNA,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,BCBS,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,CIGNA,COM,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,TRICARE,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,UNITED HEALTHCARE,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,UNITED HEALTHCARE,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,VA,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,VA TRICARE,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,WELLMED,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,HUMANA,MGD,192.57,,,,,,,per diem,192.57,192.57,"Per diem rate, code is bundled with other services"
ACTHB                         ,38251624,CDM,301,RC,82024,CPT,,,,Inpatient,,,192.57,192.57,HUMANA CHOICE PLUS,MGD,192.57,,,,,,,case rate,192.57,192.57,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,AETNA,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,BCBS,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,CIGNA,COM,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,TRICARE,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,UNITED HEALTHCARE,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,UNITED HEALTHCARE,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,VA,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,VA TRICARE,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,WELLMED,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,HUMANA,MGD,356.9,,,,,,,per diem,356.9,356.9,"Per diem rate, code is bundled with other services"
TB INTERERON GAMMA            ,38251625,CDM,305,RC,,,,,,Inpatient,,,356.9,356.9,HUMANA CHOICE PLUS,MGD,356.9,,,,,,,case rate,356.9,356.9,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,AETNA,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,CIGNA,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,TRICARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,UNITED HEALTHCARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,UNITED HEALTHCARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,VA,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,VA TRICARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,WELLMED,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,HUMANA,MGD,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
GHB SERUM CONFIRMATION        ,38251626,CDM,301,RC,,,,,,Inpatient,,,350.41,350.41,HUMANA CHOICE PLUS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,AETNA,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,BCBS,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,CIGNA,COM,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,TRICARE,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,UNITED HEALTHCARE,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,UNITED HEALTHCARE,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,VA,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,VA TRICARE,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,WELLMED,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,HUMANA,MGD,144.92,,,,,,,per diem,144.92,144.92,"Per diem rate, code is bundled with other services"
UCF URINE DRUG ABUSE PANE     ,38251627,CDM,301,RC,,,,,,Inpatient,,,144.92,144.92,HUMANA CHOICE PLUS,MGD,144.92,,,,,,,case rate,144.92,144.92,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,AETNA,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,BCBS,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,CIGNA,COM,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,TRICARE,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,UNITED HEALTHCARE,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,UNITED HEALTHCARE,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,VA,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,VA TRICARE,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,WELLMED,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,HUMANA,MGD,219.45,,,,,,,per diem,219.45,219.45,"Per diem rate, code is bundled with other services"
"PLT ANTIBODY, DIRECT          ",38251628,CDM,300,RC,,,,,,Inpatient,,,219.45,219.45,HUMANA CHOICE PLUS,MGD,219.45,,,,,,,case rate,219.45,219.45,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,AETNA,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,BCBS,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,CIGNA,COM,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,TRICARE,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,UNITED HEALTHCARE,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,UNITED HEALTHCARE,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,VA,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,VA TRICARE,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,WELLMED,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,HUMANA,MGD,168,,,,,,,per diem,168,168,"Per diem rate, code is bundled with other services"
"FOLATE, RBC W/HCT             ",38251629,CDM,301,RC,,,,,,Inpatient,,,168,168,HUMANA CHOICE PLUS,MGD,168,,,,,,,case rate,168,168,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,AETNA,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,BCBS,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,CIGNA,COM,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,TRICARE,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,UNITED HEALTHCARE,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,UNITED HEALTHCARE,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,VA,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,VA TRICARE,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,WELLMED,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,HUMANA,MGD,95.55,,,,,,,per diem,95.55,95.55,"Per diem rate, code is bundled with other services"
IRON W/TIBC                   ,38251630,CDM,301,RC,,,,,,Inpatient,,,95.55,95.55,HUMANA CHOICE PLUS,MGD,95.55,,,,,,,case rate,95.55,95.55,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,AETNA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,CIGNA,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,VA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,VA TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,WELLMED,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,HUMANA,MGD,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
CHG URINE PREGNANCY  TEST     ,38251638,CDM,301,RC,,,,,,Inpatient,,,117.6,117.6,HUMANA CHOICE PLUS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,AETNA,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,BCBS,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,CIGNA,COM,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,TRICARE,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,UNITED HEALTHCARE,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,UNITED HEALTHCARE,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,VA,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,VA TRICARE,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,WELLMED,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,HUMANA,MGD,49.47,,,,,,,per diem,49.47,49.47,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD TEST            ,38251639,CDM,301,RC,,,,,,Inpatient,,,49.47,49.47,HUMANA CHOICE PLUS,MGD,49.47,,,,,,,case rate,49.47,49.47,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,AETNA,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,BCBS,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,CIGNA,COM,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,TRICARE,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,UNITED HEALTHCARE,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,UNITED HEALTHCARE,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,VA,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,VA TRICARE,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,WELLMED,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,HUMANA,MGD,151.62,,,,,,,per diem,151.62,151.62,"Per diem rate, code is bundled with other services"
CHG CRE CULTURE TYPING ID     ,38251643,CDM,306,RC,,,,,,Inpatient,,,151.62,151.62,HUMANA CHOICE PLUS,MGD,151.62,,,,,,,case rate,151.62,151.62,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,AETNA,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,BCBS,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,CIGNA,COM,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,TRICARE,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,UNITED HEALTHCARE,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,UNITED HEALTHCARE,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,VA,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,VA TRICARE,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,WELLMED,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,HUMANA,MGD,316.58,,,,,,,per diem,316.58,316.58,"Per diem rate, code is bundled with other services"
CHG STAPH AUREUS DNA AMP      ,38251644,CDM,306,RC,,,,,,Inpatient,,,316.58,316.58,HUMANA CHOICE PLUS,MGD,316.58,,,,,,,case rate,316.58,316.58,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,AETNA,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,BCBS,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,CIGNA,COM,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,TRICARE,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,UNITED HEALTHCARE,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,UNITED HEALTHCARE,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,VA,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,VA TRICARE,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,WELLMED,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,HUMANA,MGD,527.1,,,,,,,per diem,527.1,527.1,"Per diem rate, code is bundled with other services"
CHG EBV BY PCR QUANT          ,38251645,CDM,306,RC,,,,,,Inpatient,,,527.1,527.1,HUMANA CHOICE PLUS,MGD,527.1,,,,,,,case rate,527.1,527.1,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,AETNA,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,BCBS,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,CIGNA,COM,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,TRICARE,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,UNITED HEALTHCARE,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,UNITED HEALTHCARE,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,VA,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,VA TRICARE,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,WELLMED,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,HUMANA,MGD,72.98,,,,,,,per diem,72.98,72.98,"Per diem rate, code is bundled with other services"
CHG RAPID STREP               ,38251646,CDM,306,RC,,,,,,Inpatient,,,72.98,72.98,HUMANA CHOICE PLUS,MGD,72.98,,,,,,,case rate,72.98,72.98,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,AETNA,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,BCBS,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,CIGNA,COM,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,TRICARE,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,UNITED HEALTHCARE,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,UNITED HEALTHCARE,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,VA,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,VA TRICARE,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,WELLMED,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,HUMANA,MGD,438,,,,,,,per diem,438,438,"Per diem rate, code is bundled with other services"
PROGRAM MULTI LEAD PAC        ,38251647,CDM,300,RC,93281,CPT,,,,Inpatient,,,438,438,HUMANA CHOICE PLUS,MGD,438,,,,,,,case rate,438,438,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,AETNA,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,BCBS,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,CIGNA,COM,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,TRICARE,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,UNITED HEALTHCARE,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,UNITED HEALTHCARE,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,VA,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,VA TRICARE,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,WELLMED,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,HUMANA,MGD,10.33,,,,,,,per diem,10.33,10.33,"Per diem rate, code is bundled with other services"
GLUCOSE BLOOD BY MONITORING DE,38251648,CDM,301,RC,82962,CPT,,,,Inpatient,,,10.33,10.33,HUMANA CHOICE PLUS,MGD,10.33,,,,,,,case rate,10.33,10.33,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,AETNA,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,BCBS,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,CIGNA,COM,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,TRICARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,UNITED HEALTHCARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,UNITED HEALTHCARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,VA,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,VA TRICARE,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,WELLMED,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,HUMANA,MGD,89.25,,,,,,,per diem,89.25,89.25,"Per diem rate, code is bundled with other services"
HC DRUG SCREEN RAPID 1PRO     ,38251650,CDM,301,RC,,,,,,Inpatient,,,89.25,89.25,HUMANA CHOICE PLUS,MGD,89.25,,,,,,,case rate,89.25,89.25,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,AETNA,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,BCBS,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,CIGNA,COM,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,TRICARE,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,UNITED HEALTHCARE,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,UNITED HEALTHCARE,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,VA,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,VA TRICARE,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,WELLMED,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,HUMANA,MGD,451.75,,,,,,,per diem,451.75,451.75,"Per diem rate, code is bundled with other services"
HC LAB HBV DNA QUAL PCR       ,38251651,CDM,306,RC,,,,,,Inpatient,,,451.75,451.75,HUMANA CHOICE PLUS,MGD,451.75,,,,,,,case rate,451.75,451.75,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,AETNA,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,BCBS,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,CIGNA,COM,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,TRICARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,UNITED HEALTHCARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,UNITED HEALTHCARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,VA,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,VA TRICARE,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,WELLMED,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,HUMANA,MGD,153.3,,,,,,,per diem,153.3,153.3,"Per diem rate, code is bundled with other services"
CHG MYCOPHENOLIC ACID         ,38251652,CDM,301,RC,,,,,,Inpatient,,,153.3,153.3,HUMANA CHOICE PLUS,MGD,153.3,,,,,,,case rate,153.3,153.3,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,AETNA,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,BCBS,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,CIGNA,COM,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,TRICARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,UNITED HEALTHCARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,UNITED HEALTHCARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,VA,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,VA TRICARE,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,WELLMED,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,HUMANA,MGD,198.45,,,,,,,per diem,198.45,198.45,"Per diem rate, code is bundled with other services"
CHG PREGABALIN LYRICA         ,38251653,CDM,301,RC,,,,,,Inpatient,,,198.45,198.45,HUMANA CHOICE PLUS,MGD,198.45,,,,,,,case rate,198.45,198.45,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,AETNA,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,BCBS,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,CIGNA,COM,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,TRICARE,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,UNITED HEALTHCARE,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,UNITED HEALTHCARE,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,VA,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,VA TRICARE,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,WELLMED,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,HUMANA,MGD,127.05,,,,,,,per diem,127.05,127.05,"Per diem rate, code is bundled with other services"
CHG RIBOFLAVIN VITAMIN B2     ,38251654,CDM,301,RC,,,,,,Inpatient,,,127.05,127.05,HUMANA CHOICE PLUS,MGD,127.05,,,,,,,case rate,127.05,127.05,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,AETNA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,BCBS,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,CIGNA,COM,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,UNITED HEALTHCARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,VA,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,VA TRICARE,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,WELLMED,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA,MGD,76.65,,,,,,,per diem,76.65,76.65,"Per diem rate, code is bundled with other services"
HEMOGRAM/DIFF/PLT             ,38251655,CDM,305,RC,,,,,,Inpatient,,,76.65,76.65,HUMANA CHOICE PLUS,MGD,76.65,,,,,,,case rate,76.65,76.65,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,AETNA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,BCBS,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,CIGNA,COM,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,UNITED HEALTHCARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,VA,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,VA TRICARE,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,WELLMED,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,HUMANA,MGD,102.9,,,,,,,per diem,102.9,102.9,"Per diem rate, code is bundled with other services"
CHG *CANDIDA DNA DIR PROB     ,38251656,CDM,306,RC,,,,,,Inpatient,,,102.9,102.9,HUMANA CHOICE PLUS,MGD,102.9,,,,,,,case rate,102.9,102.9,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,AETNA,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,BCBS,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,CIGNA,COM,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,TRICARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,UNITED HEALTHCARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,UNITED HEALTHCARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,VA,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,VA TRICARE,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,WELLMED,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,HUMANA,MGD,86.1,,,,,,,per diem,86.1,86.1,"Per diem rate, code is bundled with other services"
CHG GARDNER VAG DNA DIR P     ,38251657,CDM,306,RC,,,,,,Inpatient,,,86.1,86.1,HUMANA CHOICE PLUS,MGD,86.1,,,,,,,case rate,86.1,86.1,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,AETNA,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,BCBS,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,CIGNA,COM,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,TRICARE,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,UNITED HEALTHCARE,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,UNITED HEALTHCARE,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,VA,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,VA TRICARE,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,WELLMED,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,HUMANA,MGD,91.35,,,,,,,per diem,91.35,91.35,"Per diem rate, code is bundled with other services"
CHG TRICHOMONAS VAG DIR P     ,38251658,CDM,306,RC,,,,,,Inpatient,,,91.35,91.35,HUMANA CHOICE PLUS,MGD,91.35,,,,,,,case rate,91.35,91.35,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,AETNA,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,BCBS,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,CIGNA,COM,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,TRICARE,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,UNITED HEALTHCARE,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,UNITED HEALTHCARE,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,VA,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,VA TRICARE,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,WELLMED,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,HUMANA,MGD,167.48,,,,,,,per diem,167.48,167.48,"Per diem rate, code is bundled with other services"
NEISSERIA GONORRHOEAE         ,38251659,CDM,306,RC,87591,CPT,,,,Inpatient,,,167.48,167.48,HUMANA CHOICE PLUS,MGD,167.48,,,,,,,case rate,167.48,167.48,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,AETNA,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,BCBS,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,CIGNA,COM,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,TRICARE,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,UNITED HEALTHCARE,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,UNITED HEALTHCARE,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,VA,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,VA TRICARE,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,WELLMED,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,HUMANA,MGD,66.62,,,,,,,per diem,66.62,66.62,"Per diem rate, code is bundled with other services"
URINALYSIS W/REFLX CULT       ,38251666,CDM,302,RC,,,,,,Inpatient,,,66.62,66.62,HUMANA CHOICE PLUS,MGD,66.62,,,,,,,case rate,66.62,66.62,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,AETNA,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,BCBS,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,CIGNA,COM,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,TRICARE,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,UNITED HEALTHCARE,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,UNITED HEALTHCARE,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,VA,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,VA TRICARE,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,WELLMED,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,HUMANA,MGD,53.08,,,,,,,per diem,53.08,53.08,"Per diem rate, code is bundled with other services"
STAPH AUREUS DNA AMP PROBE    ,38251668,CDM,300,RC,87640,CPT,,,,Inpatient,,,53.08,53.08,HUMANA CHOICE PLUS,MGD,53.08,,,,,,,case rate,53.08,53.08,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,AETNA,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,BCBS,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,CIGNA,COM,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,TRICARE,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,UNITED HEALTHCARE,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,UNITED HEALTHCARE,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,VA,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,VA TRICARE,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,WELLMED,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,HUMANA,MGD,97.47,,,,,,,per diem,97.47,97.47,"Per diem rate, code is bundled with other services"
CULTURE TYPE NUC ACID AMP PROB,38251669,CDM,306,RC,87150,CPT,,,,Inpatient,,,97.47,97.47,HUMANA CHOICE PLUS,MGD,97.47,,,,,,,case rate,97.47,97.47,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,AETNA,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,BCBS,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,CIGNA,COM,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,TRICARE,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,UNITED HEALTHCARE,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,UNITED HEALTHCARE,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,VA,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,VA TRICARE,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,WELLMED,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,HUMANA,MGD,156.46,,,,,,,per diem,156.46,156.46,"Per diem rate, code is bundled with other services"
LYME BY PCR                   ,38251670,CDM,300,RC,87476,CPT,,,,Inpatient,,,156.46,156.46,HUMANA CHOICE PLUS,MGD,156.46,,,,,,,case rate,156.46,156.46,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,AETNA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,BCBS,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,CIGNA,COM,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,UNITED HEALTHCARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,VA,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,VA TRICARE,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,WELLMED,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA,MGD,92.4,,,,,,,per diem,92.4,92.4,"Per diem rate, code is bundled with other services"
SUGARS SINGLE QUAN EA SPE     ,38251671,CDM,300,RC,,,,,,Inpatient,,,92.4,92.4,HUMANA CHOICE PLUS,MGD,92.4,,,,,,,case rate,92.4,92.4,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,AETNA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,CIGNA,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,VA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,VA TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,WELLMED,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,HUMANA,MGD,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
VON WILLEBRAND FACTOR ACTIVITY,38251672,CDM,305,RC,85397,CPT,,,,Inpatient,,,73.5,73.5,HUMANA CHOICE PLUS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,AETNA,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,BCBS,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,CIGNA,COM,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,TRICARE,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,UNITED HEALTHCARE,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,UNITED HEALTHCARE,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,VA,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,VA TRICARE,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,WELLMED,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,HUMANA,MGD,1127.95,,,,,,,per diem,1127.95,1127.95,"Per diem rate, code is bundled with other services"
RESP VIRUS 12-25 TARGETS      ,38251673,CDM,306,RC,87633,CPT,,,,Inpatient,,,1127.95,1127.95,HUMANA CHOICE PLUS,MGD,1127.95,,,,,,,case rate,1127.95,1127.95,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,AETNA,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,BCBS,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,CIGNA,COM,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,TRICARE,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,UNITED HEALTHCARE,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,UNITED HEALTHCARE,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,VA,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,VA TRICARE,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,WELLMED,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,HUMANA,MGD,244.42,,,,,,,per diem,244.42,244.42,"Per diem rate, code is bundled with other services"
ZONISAMIDE/ZONRGRAN           ,38251674,CDM,301,RC,80203,CPT,,,,Inpatient,,,244.42,244.42,HUMANA CHOICE PLUS,MGD,244.42,,,,,,,case rate,244.42,244.42,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,AETNA,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,BCBS,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,CIGNA,COM,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,TRICARE,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,UNITED HEALTHCARE,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,UNITED HEALTHCARE,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,VA,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,VA TRICARE,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,WELLMED,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,HUMANA,MGD,188.55,,,,,,,per diem,188.55,188.55,"Per diem rate, code is bundled with other services"
HLA CLASS I AB BY LUMINEX     ,38251675,CDM,300,RC,86832,CPT,,,,Inpatient,,,188.55,188.55,HUMANA CHOICE PLUS,MGD,188.55,,,,,,,case rate,188.55,188.55,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,AETNA,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,BCBS,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,CIGNA,COM,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,TRICARE,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,UNITED HEALTHCARE,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,UNITED HEALTHCARE,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,VA,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,VA TRICARE,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,WELLMED,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,HUMANA,MGD,171.41,,,,,,,per diem,171.41,171.41,"Per diem rate, code is bundled with other services"
HLA CLASS II AB BY LUMINEXT   ,38251676,CDM,300,RC,86833,CPT,,,,Inpatient,,,171.41,171.41,HUMANA CHOICE PLUS,MGD,171.41,,,,,,,case rate,171.41,171.41,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,AETNA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,BCBS,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,CIGNA,COM,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,UNITED HEALTHCARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,VA,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,VA TRICARE,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,WELLMED,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,HUMANA,MGD,190.64,,,,,,,per diem,190.64,190.64,"Per diem rate, code is bundled with other services"
FLU/RSV BY PCR                ,38251678,CDM,300,RC,87631,CPT,,,,Inpatient,,,190.64,190.64,HUMANA CHOICE PLUS,MGD,190.64,,,,,,,case rate,190.64,190.64,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,AETNA,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,BCBS,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,CIGNA,COM,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,TRICARE,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,UNITED HEALTHCARE,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,UNITED HEALTHCARE,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,VA,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,VA TRICARE,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,WELLMED,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,HUMANA,MGD,54.61,,,,,,,per diem,54.61,54.61,"Per diem rate, code is bundled with other services"
INFLUENZA A AG RAPID          ,38251679,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.61,54.61,HUMANA CHOICE PLUS,MGD,54.61,,,,,,,case rate,54.61,54.61,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,AETNA,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,BCBS,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,CIGNA,COM,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,TRICARE,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,UNITED HEALTHCARE,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,UNITED HEALTHCARE,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,VA,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,VA TRICARE,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,WELLMED,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,HUMANA,MGD,54.52,,,,,,,per diem,54.52,54.52,"Per diem rate, code is bundled with other services"
INFLUENZA B AG RAPID          ,38251680,CDM,306,RC,87084,CPT,,,,Inpatient,,,54.52,54.52,HUMANA CHOICE PLUS,MGD,54.52,,,,,,,case rate,54.52,54.52,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,AETNA,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,BCBS,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,CIGNA,COM,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,TRICARE,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,UNITED HEALTHCARE,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,UNITED HEALTHCARE,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,VA,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,VA TRICARE,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,WELLMED,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,HUMANA,MGD,137.82,,,,,,,per diem,137.82,137.82,"Per diem rate, code is bundled with other services"
CADMIUM                       ,38251681,CDM,301,RC,82300,CPT,,,,Inpatient,,,137.82,137.82,HUMANA CHOICE PLUS,MGD,137.82,,,,,,,case rate,137.82,137.82,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,AETNA,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,BCBS,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,CIGNA,COM,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,TRICARE,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,UNITED HEALTHCARE,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,UNITED HEALTHCARE,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,VA,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,VA TRICARE,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,WELLMED,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,HUMANA,MGD,224.79,,,,,,,per diem,224.79,224.79,"Per diem rate, code is bundled with other services"
ALKALOIDS NOS                 ,38251704,CDM,301,RC,80323,CPT,,,,Inpatient,,,224.79,224.79,HUMANA CHOICE PLUS,MGD,224.79,,,,,,,case rate,224.79,224.79,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,AETNA,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,CIGNA,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,TRICARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,UNITED HEALTHCARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,UNITED HEALTHCARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,VA,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,VA TRICARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,WELLMED,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,HUMANA,MGD,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
MALDI MICROBIAL IDENTIFICATION,38251705,CDM,300,RC,87158,CPT,,,,Inpatient,,,27.22,27.22,HUMANA CHOICE PLUS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,AETNA,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,BCBS,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,CIGNA,COM,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,TRICARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,UNITED HEALTHCARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,UNITED HEALTHCARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,VA,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,VA TRICARE,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,WELLMED,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,HUMANA,MGD,31.85,,,,,,,per diem,31.85,31.85,"Per diem rate, code is bundled with other services"
INSULIN ANTIBODIES            ,38251706,CDM,302,RC,86337,CPT,,,,Inpatient,,,31.85,31.85,HUMANA CHOICE PLUS,MGD,31.85,,,,,,,case rate,31.85,31.85,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,AETNA,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,CIGNA,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,TRICARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,UNITED HEALTHCARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,UNITED HEALTHCARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,VA,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,VA TRICARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,WELLMED,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,HUMANA,MGD,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
CRYOFIBRINOGEN                ,38251707,CDM,301,RC,82585,CPT,,,,Inpatient,,,12.76,12.76,HUMANA CHOICE PLUS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,AETNA,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,BCBS,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,CIGNA,COM,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,TRICARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,UNITED HEALTHCARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,UNITED HEALTHCARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,VA,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,VA TRICARE,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,WELLMED,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,HUMANA,MGD,100.8,,,,,,,per diem,100.8,100.8,"Per diem rate, code is bundled with other services"
TRICHOMONAS VAGINAL AG IA W OP,38251708,CDM,306,RC,87808,CPT,,,,Inpatient,,,100.8,100.8,HUMANA CHOICE PLUS,MGD,100.8,,,,,,,case rate,100.8,100.8,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,AETNA,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,BCBS,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,CIGNA,COM,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,TRICARE,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,UNITED HEALTHCARE,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,UNITED HEALTHCARE,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,VA,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,VA TRICARE,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,WELLMED,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,HUMANA,MGD,152.25,,,,,,,per diem,152.25,152.25,"Per diem rate, code is bundled with other services"
ENTEROVIROUS AMPLIFIED PROBE  ,38251709,CDM,306,RC,87498,CPT,,,,Inpatient,,,152.25,152.25,HUMANA CHOICE PLUS,MGD,152.25,,,,,,,case rate,152.25,152.25,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,AETNA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,BCBS,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,CIGNA,COM,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,UNITED HEALTHCARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,VA,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,VA TRICARE,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,WELLMED,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,HUMANA,MGD,159.6,,,,,,,per diem,159.6,159.6,"Per diem rate, code is bundled with other services"
HIV-1 AG W HIV1 & 2 AB DIR OPT,38251710,CDM,306,RC,87806,CPT,,,,Inpatient,,,159.6,159.6,HUMANA CHOICE PLUS,MGD,159.6,,,,,,,case rate,159.6,159.6,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,AETNA,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,BCBS,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,CIGNA,COM,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,TRICARE,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,UNITED HEALTHCARE,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,UNITED HEALTHCARE,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,VA,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,VA TRICARE,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,WELLMED,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,HUMANA,MGD,17.84,,,,,,,per diem,17.84,17.84,"Per diem rate, code is bundled with other services"
RAPID STREP                   ,38251712,CDM,306,RC,87880,CPT,,,,Inpatient,,,17.84,17.84,HUMANA CHOICE PLUS,MGD,17.84,,,,,,,case rate,17.84,17.84,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,AETNA,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,BCBS,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,CIGNA,COM,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,TRICARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,UNITED HEALTHCARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,UNITED HEALTHCARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,VA,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,VA TRICARE,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,WELLMED,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,HUMANA,MGD,466.96,,,,,,,per diem,466.96,466.96,"Per diem rate, code is bundled with other services"
TOOL PATHOGEN PCR PANEL       ,38251713,CDM,300,RC,87505,CPT,,,,Inpatient,,,466.96,466.96,HUMANA CHOICE PLUS,MGD,466.96,,,,,,,case rate,466.96,466.96,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,AETNA,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,BCBS,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,CIGNA,COM,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,TRICARE,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,UNITED HEALTHCARE,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,UNITED HEALTHCARE,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,VA,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,VA TRICARE,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,WELLMED,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,HUMANA,MGD,1612.88,,,,,,,per diem,1612.88,1612.88,"Per diem rate, code is bundled with other services"
STATIFY JVC ANTIBODY          ,38251714,CDM,300,RC,,,,,,Inpatient,,,1612.88,1612.88,HUMANA CHOICE PLUS,MGD,1612.88,,,,,,,case rate,1612.88,1612.88,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,AETNA,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,BCBS,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,CIGNA,COM,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,TRICARE,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,UNITED HEALTHCARE,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,UNITED HEALTHCARE,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,VA,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,VA TRICARE,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,WELLMED,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,HUMANA,MGD,145.72,,,,,,,per diem,145.72,145.72,"Per diem rate, code is bundled with other services"
COVID-19 CDC                  ,38251716,CDM,300,RC,U0001,CPT,U0001,HCPCS,,Inpatient,,,145.72,145.72,HUMANA CHOICE PLUS,MGD,145.72,,,,,,,case rate,145.72,145.72,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,AETNA,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,BCBS,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,CIGNA,COM,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,TRICARE,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,UNITED HEALTHCARE,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,UNITED HEALTHCARE,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,VA,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,VA TRICARE,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,WELLMED,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,HUMANA,MGD,185.75,,,,,,,per diem,185.75,185.75,"Per diem rate, code is bundled with other services"
RGNCONV- COMPUTERIZED DIAGNOST,38270001,CDM,300,RC,,,,,,Inpatient,,,185.75,185.75,HUMANA CHOICE PLUS,MGD,185.75,,,,,,,case rate,185.75,185.75,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,AETNA,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,BCBS,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,CIGNA,COM,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,TRICARE,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,UNITED HEALTHCARE,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,UNITED HEALTHCARE,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,VA,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,VA TRICARE,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,WELLMED,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,HUMANA,MGD,1822.01,,,,,,,per diem,1822.01,1822.01,"Per diem rate, code is bundled with other services"
RGNCONV-ABDOMINAL PARACENTESIS,38270002,CDM,300,RC,,,,,,Inpatient,,,1822.01,1822.01,HUMANA CHOICE PLUS,MGD,1822.01,,,,,,,case rate,1822.01,1822.01,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,AETNA,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,BCBS,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,CIGNA,COM,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,TRICARE,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,UNITED HEALTHCARE,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,UNITED HEALTHCARE,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,VA,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,VA TRICARE,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,WELLMED,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,HUMANA,MGD,768.22,,,,,,,per diem,768.22,768.22,"Per diem rate, code is bundled with other services"
RGNCONV-ADD HALO REPLACEMENT L,38270003,CDM,300,RC,,,,,,Inpatient,,,768.22,768.22,HUMANA CHOICE PLUS,MGD,768.22,,,,,,,case rate,768.22,768.22,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,AETNA,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,BCBS,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,CIGNA,COM,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,TRICARE,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,UNITED HEALTHCARE,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,UNITED HEALTHCARE,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,VA,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,VA TRICARE,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,WELLMED,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,HUMANA,MGD,338.25,,,,,,,per diem,338.25,338.25,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE LMTD ANKLE M,38270004,CDM,300,RC,,,,,,Inpatient,,,338.25,338.25,HUMANA CHOICE PLUS,MGD,338.25,,,,,,,case rate,338.25,338.25,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,AETNA,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,BCBS,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,CIGNA,COM,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,TRICARE,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,UNITED HEALTHCARE,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,UNITED HEALTHCARE,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,VA,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,VA TRICARE,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,WELLMED,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,HUMANA,MGD,175.43,,,,,,,per diem,175.43,175.43,"Per diem rate, code is bundled with other services"
RGNCONV-ADD TO LE PADDED LINER,38270005,CDM,300,RC,,,,,,Inpatient,,,175.43,175.43,HUMANA CHOICE PLUS,MGD,175.43,,,,,,,case rate,175.43,175.43,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,AETNA,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,BCBS,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,CIGNA,COM,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,TRICARE,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,UNITED HEALTHCARE,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,UNITED HEALTHCARE,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,VA,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,VA TRICARE,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,WELLMED,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,HUMANA,MGD,338.3,,,,,,,per diem,338.3,338.3,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, DORSIFLEX A",38270006,CDM,300,RC,,,,,,Inpatient,,,338.3,338.3,HUMANA CHOICE PLUS,MGD,338.3,,,,,,,case rate,338.3,338.3,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,AETNA,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,BCBS,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,CIGNA,COM,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,TRICARE,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,UNITED HEALTHCARE,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,UNITED HEALTHCARE,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,VA,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,VA TRICARE,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,WELLMED,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,HUMANA,MGD,519.41,,,,,,,per diem,519.41,519.41,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE, PRE TIBIAL ",38270007,CDM,300,RC,,,,,,Inpatient,,,519.41,519.41,HUMANA CHOICE PLUS,MGD,519.41,,,,,,,case rate,519.41,519.41,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,AETNA,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,BCBS,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,CIGNA,COM,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,TRICARE,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,UNITED HEALTHCARE,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,UNITED HEALTHCARE,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,VA,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,VA TRICARE,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,WELLMED,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,HUMANA,MGD,129.57,,,,,,,per diem,129.57,129.57,"Per diem rate, code is bundled with other services"
"RGNCONV-ADD TO LE,VARUS/VALGUS",38270008,CDM,300,RC,,,,,,Inpatient,,,129.57,129.57,HUMANA CHOICE PLUS,MGD,129.57,,,,,,,case rate,129.57,129.57,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,AETNA,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,BCBS,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,CIGNA,COM,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,TRICARE,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,UNITED HEALTHCARE,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,UNITED HEALTHCARE,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,VA,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,VA TRICARE,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,WELLMED,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,HUMANA,MGD,1565.11,,,,,,,per diem,1565.11,1565.11,"Per diem rate, code is bundled with other services"
RGNCONV-AFO PLASTIC W/ ANKLE J,38270009,CDM,300,RC,,,,,,Inpatient,,,1565.11,1565.11,HUMANA CHOICE PLUS,MGD,1565.11,,,,,,,case rate,1565.11,1565.11,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,AETNA,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,BCBS,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,CIGNA,COM,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,TRICARE,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,UNITED HEALTHCARE,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,UNITED HEALTHCARE,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,VA,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,VA TRICARE,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,WELLMED,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,HUMANA,MGD,1777.23,,,,,,,per diem,1777.23,1777.23,"Per diem rate, code is bundled with other services"
"RGNCONV-AFO PLASTIC, FLOOR REA",38270010,CDM,300,RC,,,,,,Inpatient,,,1777.23,1777.23,HUMANA CHOICE PLUS,MGD,1777.23,,,,,,,case rate,1777.23,1777.23,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,AETNA,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,BCBS,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,CIGNA,COM,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,TRICARE,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,UNITED HEALTHCARE,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,UNITED HEALTHCARE,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,VA,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,VA TRICARE,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,WELLMED,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,HUMANA,MGD,1268.14,,,,,,,per diem,1268.14,1268.14,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SOLID POSTERIOR AN,38270011,CDM,300,RC,,,,,,Inpatient,,,1268.14,1268.14,HUMANA CHOICE PLUS,MGD,1268.14,,,,,,,case rate,1268.14,1268.14,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,AETNA,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,BCBS,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,CIGNA,COM,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,TRICARE,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,UNITED HEALTHCARE,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,UNITED HEALTHCARE,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,VA,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,VA TRICARE,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,WELLMED,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,HUMANA,MGD,1375.92,,,,,,,per diem,1375.92,1375.92,"Per diem rate, code is bundled with other services"
RGNCONV-AFO SPIRAL PLASTIC/OTH,38270012,CDM,300,RC,,,,,,Inpatient,,,1375.92,1375.92,HUMANA CHOICE PLUS,MGD,1375.92,,,,,,,case rate,1375.92,1375.92,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,AETNA,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,BCBS,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,CIGNA,COM,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,TRICARE,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,UNITED HEALTHCARE,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,UNITED HEALTHCARE,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,VA,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,VA TRICARE,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,WELLMED,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,HUMANA,MGD,426.53,,,,,,,per diem,426.53,426.53,"Per diem rate, code is bundled with other services"
RGNCONV-AFO/PRAFO STATIC      ,38270013,CDM,300,RC,,,,,,Inpatient,,,426.53,426.53,HUMANA CHOICE PLUS,MGD,426.53,,,,,,,case rate,426.53,426.53,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,AETNA,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,BCBS,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,CIGNA,COM,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,TRICARE,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,UNITED HEALTHCARE,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,UNITED HEALTHCARE,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,VA,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,VA TRICARE,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,WELLMED,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,HUMANA,MGD,109.1,,,,,,,per diem,109.1,109.1,"Per diem rate, code is bundled with other services"
RGNCONV-ANGIO TRAY            ,38270014,CDM,300,RC,,,,,,Inpatient,,,109.1,109.1,HUMANA CHOICE PLUS,MGD,109.1,,,,,,,case rate,109.1,109.1,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,AETNA,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,BCBS,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,CIGNA,COM,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,TRICARE,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,UNITED HEALTHCARE,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,UNITED HEALTHCARE,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,VA,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,VA TRICARE,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,WELLMED,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,HUMANA,MGD,65.96,,,,,,,per diem,65.96,65.96,"Per diem rate, code is bundled with other services"
"RGNCONV-ANKLE-FOOT ORTHOSIS, M",38270015,CDM,300,RC,,,,,,Inpatient,,,65.96,65.96,HUMANA CHOICE PLUS,MGD,65.96,,,,,,,case rate,65.96,65.96,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,AETNA,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,BCBS,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,CIGNA,COM,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,TRICARE,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,UNITED HEALTHCARE,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,UNITED HEALTHCARE,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,VA,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,VA TRICARE,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,WELLMED,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,HUMANA,MGD,379.58,,,,,,,per diem,379.58,379.58,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT ARM  ,38270016,CDM,300,RC,,,,,,Inpatient,,,379.58,379.58,HUMANA CHOICE PLUS,MGD,379.58,,,,,,,case rate,379.58,379.58,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,AETNA,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,BCBS,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,CIGNA,COM,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,TRICARE,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,UNITED HEALTHCARE,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,UNITED HEALTHCARE,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,VA,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,VA TRICARE,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,WELLMED,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,HUMANA,MGD,546.99,,,,,,,per diem,546.99,546.99,"Per diem rate, code is bundled with other services"
RGNCONV-APPLY CAST SHORT LEG  ,38270017,CDM,300,RC,,,,,,Inpatient,,,546.99,546.99,HUMANA CHOICE PLUS,MGD,546.99,,,,,,,case rate,546.99,546.99,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,AETNA,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,BCBS,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,CIGNA,COM,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,TRICARE,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,UNITED HEALTHCARE,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,UNITED HEALTHCARE,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,VA,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,VA TRICARE,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,WELLMED,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,HUMANA,MGD,28.83,,,,,,,per diem,28.83,28.83,"Per diem rate, code is bundled with other services"
RGNCONV-AUTOMATED DIFF WBC COU,38270018,CDM,300,RC,,,,,,Inpatient,,,28.83,28.83,HUMANA CHOICE PLUS,MGD,28.83,,,,,,,case rate,28.83,28.83,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,AETNA,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,BCBS,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,CIGNA,COM,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,TRICARE,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,UNITED HEALTHCARE,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,UNITED HEALTHCARE,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,VA,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,VA TRICARE,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,WELLMED,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,HUMANA,MGD,82.45,,,,,,,per diem,82.45,82.45,"Per diem rate, code is bundled with other services"
RGNCONV-BATH BENCH WITH BACK  ,38270019,CDM,300,RC,,,,,,Inpatient,,,82.45,82.45,HUMANA CHOICE PLUS,MGD,82.45,,,,,,,case rate,82.45,82.45,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,AETNA,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,BCBS,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,CIGNA,COM,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,TRICARE,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,UNITED HEALTHCARE,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,UNITED HEALTHCARE,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,VA,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,VA TRICARE,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,WELLMED,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,HUMANA,MGD,432.33,,,,,,,per diem,432.33,432.33,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY FORCEPS        ,38270020,CDM,300,RC,,,,,,Inpatient,,,432.33,432.33,HUMANA CHOICE PLUS,MGD,432.33,,,,,,,case rate,432.33,432.33,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,AETNA,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,BCBS,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,CIGNA,COM,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,TRICARE,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,UNITED HEALTHCARE,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,UNITED HEALTHCARE,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,VA,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,VA TRICARE,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,WELLMED,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,HUMANA,MGD,1506.63,,,,,,,per diem,1506.63,1506.63,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY MUSCLE PERCUTAN,38270021,CDM,300,RC,,,,,,Inpatient,,,1506.63,1506.63,HUMANA CHOICE PLUS,MGD,1506.63,,,,,,,case rate,1506.63,1506.63,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,AETNA,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,BCBS,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,CIGNA,COM,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,TRICARE,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,UNITED HEALTHCARE,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,UNITED HEALTHCARE,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,VA,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,VA TRICARE,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,WELLMED,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,HUMANA,MGD,1070.93,,,,,,,per diem,1070.93,1070.93,"Per diem rate, code is bundled with other services"
RGNCONV-BIOPSY/EXCISE LYMPH NO,38270022,CDM,300,RC,,,,,,Inpatient,,,1070.93,1070.93,HUMANA CHOICE PLUS,MGD,1070.93,,,,,,,case rate,1070.93,1070.93,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,AETNA,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,BCBS,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,CIGNA,COM,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,TRICARE,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,UNITED HEALTHCARE,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,UNITED HEALTHCARE,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,VA,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,VA TRICARE,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,WELLMED,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,HUMANA,MGD,191,,,,,,,per diem,191,191,"Per diem rate, code is bundled with other services"
RGNCONV-BK VIRUS QUANTITATIVE ,38270023,CDM,300,RC,,,,,,Inpatient,,,191,191,HUMANA CHOICE PLUS,MGD,191,,,,,,,case rate,191,191,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,AETNA,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,BCBS,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,CIGNA,COM,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,TRICARE,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,UNITED HEALTHCARE,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,UNITED HEALTHCARE,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,VA,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,VA TRICARE,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,WELLMED,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,HUMANA,MGD,43.03,,,,,,,per diem,43.03,43.03,"Per diem rate, code is bundled with other services"
"RGNCONV-BODY SOCK, PROTECTIVE,",38270024,CDM,300,RC,,,,,,Inpatient,,,43.03,43.03,HUMANA CHOICE PLUS,MGD,43.03,,,,,,,case rate,43.03,43.03,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,AETNA,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,BCBS,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,CIGNA,COM,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,TRICARE,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,UNITED HEALTHCARE,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,UNITED HEALTHCARE,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,VA,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,VA TRICARE,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,WELLMED,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,HUMANA,MGD,77.86,,,,,,,per diem,77.86,77.86,"Per diem rate, code is bundled with other services"
RGNCONV-CANE QUAD LARGE BASE  ,38270025,CDM,300,RC,,,,,,Inpatient,,,77.86,77.86,HUMANA CHOICE PLUS,MGD,77.86,,,,,,,case rate,77.86,77.86,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,AETNA,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,BCBS,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,CIGNA,COM,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,TRICARE,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,UNITED HEALTHCARE,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,UNITED HEALTHCARE,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,VA,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,VA TRICARE,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,WELLMED,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,HUMANA,MGD,50.45,,,,,,,per diem,50.45,50.45,"Per diem rate, code is bundled with other services"
RGNCONV-CATH                  ,38270026,CDM,300,RC,,,,,,Inpatient,,,50.45,50.45,HUMANA CHOICE PLUS,MGD,50.45,,,,,,,case rate,50.45,50.45,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,AETNA,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,BCBS,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,CIGNA,COM,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,TRICARE,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,UNITED HEALTHCARE,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,UNITED HEALTHCARE,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,VA,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,VA TRICARE,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,WELLMED,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,HUMANA,MGD,125.03,,,,,,,per diem,125.03,125.03,"Per diem rate, code is bundled with other services"
"RGNCONV-CATH, GLIDE           ",38270027,CDM,300,RC,,,,,,Inpatient,,,125.03,125.03,HUMANA CHOICE PLUS,MGD,125.03,,,,,,,case rate,125.03,125.03,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,AETNA,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,BCBS,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,CIGNA,COM,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,TRICARE,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,UNITED HEALTHCARE,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,UNITED HEALTHCARE,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,VA,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,VA TRICARE,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,WELLMED,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,HUMANA,MGD,170.9,,,,,,,per diem,170.9,170.9,"Per diem rate, code is bundled with other services"
RGNCONV-CATHETER RIGHT HEART  ,38270028,CDM,300,RC,,,,,,Inpatient,,,170.9,170.9,HUMANA CHOICE PLUS,MGD,170.9,,,,,,,case rate,170.9,170.9,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,AETNA,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,BCBS,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,CIGNA,COM,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,TRICARE,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,UNITED HEALTHCARE,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,UNITED HEALTHCARE,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,VA,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,VA TRICARE,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,WELLMED,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,HUMANA,MGD,139.88,,,,,,,per diem,139.88,139.88,"Per diem rate, code is bundled with other services"
"RGNCONV-CERVICAL COLLAR, MIAMI",38270029,CDM,300,RC,,,,,,Inpatient,,,139.88,139.88,HUMANA CHOICE PLUS,MGD,139.88,,,,,,,case rate,139.88,139.88,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,AETNA,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,BCBS,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,CIGNA,COM,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,TRICARE,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,UNITED HEALTHCARE,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,UNITED HEALTHCARE,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,VA,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,VA TRICARE,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,WELLMED,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,HUMANA,MGD,2342.51,,,,,,,per diem,2342.51,2342.51,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE GASTROSTOMY TUB,38270030,CDM,300,RC,,,,,,Inpatient,,,2342.51,2342.51,HUMANA CHOICE PLUS,MGD,2342.51,,,,,,,case rate,2342.51,2342.51,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,AETNA,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,BCBS,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,CIGNA,COM,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,TRICARE,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,UNITED HEALTHCARE,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,UNITED HEALTHCARE,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,VA,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,VA TRICARE,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,WELLMED,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,HUMANA,MGD,2342.56,,,,,,,per diem,2342.56,2342.56,"Per diem rate, code is bundled with other services"
RGNCONV-CHANGE G-J TUBE W/ FLU,38270031,CDM,300,RC,,,,,,Inpatient,,,2342.56,2342.56,HUMANA CHOICE PLUS,MGD,2342.56,,,,,,,case rate,2342.56,2342.56,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,AETNA,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,BCBS,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,CIGNA,COM,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,TRICARE,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,UNITED HEALTHCARE,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,UNITED HEALTHCARE,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,VA,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,VA TRICARE,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,WELLMED,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,HUMANA,MGD,362.32,,,,,,,per diem,362.32,362.32,"Per diem rate, code is bundled with other services"
RGNCONV-CHEMO INJ SQ/IM NON-HO,38270032,CDM,300,RC,,,,,,Inpatient,,,362.32,362.32,HUMANA CHOICE PLUS,MGD,362.32,,,,,,,case rate,362.32,362.32,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,AETNA,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,BCBS,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,CIGNA,COM,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,TRICARE,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,UNITED HEALTHCARE,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,UNITED HEALTHCARE,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,VA,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,VA TRICARE,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,WELLMED,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,HUMANA,MGD,146.77,,,,,,,per diem,146.77,146.77,"Per diem rate, code is bundled with other services"
RGNCONV-CORE NEEDLE           ,38270033,CDM,300,RC,,,,,,Inpatient,,,146.77,146.77,HUMANA CHOICE PLUS,MGD,146.77,,,,,,,case rate,146.77,146.77,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,AETNA,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,BCBS,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,CIGNA,COM,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,TRICARE,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,UNITED HEALTHCARE,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,UNITED HEALTHCARE,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,VA,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,VA TRICARE,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,WELLMED,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,HUMANA,MGD,143.38,,,,,,,per diem,143.38,143.38,"Per diem rate, code is bundled with other services"
RGNCONV-CTO REPLACEMENT PAD   ,38270034,CDM,300,RC,,,,,,Inpatient,,,143.38,143.38,HUMANA CHOICE PLUS,MGD,143.38,,,,,,,case rate,143.38,143.38,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,AETNA,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,BCBS,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,CIGNA,COM,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,TRICARE,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,UNITED HEALTHCARE,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,UNITED HEALTHCARE,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,VA,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,VA TRICARE,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,WELLMED,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,HUMANA,MGD,15.39,,,,,,,per diem,15.39,15.39,"Per diem rate, code is bundled with other services"
RGNCONV-DILATOR               ,38270035,CDM,300,RC,,,,,,Inpatient,,,15.39,15.39,HUMANA CHOICE PLUS,MGD,15.39,,,,,,,case rate,15.39,15.39,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,AETNA,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,BCBS,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,CIGNA,COM,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,TRICARE,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,UNITED HEALTHCARE,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,UNITED HEALTHCARE,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,VA,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,VA TRICARE,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,WELLMED,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,HUMANA,MGD,1922.84,,,,,,,per diem,1922.84,1922.84,"Per diem rate, code is bundled with other services"
RGNCONV-ED LEVEL 4 VISIT      ,38270036,CDM,300,RC,,,,,,Inpatient,,,1922.84,1922.84,HUMANA CHOICE PLUS,MGD,1922.84,,,,,,,case rate,1922.84,1922.84,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,AETNA,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,BCBS,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,CIGNA,COM,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,TRICARE,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,UNITED HEALTHCARE,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,UNITED HEALTHCARE,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,VA,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,VA TRICARE,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,WELLMED,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,HUMANA,MGD,4659.78,,,,,,,per diem,4659.78,4659.78,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOMYOCARDIAL BIOPSY ,38270037,CDM,300,RC,,,,,,Inpatient,,,4659.78,4659.78,HUMANA CHOICE PLUS,MGD,4659.78,,,,,,,case rate,4659.78,4659.78,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,AETNA,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,BCBS,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,CIGNA,COM,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,TRICARE,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,UNITED HEALTHCARE,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,UNITED HEALTHCARE,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,VA,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,VA TRICARE,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,WELLMED,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,HUMANA,MGD,465.52,,,,,,,per diem,465.52,465.52,"Per diem rate, code is bundled with other services"
RGNCONV-ENDOSCOPY NASAL DIAGNO,38270038,CDM,300,RC,,,,,,Inpatient,,,465.52,465.52,HUMANA CHOICE PLUS,MGD,465.52,,,,,,,case rate,465.52,465.52,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,AETNA,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,BCBS,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,CIGNA,COM,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,TRICARE,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,UNITED HEALTHCARE,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,UNITED HEALTHCARE,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,VA,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,VA TRICARE,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,WELLMED,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,HUMANA,MGD,72.84,,,,,,,per diem,72.84,72.84,"Per diem rate, code is bundled with other services"
RGNCONV-EVEROLIMUS            ,38270039,CDM,300,RC,,,,,,Inpatient,,,72.84,72.84,HUMANA CHOICE PLUS,MGD,72.84,,,,,,,case rate,72.84,72.84,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,AETNA,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,BCBS,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,CIGNA,COM,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,TRICARE,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,UNITED HEALTHCARE,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,UNITED HEALTHCARE,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,VA,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,VA TRICARE,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,WELLMED,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,HUMANA,MGD,3353.86,,,,,,,per diem,3353.86,3353.86,"Per diem rate, code is bundled with other services"
"RGNCONV-FILTER, VENATECH      ",38270040,CDM,300,RC,,,,,,Inpatient,,,3353.86,3353.86,HUMANA CHOICE PLUS,MGD,3353.86,,,,,,,case rate,3353.86,3353.86,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,AETNA,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,BCBS,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,CIGNA,COM,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,TRICARE,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,UNITED HEALTHCARE,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,UNITED HEALTHCARE,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,VA,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,VA TRICARE,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,WELLMED,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,HUMANA,MGD,571.88,,,,,,,per diem,571.88,571.88,"Per diem rate, code is bundled with other services"
RGNCONV-FLU/RSV BY PCR        ,38270041,CDM,300,RC,,,,,,Inpatient,,,571.88,571.88,HUMANA CHOICE PLUS,MGD,571.88,,,,,,,case rate,571.88,571.88,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,AETNA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,BCBS,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,CIGNA,COM,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,UNITED HEALTHCARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,VA,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,VA TRICARE,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,WELLMED,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,HUMANA,MGD,23.26,,,,,,,per diem,23.26,23.26,"Per diem rate, code is bundled with other services"
RGNCONV-FLUID DUMP SYSTEM     ,38270042,CDM,300,RC,,,,,,Inpatient,,,23.26,23.26,HUMANA CHOICE PLUS,MGD,23.26,,,,,,,case rate,23.26,23.26,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,AETNA,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,BCBS,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,CIGNA,COM,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,TRICARE,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,UNITED HEALTHCARE,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,UNITED HEALTHCARE,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,VA,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,VA TRICARE,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,WELLMED,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,HUMANA,MGD,660.44,,,,,,,per diem,660.44,660.44,"Per diem rate, code is bundled with other services"
RGNCONV-FLUORSCN ANGIO* ICG/FL,38270043,CDM,300,RC,,,,,,Inpatient,,,660.44,660.44,HUMANA CHOICE PLUS,MGD,660.44,,,,,,,case rate,660.44,660.44,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,AETNA,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,BCBS,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,CIGNA,COM,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,TRICARE,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,UNITED HEALTHCARE,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,UNITED HEALTHCARE,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,VA,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,VA TRICARE,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,WELLMED,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,HUMANA,MGD,182.36,,,,,,,per diem,182.36,182.36,"Per diem rate, code is bundled with other services"
RGNCONV-FUNDUS PHOTOS 1 - 2   ,38270044,CDM,300,RC,,,,,,Inpatient,,,182.36,182.36,HUMANA CHOICE PLUS,MGD,182.36,,,,,,,case rate,182.36,182.36,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,AETNA,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,BCBS,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,CIGNA,COM,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,TRICARE,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,UNITED HEALTHCARE,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,UNITED HEALTHCARE,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,VA,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,VA TRICARE,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,WELLMED,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,HUMANA,MGD,24.9,,,,,,,per diem,24.9,24.9,"Per diem rate, code is bundled with other services"
"RGNCONV-GLUCOSE, POC          ",38270045,CDM,300,RC,,,,,,Inpatient,,,24.9,24.9,HUMANA CHOICE PLUS,MGD,24.9,,,,,,,case rate,24.9,24.9,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,AETNA,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,BCBS,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,CIGNA,COM,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,TRICARE,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,UNITED HEALTHCARE,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,UNITED HEALTHCARE,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,VA,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,VA TRICARE,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,WELLMED,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,HUMANA,MGD,759.05,,,,,,,per diem,759.05,759.05,"Per diem rate, code is bundled with other services"
RGNCONV-HEMOGLIDE             ,38270046,CDM,300,RC,,,,,,Inpatient,,,759.05,759.05,HUMANA CHOICE PLUS,MGD,759.05,,,,,,,case rate,759.05,759.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,AETNA,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,BCBS,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,CIGNA,COM,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,TRICARE,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,UNITED HEALTHCARE,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,UNITED HEALTHCARE,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,VA,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,VA TRICARE,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,WELLMED,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,HUMANA,MGD,219.05,,,,,,,per diem,219.05,219.05,"Per diem rate, code is bundled with other services"
"RGNCONV-HOVERMAT 34"" MATTRESS ",38270047,CDM,300,RC,,,,,,Inpatient,,,219.05,219.05,HUMANA CHOICE PLUS,MGD,219.05,,,,,,,case rate,219.05,219.05,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,AETNA,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,BCBS,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,CIGNA,COM,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,TRICARE,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,UNITED HEALTHCARE,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,UNITED HEALTHCARE,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,VA,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,VA TRICARE,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,WELLMED,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,HUMANA,MGD,29.59,,,,,,,per diem,29.59,29.59,"Per diem rate, code is bundled with other services"
"RGNCONV-IMMOBILIZER, KNEE OTS ",38270048,CDM,300,RC,,,,,,Inpatient,,,29.59,29.59,HUMANA CHOICE PLUS,MGD,29.59,,,,,,,case rate,29.59,29.59,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,AETNA,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,CIGNA,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,TRICARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,UNITED HEALTHCARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,UNITED HEALTHCARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,VA,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,VA TRICARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,WELLMED,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,HUMANA,MGD,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
RGNCONV-IMMUNOCYTOCHEM STAIN E,38270049,CDM,300,RC,,,,,,Inpatient,,,340.6,340.6,HUMANA CHOICE PLUS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,AETNA,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,BCBS,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,CIGNA,COM,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,TRICARE,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,UNITED HEALTHCARE,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,UNITED HEALTHCARE,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,VA,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,VA TRICARE,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,WELLMED,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,HUMANA,MGD,4800.87,,,,,,,per diem,4800.87,4800.87,"Per diem rate, code is bundled with other services"
RGNCONV-INSERT TUNNELED CENTRA,38270050,CDM,300,RC,,,,,,Inpatient,,,4800.87,4800.87,HUMANA CHOICE PLUS,MGD,4800.87,,,,,,,case rate,4800.87,4800.87,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,AETNA,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,BCBS,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,CIGNA,COM,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,TRICARE,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,UNITED HEALTHCARE,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,UNITED HEALTHCARE,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,VA,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,VA TRICARE,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,WELLMED,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,HUMANA,MGD,350.86,,,,,,,per diem,350.86,350.86,"Per diem rate, code is bundled with other services"
RGNCONV-INTERROGATION VAD DEVI,38270051,CDM,300,RC,,,,,,Inpatient,,,350.86,350.86,HUMANA CHOICE PLUS,MGD,350.86,,,,,,,case rate,350.86,350.86,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,AETNA,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,BCBS,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,CIGNA,COM,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,TRICARE,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,UNITED HEALTHCARE,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,UNITED HEALTHCARE,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,VA,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,VA TRICARE,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,WELLMED,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,HUMANA,MGD,155.94,,,,,,,per diem,155.94,155.94,"Per diem rate, code is bundled with other services"
RGNCONV-IV INFUSION TPD EACH A,38270052,CDM,300,RC,,,,,,Inpatient,,,155.94,155.94,HUMANA CHOICE PLUS,MGD,155.94,,,,,,,case rate,155.94,155.94,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,AETNA,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,CIGNA,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,TRICARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,UNITED HEALTHCARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,UNITED HEALTHCARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,VA,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,VA TRICARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,WELLMED,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,HUMANA,MGD,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270053,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,HUMANA CHOICE PLUS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,AETNA,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,BCBS,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,CIGNA,COM,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,TRICARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,UNITED HEALTHCARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,UNITED HEALTHCARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,VA,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,VA TRICARE,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,WELLMED,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,HUMANA,MGD,60.93,,,,,,,per diem,60.93,60.93,"Per diem rate, code is bundled with other services"
RGNCONV-IV SOLUTION PER BAG   ,38270054,CDM,300,RC,,,,,,Inpatient,,,60.93,60.93,HUMANA CHOICE PLUS,MGD,60.93,,,,,,,case rate,60.93,60.93,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,AETNA,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,BCBS,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,CIGNA,COM,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,TRICARE,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,UNITED HEALTHCARE,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,UNITED HEALTHCARE,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,VA,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,VA TRICARE,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,WELLMED,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,HUMANA,MGD,679.33,,,,,,,per diem,679.33,679.33,"Per diem rate, code is bundled with other services"
RGNCONV-KO ADJUST JNT RIGID PR,38270055,CDM,300,RC,,,,,,Inpatient,,,679.33,679.33,HUMANA CHOICE PLUS,MGD,679.33,,,,,,,case rate,679.33,679.33,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,AETNA,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,BCBS,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,CIGNA,COM,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,TRICARE,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,UNITED HEALTHCARE,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,UNITED HEALTHCARE,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,VA,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,VA TRICARE,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,WELLMED,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,HUMANA,MGD,1866.67,,,,,,,per diem,1866.67,1866.67,"Per diem rate, code is bundled with other services"
RGNCONV-KO DBL UPRT JNT MLDED ,38270056,CDM,300,RC,,,,,,Inpatient,,,1866.67,1866.67,HUMANA CHOICE PLUS,MGD,1866.67,,,,,,,case rate,1866.67,1866.67,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,AETNA,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,BCBS,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,CIGNA,COM,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,TRICARE,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,UNITED HEALTHCARE,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,UNITED HEALTHCARE,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,VA,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,VA TRICARE,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,WELLMED,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,HUMANA,MGD,3325.14,,,,,,,per diem,3325.14,3325.14,"Per diem rate, code is bundled with other services"
RGNCONV-KO DOUBLE UPRIGHT JOIN,38270057,CDM,300,RC,,,,,,Inpatient,,,3325.14,3325.14,HUMANA CHOICE PLUS,MGD,3325.14,,,,,,,case rate,3325.14,3325.14,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,AETNA,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,BCBS,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,CIGNA,COM,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,TRICARE,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,UNITED HEALTHCARE,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,UNITED HEALTHCARE,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,VA,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,VA TRICARE,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,WELLMED,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,HUMANA,MGD,272.35,,,,,,,per diem,272.35,272.35,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ JOINTS  ,38270058,CDM,300,RC,,,,,,Inpatient,,,272.35,272.35,HUMANA CHOICE PLUS,MGD,272.35,,,,,,,case rate,272.35,272.35,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,AETNA,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,BCBS,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,CIGNA,COM,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,TRICARE,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,UNITED HEALTHCARE,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,UNITED HEALTHCARE,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,VA,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,VA TRICARE,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,WELLMED,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,HUMANA,MGD,258.04,,,,,,,per diem,258.04,258.04,"Per diem rate, code is bundled with other services"
RGNCONV-KO ELASTIC W/ PADS & J,38270059,CDM,300,RC,,,,,,Inpatient,,,258.04,258.04,HUMANA CHOICE PLUS,MGD,258.04,,,,,,,case rate,258.04,258.04,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,AETNA,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,BCBS,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,CIGNA,COM,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,TRICARE,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,UNITED HEALTHCARE,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,UNITED HEALTHCARE,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,VA,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,VA TRICARE,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,WELLMED,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,HUMANA,MGD,388.75,,,,,,,per diem,388.75,388.75,"Per diem rate, code is bundled with other services"
RGNCONV-LARYNGOSCOY FLEXIBLE F,38270060,CDM,300,RC,,,,,,Inpatient,,,388.75,388.75,HUMANA CHOICE PLUS,MGD,388.75,,,,,,,case rate,388.75,388.75,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,AETNA,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,BCBS,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,CIGNA,COM,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,TRICARE,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,UNITED HEALTHCARE,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,UNITED HEALTHCARE,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,VA,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,VA TRICARE,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,WELLMED,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,HUMANA,MGD,1442.43,,,,,,,per diem,1442.43,1442.43,"Per diem rate, code is bundled with other services"
RGNCONV-LUNG VENTILATION/PERFU,38270061,CDM,300,RC,,,,,,Inpatient,,,1442.43,1442.43,HUMANA CHOICE PLUS,MGD,1442.43,,,,,,,case rate,1442.43,1442.43,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,AETNA,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,BCBS,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,CIGNA,COM,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,TRICARE,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,UNITED HEALTHCARE,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,UNITED HEALTHCARE,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,VA,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,VA TRICARE,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,WELLMED,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,HUMANA,MGD,26.31,,,,,,,per diem,26.31,26.31,"Per diem rate, code is bundled with other services"
"RGNCONV-LVAD DRESSING KIT, DAI",38270062,CDM,300,RC,,,,,,Inpatient,,,26.31,26.31,HUMANA CHOICE PLUS,MGD,26.31,,,,,,,case rate,26.31,26.31,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,AETNA,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,BCBS,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,CIGNA,COM,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,TRICARE,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,UNITED HEALTHCARE,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,UNITED HEALTHCARE,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,VA,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,VA TRICARE,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,WELLMED,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,HUMANA,MGD,63.01,,,,,,,per diem,63.01,63.01,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE INTRODUC,38270063,CDM,300,RC,,,,,,Inpatient,,,63.01,63.01,HUMANA CHOICE PLUS,MGD,63.01,,,,,,,case rate,63.01,63.01,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,AETNA,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,BCBS,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,CIGNA,COM,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,TRICARE,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,UNITED HEALTHCARE,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,UNITED HEALTHCARE,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,VA,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,VA TRICARE,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,WELLMED,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,HUMANA,MGD,108.11,,,,,,,per diem,108.11,108.11,"Per diem rate, code is bundled with other services"
RGNCONV-MICROPUNCTURE SET     ,38270064,CDM,300,RC,,,,,,Inpatient,,,108.11,108.11,HUMANA CHOICE PLUS,MGD,108.11,,,,,,,case rate,108.11,108.11,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,AETNA,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,BCBS,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,CIGNA,COM,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,TRICARE,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,UNITED HEALTHCARE,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,UNITED HEALTHCARE,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,VA,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,VA TRICARE,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,WELLMED,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,HUMANA,MGD,279.77,,,,,,,per diem,279.77,279.77,"Per diem rate, code is bundled with other services"
"RGNCONV-MINIMAL SEDATION, 1ST ",38270065,CDM,300,RC,,,,,,Inpatient,,,279.77,279.77,HUMANA CHOICE PLUS,MGD,279.77,,,,,,,case rate,279.77,279.77,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,AETNA,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,BCBS,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,CIGNA,COM,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,TRICARE,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,UNITED HEALTHCARE,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,UNITED HEALTHCARE,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,VA,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,VA TRICARE,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,WELLMED,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,HUMANA,MGD,166.53,,,,,,,per diem,166.53,166.53,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5 ,38270066,CDM,300,RC,,,,,,Inpatient,,,166.53,166.53,HUMANA CHOICE PLUS,MGD,166.53,,,,,,,case rate,166.53,166.53,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,AETNA,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,BCBS,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,CIGNA,COM,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,TRICARE,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,UNITED HEALTHCARE,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,UNITED HEALTHCARE,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,VA,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,VA TRICARE,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,WELLMED,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,HUMANA,MGD,318.76,,,,,,,per diem,318.76,318.76,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION >=5Y,38270067,CDM,300,RC,,,,,,Inpatient,,,318.76,318.76,HUMANA CHOICE PLUS,MGD,318.76,,,,,,,case rate,318.76,318.76,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,AETNA,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,BCBS,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,CIGNA,COM,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,TRICARE,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,UNITED HEALTHCARE,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,UNITED HEALTHCARE,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,VA,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,VA TRICARE,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,WELLMED,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,HUMANA,MGD,133,,,,,,,per diem,133,133,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270068,CDM,300,RC,,,,,,Inpatient,,,133,133,HUMANA CHOICE PLUS,MGD,133,,,,,,,case rate,133,133,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,AETNA,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,BCBS,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,CIGNA,COM,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,TRICARE,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,UNITED HEALTHCARE,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,UNITED HEALTHCARE,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,VA,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,VA TRICARE,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,WELLMED,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,HUMANA,MGD,149.71,,,,,,,per diem,149.71,149.71,"Per diem rate, code is bundled with other services"
RGNCONV-MODERATE SEDATION EACH,38270069,CDM,300,RC,,,,,,Inpatient,,,149.71,149.71,HUMANA CHOICE PLUS,MGD,149.71,,,,,,,case rate,149.71,149.71,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,AETNA,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,BCBS,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,CIGNA,COM,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,TRICARE,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,UNITED HEALTHCARE,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,UNITED HEALTHCARE,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,VA,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,VA TRICARE,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,WELLMED,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,HUMANA,MGD,156.48,,,,,,,per diem,156.48,156.48,"Per diem rate, code is bundled with other services"
RGNCONV-MSSA BY PCR           ,38270070,CDM,300,RC,,,,,,Inpatient,,,156.48,156.48,HUMANA CHOICE PLUS,MGD,156.48,,,,,,,case rate,156.48,156.48,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,AETNA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,CIGNA,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,VA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,VA TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,WELLMED,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,HUMANA,MGD,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
"RGNCONV-NEEDLE, SPINAL        ",38270071,CDM,300,RC,,,,,,Inpatient,,,7.97,7.97,HUMANA CHOICE PLUS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,AETNA,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,BCBS,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,CIGNA,COM,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,TRICARE,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,UNITED HEALTHCARE,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,UNITED HEALTHCARE,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,VA,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,VA TRICARE,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,WELLMED,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,HUMANA,MGD,330.44,,,,,,,per diem,330.44,330.44,"Per diem rate, code is bundled with other services"
"RGNCONV-OPTHALMIC US, DIAGNOST",38270072,CDM,300,RC,,,,,,Inpatient,,,330.44,330.44,HUMANA CHOICE PLUS,MGD,330.44,,,,,,,case rate,330.44,330.44,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,AETNA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,BCBS,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,CIGNA,COM,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,UNITED HEALTHCARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,VA,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,VA TRICARE,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,WELLMED,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,HUMANA,MGD,40.95,,,,,,,per diem,40.95,40.95,"Per diem rate, code is bundled with other services"
RGNCONV-OR PROBE COVERS       ,38270073,CDM,300,RC,,,,,,Inpatient,,,40.95,40.95,HUMANA CHOICE PLUS,MGD,40.95,,,,,,,case rate,40.95,40.95,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,AETNA,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,BCBS,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,CIGNA,COM,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,TRICARE,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,UNITED HEALTHCARE,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,UNITED HEALTHCARE,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,VA,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,VA TRICARE,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,WELLMED,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,HUMANA,MGD,80.81,,,,,,,per diem,80.81,80.81,"Per diem rate, code is bundled with other services"
RGNCONV-PARACENTESIS/THORA NEE,38270074,CDM,300,RC,,,,,,Inpatient,,,80.81,80.81,HUMANA CHOICE PLUS,MGD,80.81,,,,,,,case rate,80.81,80.81,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,AETNA,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,BCBS,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,CIGNA,COM,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,TRICARE,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,UNITED HEALTHCARE,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,UNITED HEALTHCARE,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,VA,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,VA TRICARE,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,WELLMED,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,HUMANA,MGD,261.43,,,,,,,per diem,261.43,261.43,"Per diem rate, code is bundled with other services"
RGNCONV-POWER PIC DOUBLE      ,38270075,CDM,300,RC,,,,,,Inpatient,,,261.43,261.43,HUMANA CHOICE PLUS,MGD,261.43,,,,,,,case rate,261.43,261.43,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,AETNA,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,BCBS,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,CIGNA,COM,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,TRICARE,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,UNITED HEALTHCARE,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,UNITED HEALTHCARE,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,VA,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,VA TRICARE,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,WELLMED,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,HUMANA,MGD,3131.42,,,,,,,per diem,3131.42,3131.42,"Per diem rate, code is bundled with other services"
RGNCONV-PR TTE W OR WO FOL WCO,38270076,CDM,300,RC,,,,,,Inpatient,,,3131.42,3131.42,HUMANA CHOICE PLUS,MGD,3131.42,,,,,,,case rate,3131.42,3131.42,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,AETNA,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,BCBS,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,CIGNA,COM,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,TRICARE,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,UNITED HEALTHCARE,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,UNITED HEALTHCARE,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,VA,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,VA TRICARE,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,WELLMED,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,HUMANA,MGD,1788.7,,,,,,,per diem,1788.7,1788.7,"Per diem rate, code is bundled with other services"
RGNCONV-PREFABRICATED CARBON F,38270077,CDM,300,RC,,,,,,Inpatient,,,1788.7,1788.7,HUMANA CHOICE PLUS,MGD,1788.7,,,,,,,case rate,1788.7,1788.7,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,AETNA,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,BCBS,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,CIGNA,COM,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,TRICARE,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,UNITED HEALTHCARE,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,UNITED HEALTHCARE,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,VA,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,VA TRICARE,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,WELLMED,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,HUMANA,MGD,433.42,,,,,,,per diem,433.42,433.42,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY IV INFUSION TP,38270078,CDM,300,RC,,,,,,Inpatient,,,433.42,433.42,HUMANA CHOICE PLUS,MGD,433.42,,,,,,,case rate,433.42,433.42,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,AETNA,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,BCBS,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,CIGNA,COM,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,TRICARE,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,UNITED HEALTHCARE,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,UNITED HEALTHCARE,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,VA,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,VA TRICARE,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,WELLMED,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,HUMANA,MGD,167.4,,,,,,,per diem,167.4,167.4,"Per diem rate, code is bundled with other services"
RGNCONV-PRIMARY TPD INJ IV PUS,38270079,CDM,300,RC,,,,,,Inpatient,,,167.4,167.4,HUMANA CHOICE PLUS,MGD,167.4,,,,,,,case rate,167.4,167.4,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,AETNA,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,BCBS,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,CIGNA,COM,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,TRICARE,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,UNITED HEALTHCARE,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,UNITED HEALTHCARE,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,VA,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,VA TRICARE,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,WELLMED,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,HUMANA,MGD,392.13,,,,,,,per diem,392.13,392.13,"Per diem rate, code is bundled with other services"
RGNCONV-PUNCT ASP ABSCESS/HEMA,38270080,CDM,300,RC,,,,,,Inpatient,,,392.13,392.13,HUMANA CHOICE PLUS,MGD,392.13,,,,,,,case rate,392.13,392.13,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,AETNA,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,BCBS,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,CIGNA,COM,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,TRICARE,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,UNITED HEALTHCARE,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,UNITED HEALTHCARE,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,VA,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,VA TRICARE,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,WELLMED,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,HUMANA,MGD,10.67,,,,,,,per diem,10.67,10.67,"Per diem rate, code is bundled with other services"
RGNCONV-RECOVERY LEVEL 2 PER M,38270081,CDM,300,RC,,,,,,Inpatient,,,10.67,10.67,HUMANA CHOICE PLUS,MGD,10.67,,,,,,,case rate,10.67,10.67,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,AETNA,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,CIGNA,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,TRICARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,UNITED HEALTHCARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,UNITED HEALTHCARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,VA,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,VA TRICARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,WELLMED,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,HUMANA,MGD,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-REM OF DEVITALIZED TIS,38270082,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,HUMANA CHOICE PLUS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,AETNA,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,BCBS,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,CIGNA,COM,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,TRICARE,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,UNITED HEALTHCARE,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,UNITED HEALTHCARE,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,VA,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,VA TRICARE,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,WELLMED,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,HUMANA,MGD,41.55,,,,,,,per diem,41.55,41.55,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT PAD ASPEN ,38270083,CDM,300,RC,,,,,,Inpatient,,,41.55,41.55,HUMANA CHOICE PLUS,MGD,41.55,,,,,,,case rate,41.55,41.55,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,AETNA,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,BCBS,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,CIGNA,COM,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,TRICARE,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,UNITED HEALTHCARE,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,UNITED HEALTHCARE,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,VA,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,VA TRICARE,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,WELLMED,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,HUMANA,MGD,69.78,,,,,,,per diem,69.78,69.78,"Per diem rate, code is bundled with other services"
RGNCONV-REPLACEMENT STRAP AFO ,38270084,CDM,300,RC,,,,,,Inpatient,,,69.78,69.78,HUMANA CHOICE PLUS,MGD,69.78,,,,,,,case rate,69.78,69.78,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,AETNA,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,BCBS,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,CIGNA,COM,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,TRICARE,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,UNITED HEALTHCARE,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,UNITED HEALTHCARE,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,VA,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,VA TRICARE,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,WELLMED,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,HUMANA,MGD,8787.54,,,,,,,per diem,8787.54,8787.54,"Per diem rate, code is bundled with other services"
RGNCONV-RIGHT HEART CATHETERIZ,38270085,CDM,300,RC,,,,,,Inpatient,,,8787.54,8787.54,HUMANA CHOICE PLUS,MGD,8787.54,,,,,,,case rate,8787.54,8787.54,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,AETNA,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,BCBS,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,CIGNA,COM,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,TRICARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,UNITED HEALTHCARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,UNITED HEALTHCARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,VA,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,VA TRICARE,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,WELLMED,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,HUMANA,MGD,131.91,,,,,,,per diem,131.91,131.91,"Per diem rate, code is bundled with other services"
RGNCONV-SEQUENTIAL INJ IV PUSH,38270086,CDM,300,RC,,,,,,Inpatient,,,131.91,131.91,HUMANA CHOICE PLUS,MGD,131.91,,,,,,,case rate,131.91,131.91,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,AETNA,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,BCBS,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,CIGNA,COM,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,TRICARE,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,UNITED HEALTHCARE,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,UNITED HEALTHCARE,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,VA,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,VA TRICARE,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,WELLMED,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,HUMANA,MGD,23.58,,,,,,,per diem,23.58,23.58,"Per diem rate, code is bundled with other services"
RGNCONV-SHEATH STANDARD SHORT ,38270087,CDM,300,RC,,,,,,Inpatient,,,23.58,23.58,HUMANA CHOICE PLUS,MGD,23.58,,,,,,,case rate,23.58,23.58,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,AETNA,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,BCBS,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,CIGNA,COM,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,TRICARE,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,UNITED HEALTHCARE,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,UNITED HEALTHCARE,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,VA,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,VA TRICARE,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,WELLMED,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,HUMANA,MGD,114.56,,,,,,,per diem,114.56,114.56,"Per diem rate, code is bundled with other services"
"RGNCONV-SHEATH, PEELAWAY 30 CM",38270088,CDM,300,RC,,,,,,Inpatient,,,114.56,114.56,HUMANA CHOICE PLUS,MGD,114.56,,,,,,,case rate,114.56,114.56,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,AETNA,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,BCBS,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,CIGNA,COM,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,TRICARE,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,UNITED HEALTHCARE,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,UNITED HEALTHCARE,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,VA,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,VA TRICARE,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,WELLMED,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,HUMANA,MGD,130.82,,,,,,,per diem,130.82,130.82,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE LIFT INTERNAL TAP,38270089,CDM,300,RC,,,,,,Inpatient,,,130.82,130.82,HUMANA CHOICE PLUS,MGD,130.82,,,,,,,case rate,130.82,130.82,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,AETNA,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,BCBS,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,CIGNA,COM,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,TRICARE,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,UNITED HEALTHCARE,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,UNITED HEALTHCARE,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,VA,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,VA TRICARE,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,WELLMED,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,HUMANA,MGD,66.39,,,,,,,per diem,66.39,66.39,"Per diem rate, code is bundled with other services"
RGNCONV-SHOE/BOOT SURGICL POST,38270090,CDM,300,RC,,,,,,Inpatient,,,66.39,66.39,HUMANA CHOICE PLUS,MGD,66.39,,,,,,,case rate,66.39,66.39,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,AETNA,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,BCBS,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,CIGNA,COM,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,TRICARE,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,UNITED HEALTHCARE,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,UNITED HEALTHCARE,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,VA,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,VA TRICARE,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,WELLMED,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,HUMANA,MGD,67.16,,,,,,,per diem,67.16,67.16,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN .9PCT NACL INJ 50,38270091,CDM,300,RC,,,,,,Inpatient,,,67.16,67.16,HUMANA CHOICE PLUS,MGD,67.16,,,,,,,case rate,67.16,67.16,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,AETNA,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,BCBS,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,CIGNA,COM,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,TRICARE,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,UNITED HEALTHCARE,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,UNITED HEALTHCARE,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,VA,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,VA TRICARE,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,WELLMED,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,HUMANA,MGD,67.7,,,,,,,per diem,67.7,67.7,"Per diem rate, code is bundled with other services"
RGNCONV-SOLN 5PCT DEXT .45PCT ,38270092,CDM,300,RC,,,,,,Inpatient,,,67.7,67.7,HUMANA CHOICE PLUS,MGD,67.7,,,,,,,case rate,67.7,67.7,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,AETNA,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,BCBS,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,CIGNA,COM,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,TRICARE,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,UNITED HEALTHCARE,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,UNITED HEALTHCARE,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,VA,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,VA TRICARE,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,WELLMED,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,HUMANA,MGD,100.24,,,,,,,per diem,100.24,100.24,"Per diem rate, code is bundled with other services"
RGNCONV-SPLINT WRIST FRACTURE ,38270093,CDM,300,RC,,,,,,Inpatient,,,100.24,100.24,HUMANA CHOICE PLUS,MGD,100.24,,,,,,,case rate,100.24,100.24,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,AETNA,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,BCBS,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,CIGNA,COM,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,TRICARE,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,UNITED HEALTHCARE,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,UNITED HEALTHCARE,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,VA,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,VA TRICARE,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,WELLMED,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,HUMANA,MGD,53.51,,,,,,,per diem,53.51,53.51,"Per diem rate, code is bundled with other services"
"RGNCONV-STREP A SCREEN, RAPID ",38270094,CDM,300,RC,,,,,,Inpatient,,,53.51,53.51,HUMANA CHOICE PLUS,MGD,53.51,,,,,,,case rate,53.51,53.51,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,AETNA,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,BCBS,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,CIGNA,COM,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,TRICARE,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,UNITED HEALTHCARE,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,UNITED HEALTHCARE,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,VA,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,VA TRICARE,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,WELLMED,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,HUMANA,MGD,333.13,,,,,,,per diem,333.13,333.13,"Per diem rate, code is bundled with other services"
RGNCONV-SWALLOW MOTION FLORO E,38270095,CDM,300,RC,,,,,,Inpatient,,,333.13,333.13,HUMANA CHOICE PLUS,MGD,333.13,,,,,,,case rate,333.13,333.13,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,AETNA,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,BCBS,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,CIGNA,COM,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,TRICARE,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,UNITED HEALTHCARE,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,UNITED HEALTHCARE,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,VA,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,VA TRICARE,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,WELLMED,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,HUMANA,MGD,90.96,,,,,,,per diem,90.96,90.96,"Per diem rate, code is bundled with other services"
RGNCONV-TPD INJECTION SUBCU/IN,38270096,CDM,300,RC,,,,,,Inpatient,,,90.96,90.96,HUMANA CHOICE PLUS,MGD,90.96,,,,,,,case rate,90.96,90.96,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,AETNA,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,BCBS,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,CIGNA,COM,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,TRICARE,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,UNITED HEALTHCARE,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,UNITED HEALTHCARE,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,VA,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,VA TRICARE,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,WELLMED,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,HUMANA,MGD,183.46,,,,,,,per diem,183.46,183.46,"Per diem rate, code is bundled with other services"
RGNCONV-TRANSFER BATH BENCH ST,38270097,CDM,300,RC,,,,,,Inpatient,,,183.46,183.46,HUMANA CHOICE PLUS,MGD,183.46,,,,,,,case rate,183.46,183.46,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,AETNA,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,BCBS,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,CIGNA,COM,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,TRICARE,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,UNITED HEALTHCARE,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,UNITED HEALTHCARE,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,VA,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,VA TRICARE,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,WELLMED,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,HUMANA,MGD,1353.84,,,,,,,per diem,1353.84,1353.84,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT AID BLK         ,38270098,CDM,300,RC,,,,,,Inpatient,,,1353.84,1353.84,HUMANA CHOICE PLUS,MGD,1353.84,,,,,,,case rate,1353.84,1353.84,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,AETNA,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,BCBS,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,CIGNA,COM,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,TRICARE,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,UNITED HEALTHCARE,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,UNITED HEALTHCARE,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,VA,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,VA TRICARE,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,WELLMED,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,HUMANA,MGD,1030.47,,,,,,,per diem,1030.47,1030.47,"Per diem rate, code is bundled with other services"
RGNCONV-TRTMT SIM-COM         ,38270099,CDM,300,RC,,,,,,Inpatient,,,1030.47,1030.47,HUMANA CHOICE PLUS,MGD,1030.47,,,,,,,case rate,1030.47,1030.47,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,AETNA,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,BCBS,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,CIGNA,COM,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,TRICARE,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,UNITED HEALTHCARE,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,UNITED HEALTHCARE,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,VA,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,VA TRICARE,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,WELLMED,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,HUMANA,MGD,97.19,,,,,,,per diem,97.19,97.19,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, G               ",38270100,CDM,300,RC,,,,,,Inpatient,,,97.19,97.19,HUMANA CHOICE PLUS,MGD,97.19,,,,,,,case rate,97.19,97.19,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,AETNA,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,BCBS,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,CIGNA,COM,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,TRICARE,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,UNITED HEALTHCARE,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,UNITED HEALTHCARE,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,VA,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,VA TRICARE,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,WELLMED,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,HUMANA,MGD,581.32,,,,,,,per diem,581.32,581.32,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, GJ              ",38270101,CDM,300,RC,,,,,,Inpatient,,,581.32,581.32,HUMANA CHOICE PLUS,MGD,581.32,,,,,,,case rate,581.32,581.32,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,AETNA,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,BCBS,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,CIGNA,COM,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,TRICARE,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,UNITED HEALTHCARE,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,UNITED HEALTHCARE,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,VA,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,VA TRICARE,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,WELLMED,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,HUMANA,MGD,401.31,,,,,,,per diem,401.31,401.31,"Per diem rate, code is bundled with other services"
"RGNCONV-TUBE, J               ",38270102,CDM,300,RC,,,,,,Inpatient,,,401.31,401.31,HUMANA CHOICE PLUS,MGD,401.31,,,,,,,case rate,401.31,401.31,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,AETNA,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,BCBS,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,CIGNA,COM,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,TRICARE,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,UNITED HEALTHCARE,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,UNITED HEALTHCARE,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,VA,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,VA TRICARE,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,WELLMED,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,HUMANA,MGD,441.82,,,,,,,per diem,441.82,441.82,"Per diem rate, code is bundled with other services"
RGNCONV-ULTRASOUND-TX KIDNEY  ,38270103,CDM,300,RC,,,,,,Inpatient,,,441.82,441.82,HUMANA CHOICE PLUS,MGD,441.82,,,,,,,case rate,441.82,441.82,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,AETNA,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,BCBS,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,CIGNA,COM,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,TRICARE,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,UNITED HEALTHCARE,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,UNITED HEALTHCARE,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,VA,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,VA TRICARE,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,WELLMED,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,HUMANA,MGD,823.26,,,,,,,per diem,823.26,823.26,"Per diem rate, code is bundled with other services"
RGNCONV-URETHROCYSTOGRAPHY RET,38270104,CDM,300,RC,,,,,,Inpatient,,,823.26,823.26,HUMANA CHOICE PLUS,MGD,823.26,,,,,,,case rate,823.26,823.26,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,AETNA,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,BCBS,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,CIGNA,COM,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,TRICARE,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,UNITED HEALTHCARE,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,UNITED HEALTHCARE,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,VA,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,VA TRICARE,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,WELLMED,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,HUMANA,MGD,18.12,,,,,,,per diem,18.12,18.12,"Per diem rate, code is bundled with other services"
RGNCONV-VAD DRIVELINE SECUREME,38270105,CDM,300,RC,,,,,,Inpatient,,,18.12,18.12,HUMANA CHOICE PLUS,MGD,18.12,,,,,,,case rate,18.12,18.12,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,AETNA,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,BCBS,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,CIGNA,COM,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,TRICARE,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,UNITED HEALTHCARE,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,UNITED HEALTHCARE,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,VA,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,VA TRICARE,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,WELLMED,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,HUMANA,MGD,463.23,,,,,,,per diem,463.23,463.23,"Per diem rate, code is bundled with other services"
RGNCONV-VNS PROGRAMMING 1ST HO,38270106,CDM,300,RC,,,,,,Inpatient,,,463.23,463.23,HUMANA CHOICE PLUS,MGD,463.23,,,,,,,case rate,463.23,463.23,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,AETNA,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,BCBS,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,CIGNA,COM,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,TRICARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,UNITED HEALTHCARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,UNITED HEALTHCARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,VA,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,VA TRICARE,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,WELLMED,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,HUMANA,MGD,326.83,,,,,,,per diem,326.83,326.83,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER 4 WHEELD W/BASK,38270107,CDM,300,RC,,,,,,Inpatient,,,326.83,326.83,HUMANA CHOICE PLUS,MGD,326.83,,,,,,,case rate,326.83,326.83,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,AETNA,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,BCBS,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,CIGNA,COM,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,TRICARE,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,UNITED HEALTHCARE,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,UNITED HEALTHCARE,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,VA,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,VA TRICARE,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,WELLMED,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,HUMANA,MGD,177.78,,,,,,,per diem,177.78,177.78,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER JUNIOR W/WHLS P,38270108,CDM,300,RC,,,,,,Inpatient,,,177.78,177.78,HUMANA CHOICE PLUS,MGD,177.78,,,,,,,case rate,177.78,177.78,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,AETNA,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,BCBS,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,CIGNA,COM,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,TRICARE,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,UNITED HEALTHCARE,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,UNITED HEALTHCARE,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,VA,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,VA TRICARE,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,WELLMED,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,HUMANA,MGD,59.51,,,,,,,per diem,59.51,59.51,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER SEAT ATTACHMENT,38270109,CDM,300,RC,,,,,,Inpatient,,,59.51,59.51,HUMANA CHOICE PLUS,MGD,59.51,,,,,,,case rate,59.51,59.51,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,AETNA,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,BCBS,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,CIGNA,COM,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,TRICARE,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,UNITED HEALTHCARE,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,UNITED HEALTHCARE,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,VA,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,VA TRICARE,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,WELLMED,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,HUMANA,MGD,221.03,,,,,,,per diem,221.03,221.03,"Per diem rate, code is bundled with other services"
RGNCONV-WALKER STD W/WHLS PURC,38270110,CDM,300,RC,,,,,,Inpatient,,,221.03,221.03,HUMANA CHOICE PLUS,MGD,221.03,,,,,,,case rate,221.03,221.03,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,AETNA,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,BCBS,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,CIGNA,COM,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,TRICARE,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,UNITED HEALTHCARE,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,UNITED HEALTHCARE,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,VA,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,VA TRICARE,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,WELLMED,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,HUMANA,MGD,240.79,,,,,,,per diem,240.79,240.79,"Per diem rate, code is bundled with other services"
RGNCONV-WALKING BOOT PNEUMATIC,38270111,CDM,300,RC,,,,,,Inpatient,,,240.79,240.79,HUMANA CHOICE PLUS,MGD,240.79,,,,,,,case rate,240.79,240.79,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,AETNA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,CIGNA,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,VA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,VA TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,WELLMED,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,HUMANA,MGD,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR ANTI-TIP DEV RN,38270112,CDM,300,RC,,,,,,Inpatient,,,11.91,11.91,HUMANA CHOICE PLUS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,AETNA,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,BCBS,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,CIGNA,COM,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,TRICARE,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,UNITED HEALTHCARE,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,UNITED HEALTHCARE,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,VA,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,VA TRICARE,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,WELLMED,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,HUMANA,MGD,96.54,,,,,,,per diem,96.54,96.54,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR CUSHION LOW PRE,38270113,CDM,300,RC,,,,,,Inpatient,,,96.54,96.54,HUMANA CHOICE PLUS,MGD,96.54,,,,,,,case rate,96.54,96.54,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,AETNA,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,BCBS,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,CIGNA,COM,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,TRICARE,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,UNITED HEALTHCARE,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,UNITED HEALTHCARE,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,VA,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,VA TRICARE,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,WELLMED,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,HUMANA,MGD,32.11,,,,,,,per diem,32.11,32.11,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR LEGREST ELV CTM,38270114,CDM,300,RC,,,,,,Inpatient,,,32.11,32.11,HUMANA CHOICE PLUS,MGD,32.11,,,,,,,case rate,32.11,32.11,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,AETNA,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,BCBS,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,CIGNA,COM,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,TRICARE,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,UNITED HEALTHCARE,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,UNITED HEALTHCARE,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,VA,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,VA TRICARE,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,WELLMED,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,HUMANA,MGD,136.5,,,,,,,per diem,136.5,136.5,"Per diem rate, code is bundled with other services"
RGNCONV-WHLCHR STANDARD RENT/M,38270115,CDM,300,RC,,,,,,Inpatient,,,136.5,136.5,HUMANA CHOICE PLUS,MGD,136.5,,,,,,,case rate,136.5,136.5,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,AETNA,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,BCBS,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,CIGNA,COM,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,TRICARE,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,UNITED HEALTHCARE,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,UNITED HEALTHCARE,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,VA,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,VA TRICARE,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,WELLMED,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,HUMANA,MGD,176.58,,,,,,,per diem,176.58,176.58,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, 018             ",38270116,CDM,300,RC,,,,,,Inpatient,,,176.58,176.58,HUMANA CHOICE PLUS,MGD,176.58,,,,,,,case rate,176.58,176.58,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,AETNA,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,BCBS,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,CIGNA,COM,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,TRICARE,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,UNITED HEALTHCARE,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,UNITED HEALTHCARE,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,VA,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,VA TRICARE,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,WELLMED,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,HUMANA,MGD,71.63,,,,,,,per diem,71.63,71.63,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, AMPLATZ         ",38270117,CDM,300,RC,,,,,,Inpatient,,,71.63,71.63,HUMANA CHOICE PLUS,MGD,71.63,,,,,,,case rate,71.63,71.63,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,AETNA,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,BCBS,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,CIGNA,COM,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,TRICARE,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,UNITED HEALTHCARE,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,UNITED HEALTHCARE,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,VA,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,VA TRICARE,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,WELLMED,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,HUMANA,MGD,22.83,,,,,,,per diem,22.83,22.83,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, DIAGNOSTIC      ",38270118,CDM,300,RC,,,,,,Inpatient,,,22.83,22.83,HUMANA CHOICE PLUS,MGD,22.83,,,,,,,case rate,22.83,22.83,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,AETNA,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,BCBS,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,CIGNA,COM,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,TRICARE,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,UNITED HEALTHCARE,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,UNITED HEALTHCARE,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,VA,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,VA TRICARE,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,WELLMED,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,HUMANA,MGD,464.43,,,,,,,per diem,464.43,464.43,"Per diem rate, code is bundled with other services"
"RGNCONV-WIRE, GLIDE           ",38270119,CDM,300,RC,,,,,,Inpatient,,,464.43,464.43,HUMANA CHOICE PLUS,MGD,464.43,,,,,,,case rate,464.43,464.43,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,AETNA,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,BCBS,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,CIGNA,COM,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,TRICARE,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,UNITED HEALTHCARE,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,UNITED HEALTHCARE,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,VA,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,VA TRICARE,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,WELLMED,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,HUMANA,MGD,246.05,,,,,,,per diem,246.05,246.05,"Per diem rate, code is bundled with other services"
RGNCONV-Laboratory            ,38270120,CDM,300,RC,,,,,,Inpatient,,,246.05,246.05,HUMANA CHOICE PLUS,MGD,246.05,,,,,,,case rate,246.05,246.05,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,AETNA,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,BCBS,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,CIGNA,COM,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,TRICARE,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,UNITED HEALTHCARE,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,UNITED HEALTHCARE,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,VA,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,VA TRICARE,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,WELLMED,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,HUMANA,MGD,30.25,,,,,,,per diem,30.25,30.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL   ,38270121,CDM,300,RC,,,,,,Inpatient,,,30.25,30.25,HUMANA CHOICE PLUS,MGD,30.25,,,,,,,case rate,30.25,30.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,AETNA,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,BCBS,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,CIGNA,COM,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,TRICARE,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,UNITED HEALTHCARE,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,UNITED HEALTHCARE,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,VA,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,VA TRICARE,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,WELLMED,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,HUMANA,MGD,31.77,,,,,,,per diem,31.77,31.77,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE 2 PCT GEL 20,38270122,CDM,300,RC,,,,,,Inpatient,,,31.77,31.77,HUMANA CHOICE PLUS,MGD,31.77,,,,,,,case rate,31.77,31.77,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,AETNA,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,BCBS,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,CIGNA,COM,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,TRICARE,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,UNITED HEALTHCARE,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,UNITED HEALTHCARE,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,VA,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,VA TRICARE,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,WELLMED,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,HUMANA,MGD,55.25,,,,,,,per diem,55.25,55.25,"Per diem rate, code is bundled with other services"
RGNCONV-LIDOCAINE PF 1PCT SOLN,38270123,CDM,300,RC,,,,,,Inpatient,,,55.25,55.25,HUMANA CHOICE PLUS,MGD,55.25,,,,,,,case rate,55.25,55.25,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,AETNA,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,BCBS,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,CIGNA,COM,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,TRICARE,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,UNITED HEALTHCARE,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,UNITED HEALTHCARE,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,VA,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,VA TRICARE,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,WELLMED,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,HUMANA,MGD,13.21,,,,,,,per diem,13.21,13.21,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270124,CDM,300,RC,,,,,,Inpatient,,,13.21,13.21,HUMANA CHOICE PLUS,MGD,13.21,,,,,,,case rate,13.21,13.21,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,AETNA,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,BCBS,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,CIGNA,COM,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,TRICARE,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,UNITED HEALTHCARE,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,UNITED HEALTHCARE,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,VA,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,VA TRICARE,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,WELLMED,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,HUMANA,MGD,21.84,,,,,,,per diem,21.84,21.84,"Per diem rate, code is bundled with other services"
RGNCONV-OXYCODONE 5 MG TABS   ,38270125,CDM,300,RC,,,,,,Inpatient,,,21.84,21.84,HUMANA CHOICE PLUS,MGD,21.84,,,,,,,case rate,21.84,21.84,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,AETNA,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,BCBS,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,CIGNA,COM,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,TRICARE,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,UNITED HEALTHCARE,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,UNITED HEALTHCARE,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,VA,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,VA TRICARE,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,WELLMED,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,HUMANA,MGD,63.99,,,,,,,per diem,63.99,63.99,"Per diem rate, code is bundled with other services"
RGNCONV-SILVER SULFADIAZINE 1 ,38270126,CDM,300,RC,,,,,,Inpatient,,,63.99,63.99,HUMANA CHOICE PLUS,MGD,63.99,,,,,,,case rate,63.99,63.99,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,AETNA,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,BCBS,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,CIGNA,COM,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,TRICARE,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,UNITED HEALTHCARE,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,UNITED HEALTHCARE,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,VA,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,VA TRICARE,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,WELLMED,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,HUMANA,MGD,74.8,,,,,,,per diem,74.8,74.8,"Per diem rate, code is bundled with other services"
RGNCONV-SODIUM BICARBONATE 8.4,38270127,CDM,300,RC,,,,,,Inpatient,,,74.8,74.8,HUMANA CHOICE PLUS,MGD,74.8,,,,,,,case rate,74.8,74.8,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,AETNA,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,BCBS,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,CIGNA,COM,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,TRICARE,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,UNITED HEALTHCARE,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,UNITED HEALTHCARE,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,VA,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,VA TRICARE,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,WELLMED,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,HUMANA,MGD,1851.82,,,,,,,per diem,1851.82,1851.82,"Per diem rate, code is bundled with other services"
RGNCONV-TECHNETIUM PENTETATE K,38270128,CDM,300,RC,,,,,,Inpatient,,,1851.82,1851.82,HUMANA CHOICE PLUS,MGD,1851.82,,,,,,,case rate,1851.82,1851.82,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,AETNA,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,BCBS,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,CIGNA,COM,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,TRICARE,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,UNITED HEALTHCARE,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,UNITED HEALTHCARE,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,VA,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,VA TRICARE,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,WELLMED,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,HUMANA,MGD,10.15,,,,,,,per diem,10.15,10.15,"Per diem rate, code is bundled with other services"
RGNCONV-TRAMADOL 50 MG TABS   ,38270129,CDM,300,RC,,,,,,Inpatient,,,10.15,10.15,HUMANA CHOICE PLUS,MGD,10.15,,,,,,,case rate,10.15,10.15,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,AETNA,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,BCBS,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,CIGNA,COM,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,TRICARE,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,UNITED HEALTHCARE,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,UNITED HEALTHCARE,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,VA,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,VA TRICARE,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,WELLMED,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,HUMANA,MGD,326.31,,,,,,,per diem,326.31,326.31,"Per diem rate, code is bundled with other services"
HEMOCRHOMATOSIS HFE GENE ANAL ,38270130,CDM,301,RC,81256,CPT,,,,Inpatient,,,326.31,326.31,HUMANA CHOICE PLUS,MGD,326.31,,,,,,,case rate,326.31,326.31,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,AETNA,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,BCBS,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,CIGNA,COM,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,TRICARE,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,UNITED HEALTHCARE,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,UNITED HEALTHCARE,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,VA,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,VA TRICARE,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,WELLMED,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,HUMANA,MGD,193.79,,,,,,,per diem,193.79,193.79,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38270131,CDM,306,RC,87075,CPT,,,,Inpatient,,,193.79,193.79,HUMANA CHOICE PLUS,MGD,193.79,,,,,,,case rate,193.79,193.79,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,AETNA,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,BCBS,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,CIGNA,COM,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,TRICARE,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,UNITED HEALTHCARE,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,UNITED HEALTHCARE,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,VA,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,VA TRICARE,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,WELLMED,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,HUMANA,MGD,42.71,,,,,,,per diem,42.71,42.71,"Per diem rate, code is bundled with other services"
HEP B SURFACE AG              ,38270132,CDM,306,RC,87340,CPT,,,,Inpatient,,,42.71,42.71,HUMANA CHOICE PLUS,MGD,42.71,,,,,,,case rate,42.71,42.71,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,AETNA,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,CIGNA,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,TRICARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,UNITED HEALTHCARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,UNITED HEALTHCARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,VA,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,VA TRICARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,WELLMED,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,HUMANA,MGD,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
"BLOOD CNT, MAN (RBC,WBC,PLT)EA",38280020,CDM,305,RC,85032,CPT,,,,Inpatient,,,79.21,79.21,HUMANA CHOICE PLUS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,AETNA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,BCBS,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,CIGNA,COM,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,UNITED HEALTHCARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,VA,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,VA TRICARE,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,WELLMED,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,HUMANA,MGD,35.15,,,,,,,per diem,35.15,35.15,"Per diem rate, code is bundled with other services"
THYROGLOBULIN LEVEL           ,38280030,CDM,301,RC,84432,CPT,,,,Inpatient,,,35.15,35.15,HUMANA CHOICE PLUS,MGD,35.15,,,,,,,case rate,35.15,35.15,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,AETNA,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,BCBS,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,CIGNA,COM,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,TRICARE,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,UNITED HEALTHCARE,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,UNITED HEALTHCARE,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,VA,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,VA TRICARE,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,WELLMED,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,HUMANA,MGD,250.44,,,,,,,per diem,250.44,250.44,"Per diem rate, code is bundled with other services"
FRUCTOSAMINE-GLYCATED PROTEIN ,38280040,CDM,301,RC,82985,CPT,,,,Inpatient,,,250.44,250.44,HUMANA CHOICE PLUS,MGD,250.44,,,,,,,case rate,250.44,250.44,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,AETNA,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,BCBS,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,CIGNA,COM,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,TRICARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,UNITED HEALTHCARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,UNITED HEALTHCARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,VA,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,VA TRICARE,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,WELLMED,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,HUMANA,MGD,33.26,,,,,,,per diem,33.26,33.26,"Per diem rate, code is bundled with other services"
METABOLIC PANEL IONIZED CA    ,38280047,CDM,301,RC,80047,CPT,,,,Inpatient,,,33.26,33.26,HUMANA CHOICE PLUS,MGD,33.26,,,,,,,case rate,33.26,33.26,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,AETNA,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,BCBS,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,CIGNA,COM,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,TRICARE,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,UNITED HEALTHCARE,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,UNITED HEALTHCARE,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,VA,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,VA TRICARE,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,WELLMED,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,HUMANA,MGD,250.5,,,,,,,per diem,250.5,250.5,"Per diem rate, code is bundled with other services"
METABOLIC PANEL TOTAL CA      ,38280048,CDM,301,RC,80048,CPT,,,,Inpatient,,,250.5,250.5,HUMANA CHOICE PLUS,MGD,250.5,,,,,,,case rate,250.5,250.5,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,AETNA,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,BCBS,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,CIGNA,COM,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,TRICARE,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,UNITED HEALTHCARE,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,UNITED HEALTHCARE,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,VA,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,VA TRICARE,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,WELLMED,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,HUMANA,MGD,269.85,,,,,,,per diem,269.85,269.85,"Per diem rate, code is bundled with other services"
MET PANEL TTL CA CHEM 8+      ,38280049,CDM,301,RC,80048,CPT,,,QW,Inpatient,,,269.85,269.85,HUMANA CHOICE PLUS,MGD,269.85,,,,,,,case rate,269.85,269.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,AETNA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,CIGNA,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,VA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,VA TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,WELLMED,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,HUMANA,MGD,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
COMPREHEN METABOLIC PANEL     ,38280053,CDM,301,RC,80053,CPT,,,,Inpatient,,,59.85,59.85,HUMANA CHOICE PLUS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,AETNA,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,BCBS,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,CIGNA,COM,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,TRICARE,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,UNITED HEALTHCARE,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,UNITED HEALTHCARE,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,VA,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,VA TRICARE,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,WELLMED,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,HUMANA,MGD,210,,,,,,,per diem,210,210,"Per diem rate, code is bundled with other services"
RENAL FUNCTION PANEL          ,38280069,CDM,301,RC,80069,CPT,,,,Inpatient,,,210,210,HUMANA CHOICE PLUS,MGD,210,,,,,,,case rate,210,210,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,AETNA,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,BCBS,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,CIGNA,COM,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,TRICARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,UNITED HEALTHCARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,UNITED HEALTHCARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,VA,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,VA TRICARE,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,WELLMED,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,HUMANA,MGD,529.07,,,,,,,per diem,529.07,529.07,"Per diem rate, code is bundled with other services"
CLOTTING FACTOR VII           ,38286433,CDM,305,RC,85230,CPT,,,,Inpatient,,,529.07,529.07,HUMANA CHOICE PLUS,MGD,529.07,,,,,,,case rate,529.07,529.07,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,AETNA,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,BCBS,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,CIGNA,COM,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,TRICARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,UNITED HEALTHCARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,UNITED HEALTHCARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,VA,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,VA TRICARE,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,WELLMED,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,HUMANA,MGD,211.05,,,,,,,per diem,211.05,211.05,"Per diem rate, code is bundled with other services"
TSH ULTRA SENSITIVE           ,38286434,CDM,300,RC,84443,CPT,,,,Inpatient,,,211.05,211.05,HUMANA CHOICE PLUS,MGD,211.05,,,,,,,case rate,211.05,211.05,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,AETNA,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,BCBS,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,CIGNA,COM,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,TRICARE,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,UNITED HEALTHCARE,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,UNITED HEALTHCARE,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,VA,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,VA TRICARE,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,WELLMED,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,HUMANA,MGD,70.14,,,,,,,per diem,70.14,70.14,"Per diem rate, code is bundled with other services"
APOLIPOPROTEIN                ,38286437,CDM,301,RC,82172,CPT,,,,Inpatient,,,70.14,70.14,HUMANA CHOICE PLUS,MGD,70.14,,,,,,,case rate,70.14,70.14,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,AETNA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,BCBS,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,CIGNA,COM,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,UNITED HEALTHCARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,VA,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,VA TRICARE,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,WELLMED,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,HUMANA,MGD,75.17,,,,,,,per diem,75.17,75.17,"Per diem rate, code is bundled with other services"
BLASTOMYCES AB                ,38286443,CDM,302,RC,86612,CPT,,,,Inpatient,,,75.17,75.17,HUMANA CHOICE PLUS,MGD,75.17,,,,,,,case rate,75.17,75.17,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,AETNA,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,BCBS,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,CIGNA,COM,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,TRICARE,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,UNITED HEALTHCARE,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,UNITED HEALTHCARE,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,VA,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,VA TRICARE,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,WELLMED,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,HUMANA,MGD,315.85,,,,,,,per diem,315.85,315.85,"Per diem rate, code is bundled with other services"
HISTOPLASMA AB                ,38286449,CDM,302,RC,86698,CPT,,,,Inpatient,,,315.85,315.85,HUMANA CHOICE PLUS,MGD,315.85,,,,,,,case rate,315.85,315.85,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,AETNA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,BCBS,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,CIGNA,COM,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,UNITED HEALTHCARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,VA,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,VA TRICARE,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,WELLMED,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,HUMANA,MGD,81.4,,,,,,,per diem,81.4,81.4,"Per diem rate, code is bundled with other services"
ANTI 1-A2 (ISLET CELL AB)     ,38286601,CDM,302,RC,86341,CPT,,,,Inpatient,,,81.4,81.4,HUMANA CHOICE PLUS,MGD,81.4,,,,,,,case rate,81.4,81.4,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,AETNA,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,BCBS,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,CIGNA,COM,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,TRICARE,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,UNITED HEALTHCARE,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,UNITED HEALTHCARE,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,VA,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,VA TRICARE,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,WELLMED,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,HUMANA,MGD,68.97,,,,,,,per diem,68.97,68.97,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287000,CDM,300,RC,81240,CPT,,,,Inpatient,,,68.97,68.97,HUMANA CHOICE PLUS,MGD,68.97,,,,,,,case rate,68.97,68.97,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,AETNA,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,BCBS,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,CIGNA,COM,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,TRICARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,UNITED HEALTHCARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,UNITED HEALTHCARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,VA,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,VA TRICARE,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,WELLMED,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,HUMANA,MGD,79.21,,,,,,,per diem,79.21,79.21,"Per diem rate, code is bundled with other services"
F5 LEIDEN GENE ANALYSIS       ,38287001,CDM,300,RC,81241,CPT,,,,Inpatient,,,79.21,79.21,HUMANA CHOICE PLUS,MGD,79.21,,,,,,,case rate,79.21,79.21,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,AETNA,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,BCBS,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,CIGNA,COM,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,TRICARE,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,UNITED HEALTHCARE,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,UNITED HEALTHCARE,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,VA,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,VA TRICARE,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,WELLMED,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,HUMANA,MGD,234.52,,,,,,,per diem,234.52,234.52,"Per diem rate, code is bundled with other services"
BCR/ABL1 TRANSLOCATION MAJ BRK,38287002,CDM,310,RC,81206,CPT,,,,Inpatient,,,234.52,234.52,HUMANA CHOICE PLUS,MGD,234.52,,,,,,,case rate,234.52,234.52,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,AETNA,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,BCBS,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,CIGNA,COM,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,TRICARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,UNITED HEALTHCARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,UNITED HEALTHCARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,VA,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,VA TRICARE,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,WELLMED,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,HUMANA,MGD,342.72,,,,,,,per diem,342.72,342.72,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 1-3 ,38288700,CDM,301,RC,80375,CPT,,,,Inpatient,,,342.72,342.72,HUMANA CHOICE PLUS,MGD,342.72,,,,,,,case rate,342.72,342.72,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,AETNA,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,BCBS,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,CIGNA,COM,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,TRICARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,UNITED HEALTHCARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,UNITED HEALTHCARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,VA,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,VA TRICARE,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,WELLMED,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,HUMANA,MGD,460.53,,,,,,,per diem,460.53,460.53,"Per diem rate, code is bundled with other services"
DRUG DEFIN QUAL/QUANT NOS 7+  ,38288702,CDM,301,RC,80377,CPT,,,,Inpatient,,,460.53,460.53,HUMANA CHOICE PLUS,MGD,460.53,,,,,,,case rate,460.53,460.53,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,AETNA,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,CIGNA,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,TRICARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,UNITED HEALTHCARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,UNITED HEALTHCARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,VA,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,VA TRICARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,WELLMED,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,HUMANA,MGD,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA A AB                ,38293900,CDM,306,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,HUMANA CHOICE PLUS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,AETNA,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,BCBS,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,CIGNA,COM,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,TRICARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,UNITED HEALTHCARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,UNITED HEALTHCARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,VA,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,VA TRICARE,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,WELLMED,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,HUMANA,MGD,144.9,,,,,,,per diem,144.9,144.9,"Per diem rate, code is bundled with other services"
INFLUENZA B AB                ,38293905,CDM,302,RC,86710,CPT,,,,Inpatient,,,144.9,144.9,HUMANA CHOICE PLUS,MGD,144.9,,,,,,,case rate,144.9,144.9,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,AETNA,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,BCBS,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,CIGNA,COM,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,TRICARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,UNITED HEALTHCARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,UNITED HEALTHCARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,VA,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,VA TRICARE,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,WELLMED,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,HUMANA,MGD,240.19,,,,,,,per diem,240.19,240.19,"Per diem rate, code is bundled with other services"
HEPB CORE AB IGM (HBCIGM)     ,38293920,CDM,302,RC,86705,CPT,,,,Inpatient,,,240.19,240.19,HUMANA CHOICE PLUS,MGD,240.19,,,,,,,case rate,240.19,240.19,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,AETNA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,BCBS,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,CIGNA,COM,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,UNITED HEALTHCARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,VA,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,VA TRICARE,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,WELLMED,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,HUMANA,MGD,144.59,,,,,,,per diem,144.59,144.59,"Per diem rate, code is bundled with other services"
PLATELET AGGREGATION EA AGENT ,38293921,CDM,305,RC,85576,CPT,,,,Inpatient,,,144.59,144.59,HUMANA CHOICE PLUS,MGD,144.59,,,,,,,case rate,144.59,144.59,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,AETNA,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,BCBS,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,CIGNA,COM,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,TRICARE,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,UNITED HEALTHCARE,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,UNITED HEALTHCARE,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,VA,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,VA TRICARE,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,WELLMED,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,HUMANA,MGD,265.18,,,,,,,per diem,265.18,265.18,"Per diem rate, code is bundled with other services"
INTRINSIC FACTOR ANTIBODY     ,38293923,CDM,302,RC,86340,CPT,,,,Inpatient,,,265.18,265.18,HUMANA CHOICE PLUS,MGD,265.18,,,,,,,case rate,265.18,265.18,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,AETNA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,BCBS,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,CIGNA,COM,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,UNITED HEALTHCARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,VA,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,VA TRICARE,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,WELLMED,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,HUMANA,MGD,73.5,,,,,,,per diem,73.5,73.5,"Per diem rate, code is bundled with other services"
DRUG SCREEN                   ,38293927,CDM,300,RC,80100,CPT,,,,Inpatient,,,73.5,73.5,HUMANA CHOICE PLUS,MGD,73.5,,,,,,,case rate,73.5,73.5,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,AETNA,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,BCBS,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,CIGNA,COM,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,TRICARE,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,UNITED HEALTHCARE,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,UNITED HEALTHCARE,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,VA,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,VA TRICARE,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,WELLMED,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,HUMANA,MGD,198.41,,,,,,,per diem,198.41,198.41,"Per diem rate, code is bundled with other services"
GABAPENTIN                    ,38293928,CDM,301,RC,80171,CPT,,,,Inpatient,,,198.41,198.41,HUMANA CHOICE PLUS,MGD,198.41,,,,,,,case rate,198.41,198.41,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,AETNA,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,BCBS,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,CIGNA,COM,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,TRICARE,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,UNITED HEALTHCARE,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,UNITED HEALTHCARE,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,VA,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,VA TRICARE,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,WELLMED,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,HUMANA,MGD,47.91,,,,,,,per diem,47.91,47.91,"Per diem rate, code is bundled with other services"
HEPARIN LEVEL                 ,38293939,CDM,305,RC,85520,CPT,,,,Inpatient,,,47.91,47.91,HUMANA CHOICE PLUS,MGD,47.91,,,,,,,case rate,47.91,47.91,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,AETNA,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,BCBS,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,CIGNA,COM,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,TRICARE,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,UNITED HEALTHCARE,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,UNITED HEALTHCARE,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,VA,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,VA TRICARE,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,WELLMED,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,HUMANA,MGD,31.25,,,,,,,per diem,31.25,31.25,"Per diem rate, code is bundled with other services"
C DIFFICILE TOXIN A/B         ,38293950,CDM,306,RC,87324,CPT,,,,Inpatient,,,31.25,31.25,HUMANA CHOICE PLUS,MGD,31.25,,,,,,,case rate,31.25,31.25,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,AETNA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,BCBS,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,CIGNA,COM,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,UNITED HEALTHCARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,VA,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,VA TRICARE,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,WELLMED,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,HUMANA,MGD,100.67,,,,,,,per diem,100.67,100.67,"Per diem rate, code is bundled with other services"
ESTRONE                       ,38293953,CDM,301,RC,82679,CPT,,,,Inpatient,,,100.67,100.67,HUMANA CHOICE PLUS,MGD,100.67,,,,,,,case rate,100.67,100.67,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,AETNA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,BCBS,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,CIGNA,COM,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,UNITED HEALTHCARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,VA,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,VA TRICARE,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,WELLMED,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,HUMANA,MGD,80.33,,,,,,,per diem,80.33,80.33,"Per diem rate, code is bundled with other services"
COLLAGEN CROSS LINKS          ,38293960,CDM,301,RC,82523,CPT,,,,Inpatient,,,80.33,80.33,HUMANA CHOICE PLUS,MGD,80.33,,,,,,,case rate,80.33,80.33,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,AETNA,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,BCBS,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,CIGNA,COM,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,TRICARE,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,UNITED HEALTHCARE,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,UNITED HEALTHCARE,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,VA,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,VA TRICARE,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,WELLMED,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,HUMANA,MGD,95.53,,,,,,,per diem,95.53,95.53,"Per diem rate, code is bundled with other services"
URINALYS QUAL/SEMIQNT XCPT IA ,38299301,CDM,301,RC,81005,CPT,,,,Inpatient,,,95.53,95.53,HUMANA CHOICE PLUS,MGD,95.53,,,,,,,case rate,95.53,95.53,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
OXYGEN SATURATION CHECK       ,38299305,CDM,301,RC,82805,CPT,,,,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,AETNA,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,BCBS,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,CIGNA,COM,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,TRICARE,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,UNITED HEALTHCARE,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,UNITED HEALTHCARE,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,VA,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,VA TRICARE,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,WELLMED,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,HUMANA,MGD,108.7,,,,,,,per diem,108.7,108.7,"Per diem rate, code is bundled with other services"
LACTOFERRIN FECAL QUAL        ,38299306,CDM,301,RC,83630,CPT,,,,Inpatient,,,108.7,108.7,HUMANA CHOICE PLUS,MGD,108.7,,,,,,,case rate,108.7,108.7,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,AETNA,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,CIGNA,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,TRICARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,UNITED HEALTHCARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,UNITED HEALTHCARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,VA,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,VA TRICARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,WELLMED,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,HUMANA,MGD,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
DEPAKOTE                      ,38299309,CDM,301,RC,80299,CPT,,,,Inpatient,,,233.1,233.1,HUMANA CHOICE PLUS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,AETNA,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,BCBS,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,CIGNA,COM,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,TRICARE,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,UNITED HEALTHCARE,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,UNITED HEALTHCARE,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,VA,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,VA TRICARE,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,WELLMED,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,HUMANA,MGD,257.25,,,,,,,per diem,257.25,257.25,"Per diem rate, code is bundled with other services"
PSA                           ,38299311,CDM,301,RC,84152,CPT,,,,Inpatient,,,257.25,257.25,HUMANA CHOICE PLUS,MGD,257.25,,,,,,,case rate,257.25,257.25,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,AETNA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,BCBS,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,CIGNA,COM,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,UNITED HEALTHCARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,VA,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,VA TRICARE,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,WELLMED,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,HUMANA,MGD,92.11,,,,,,,per diem,92.11,92.11,"Per diem rate, code is bundled with other services"
IMMUNOASSAY FOR TUMOR ANTIGEN ,38299312,CDM,302,RC,86316,CPT,,,,Inpatient,,,92.11,92.11,HUMANA CHOICE PLUS,MGD,92.11,,,,,,,case rate,92.11,92.11,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,AETNA,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,BCBS,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,CIGNA,COM,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,TRICARE,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,UNITED HEALTHCARE,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,UNITED HEALTHCARE,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,VA,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,VA TRICARE,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,WELLMED,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,HUMANA,MGD,323.69,,,,,,,per diem,323.69,323.69,"Per diem rate, code is bundled with other services"
HERPES SIMPLEX NON-SPEC TYPE  ,38299313,CDM,302,RC,86694,CPT,,,,Inpatient,,,323.69,323.69,HUMANA CHOICE PLUS,MGD,323.69,,,,,,,case rate,323.69,323.69,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,AETNA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,BCBS,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,CIGNA,COM,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,UNITED HEALTHCARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,VA,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,VA TRICARE,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,WELLMED,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,HUMANA,MGD,187.43,,,,,,,per diem,187.43,187.43,"Per diem rate, code is bundled with other services"
DTT SERUM TREATMENT           ,38299315,CDM,302,RC,86977,CPT,,,,Inpatient,,,187.43,187.43,HUMANA CHOICE PLUS,MGD,187.43,,,,,,,case rate,187.43,187.43,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,AETNA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,BCBS,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,CIGNA,COM,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,UNITED HEALTHCARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,VA,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,VA TRICARE,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,WELLMED,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,HUMANA,MGD,159.58,,,,,,,per diem,159.58,159.58,"Per diem rate, code is bundled with other services"
B CELL TOTAL COUNT            ,38299316,CDM,302,RC,86355,CPT,,,,Inpatient,,,159.58,159.58,HUMANA CHOICE PLUS,MGD,159.58,,,,,,,case rate,159.58,159.58,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,AETNA,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,BCBS,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,CIGNA,COM,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,TRICARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,UNITED HEALTHCARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,UNITED HEALTHCARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,VA,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,VA TRICARE,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,WELLMED,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,HUMANA,MGD,265.61,,,,,,,per diem,265.61,265.61,"Per diem rate, code is bundled with other services"
DTT CELL TREATMENT            ,38299317,CDM,302,RC,86970,CPT,,,,Inpatient,,,265.61,265.61,HUMANA CHOICE PLUS,MGD,265.61,,,,,,,case rate,265.61,265.61,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,AETNA,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,BCBS,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,CIGNA,COM,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,TRICARE,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,UNITED HEALTHCARE,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,UNITED HEALTHCARE,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,VA,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,VA TRICARE,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,WELLMED,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,HUMANA,MGD,319.56,,,,,,,per diem,319.56,319.56,"Per diem rate, code is bundled with other services"
T CELL TOTAL COUNT            ,38299318,CDM,302,RC,86359,CPT,,,,Inpatient,,,319.56,319.56,HUMANA CHOICE PLUS,MGD,319.56,,,,,,,case rate,319.56,319.56,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
CBC WITHOUT PLATELETS         ,38299323,CDM,305,RC,G0307,CPT,G0307,HCPCS,,Inpatient,,,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,AETNA,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,BCBS,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,CIGNA,COM,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,TRICARE,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,UNITED HEALTHCARE,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,UNITED HEALTHCARE,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,VA,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,VA TRICARE,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,WELLMED,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,HUMANA,MGD,304.76,,,,,,,per diem,304.76,304.76,"Per diem rate, code is bundled with other services"
INF AGT NAP AMP PRB TECH MRSA ,38299324,CDM,306,RC,87641,CPT,,,,Inpatient,,,304.76,304.76,HUMANA CHOICE PLUS,MGD,304.76,,,,,,,case rate,304.76,304.76,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,AETNA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,CIGNA,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,VA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,VA TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,WELLMED,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,HUMANA,MGD,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
CULTURE TISSUE ADDL STUDIES   ,38299327,CDM,306,RC,87253,CPT,,,,Inpatient,,,110.31,110.31,HUMANA CHOICE PLUS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,AETNA,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,BCBS,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,CIGNA,COM,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,TRICARE,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,UNITED HEALTHCARE,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,UNITED HEALTHCARE,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,VA,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,VA TRICARE,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,WELLMED,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,HUMANA,MGD,300.02,,,,,,,per diem,300.02,300.02,"Per diem rate, code is bundled with other services"
CULTURE FUNGUS SKIN           ,38299328,CDM,306,RC,87101,CPT,,,,Inpatient,,,300.02,300.02,HUMANA CHOICE PLUS,MGD,300.02,,,,,,,case rate,300.02,300.02,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,AETNA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,BCBS,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,CIGNA,COM,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,UNITED HEALTHCARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,VA,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,VA TRICARE,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,WELLMED,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,HUMANA,MGD,198.14,,,,,,,per diem,198.14,198.14,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING             ,38299329,CDM,306,RC,87299,CPT,,,,Inpatient,,,198.14,198.14,HUMANA CHOICE PLUS,MGD,198.14,,,,,,,case rate,198.14,198.14,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,AETNA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,BCBS,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,CIGNA,COM,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,UNITED HEALTHCARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,VA,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,VA TRICARE,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,WELLMED,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,HUMANA,MGD,311.85,,,,,,,per diem,311.85,311.85,"Per diem rate, code is bundled with other services"
CULTURE ANAEROBIC             ,38299330,CDM,306,RC,87073,CPT,,,,Inpatient,,,311.85,311.85,HUMANA CHOICE PLUS,MGD,311.85,,,,,,,case rate,311.85,311.85,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,AETNA,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,BCBS,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,CIGNA,COM,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,TRICARE,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,UNITED HEALTHCARE,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,UNITED HEALTHCARE,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,VA,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,VA TRICARE,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,WELLMED,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,HUMANA,MGD,123.51,,,,,,,per diem,123.51,123.51,"Per diem rate, code is bundled with other services"
SHIGA-LIKE TOXIN              ,38299331,CDM,306,RC,87427,CPT,,,,Inpatient,,,123.51,123.51,HUMANA CHOICE PLUS,MGD,123.51,,,,,,,case rate,123.51,123.51,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,AETNA,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,BCBS,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,CIGNA,COM,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,TRICARE,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,UNITED HEALTHCARE,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,UNITED HEALTHCARE,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,VA,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,VA TRICARE,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,WELLMED,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,HUMANA,MGD,102.38,,,,,,,per diem,102.38,102.38,"Per diem rate, code is bundled with other services"
HEP B S AG EIA                ,38299332,CDM,306,RC,87515,CPT,,,,Inpatient,,,102.38,102.38,HUMANA CHOICE PLUS,MGD,102.38,,,,,,,case rate,102.38,102.38,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,AETNA,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,BCBS,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,CIGNA,COM,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,TRICARE,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,UNITED HEALTHCARE,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,UNITED HEALTHCARE,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,VA,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,VA TRICARE,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,WELLMED,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,HUMANA,MGD,276.9,,,,,,,per diem,276.9,276.9,"Per diem rate, code is bundled with other services"
ANTIGEN RSV                   ,38299334,CDM,306,RC,87420,CPT,,,,Inpatient,,,276.9,276.9,HUMANA CHOICE PLUS,MGD,276.9,,,,,,,case rate,276.9,276.9,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
WESTERN BLOT                  ,38299338,CDM,301,RC,84181,CPT,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,AETNA,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,BCBS,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,CIGNA,COM,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,TRICARE,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,UNITED HEALTHCARE,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,UNITED HEALTHCARE,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,VA,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,VA TRICARE,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,WELLMED,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,HUMANA,MGD,76.31,,,,,,,per diem,76.31,76.31,"Per diem rate, code is bundled with other services"
ICTOTEST                      ,38299339,CDM,301,RC,81007,CPT,,,,Inpatient,,,76.31,76.31,HUMANA CHOICE PLUS,MGD,76.31,,,,,,,case rate,76.31,76.31,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,AETNA,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,BCBS,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,CIGNA,COM,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,TRICARE,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,UNITED HEALTHCARE,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,UNITED HEALTHCARE,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,VA,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,VA TRICARE,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,WELLMED,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,HUMANA,MGD,671.08,,,,,,,per diem,671.08,671.08,"Per diem rate, code is bundled with other services"
"HERPES SIMP VIRUS,PCR,        ",38299341,CDM,306,RC,87529,CPT,,,,Inpatient,,,671.08,671.08,HUMANA CHOICE PLUS,MGD,671.08,,,,,,,case rate,671.08,671.08,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,AETNA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,CIGNA,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,VA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,VA TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,WELLMED,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,HUMANA,MGD,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
CULTURE TB                    ,38299344,CDM,306,RC,87116,CPT,,,,Inpatient,,,173.25,173.25,HUMANA CHOICE PLUS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,AETNA,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,BCBS,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,CIGNA,COM,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,TRICARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,UNITED HEALTHCARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,UNITED HEALTHCARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,VA,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,VA TRICARE,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,WELLMED,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,HUMANA,MGD,27.04,,,,,,,per diem,27.04,27.04,"Per diem rate, code is bundled with other services"
HEMOCHRON ACT                 ,38299345,CDM,306,RC,85347,CPT,,,,Inpatient,,,27.04,27.04,HUMANA CHOICE PLUS,MGD,27.04,,,,,,,case rate,27.04,27.04,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,AETNA,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,BCBS,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,CIGNA,COM,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,TRICARE,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,UNITED HEALTHCARE,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,UNITED HEALTHCARE,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,VA,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,VA TRICARE,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,WELLMED,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,HUMANA,MGD,247.64,,,,,,,per diem,247.64,247.64,"Per diem rate, code is bundled with other services"
C DIFFICILE AMP PROBE         ,38299350,CDM,306,RC,87493,CPT,,,,Inpatient,,,247.64,247.64,HUMANA CHOICE PLUS,MGD,247.64,,,,,,,case rate,247.64,247.64,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,AETNA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,BCBS,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,CIGNA,COM,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,UNITED HEALTHCARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,VA TRICARE,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,WELLMED,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA,MGD,229.95,,,,,,,per diem,229.95,229.95,"Per diem rate, code is bundled with other services"
DILANTIN ASSAY                ,38299351,CDM,301,RC,80299,CPT,,,,Inpatient,,,229.95,229.95,HUMANA CHOICE PLUS,MGD,229.95,,,,,,,case rate,229.95,229.95,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,AETNA,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,BCBS,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,CIGNA,COM,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,TRICARE,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,UNITED HEALTHCARE,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,UNITED HEALTHCARE,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,VA,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,VA TRICARE,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,WELLMED,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,HUMANA,MGD,660.89,,,,,,,per diem,660.89,660.89,"Per diem rate, code is bundled with other services"
ASSAY VITAMIN K               ,38299352,CDM,301,RC,84597,CPT,,,,Inpatient,,,660.89,660.89,HUMANA CHOICE PLUS,MGD,660.89,,,,,,,case rate,660.89,660.89,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,AETNA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,BCBS,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,CIGNA,COM,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,UNITED HEALTHCARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,VA,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,VA TRICARE,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,WELLMED,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,HUMANA,MGD,43.91,,,,,,,per diem,43.91,43.91,"Per diem rate, code is bundled with other services"
ANTIPHOSPHOLIPID AB           ,38299353,CDM,302,RC,86148,CPT,,,,Inpatient,,,43.91,43.91,HUMANA CHOICE PLUS,MGD,43.91,,,,,,,case rate,43.91,43.91,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,AETNA,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,BCBS,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,CIGNA,COM,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,TRICARE,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,UNITED HEALTHCARE,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,UNITED HEALTHCARE,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,VA,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,VA TRICARE,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,WELLMED,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,HUMANA,MGD,162.32,,,,,,,per diem,162.32,162.32,"Per diem rate, code is bundled with other services"
CYCLIC CITRULLINATD PEPTIDE AB,38299354,CDM,302,RC,86200,CPT,,,,Inpatient,,,162.32,162.32,HUMANA CHOICE PLUS,MGD,162.32,,,,,,,case rate,162.32,162.32,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,AETNA,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,CIGNA,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,TRICARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,UNITED HEALTHCARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,UNITED HEALTHCARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,VA,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,VA TRICARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,WELLMED,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,HUMANA,MGD,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
OCCULT BLOOD 1-3 DETERM       ,38299356,CDM,301,RC,82272,CPT,,,,Inpatient,,,75.81,75.81,HUMANA CHOICE PLUS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,AETNA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,BCBS,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,CIGNA,COM,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,UNITED HEALTHCARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,VA,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,VA TRICARE,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,WELLMED,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,HUMANA,MGD,52.48,,,,,,,per diem,52.48,52.48,"Per diem rate, code is bundled with other services"
Q FEVER AB COXIELLA BURNETII  ,38299357,CDM,302,RC,86638,CPT,,,,Inpatient,,,52.48,52.48,HUMANA CHOICE PLUS,MGD,52.48,,,,,,,case rate,52.48,52.48,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,AETNA,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,BCBS,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,CIGNA,COM,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,TRICARE,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,UNITED HEALTHCARE,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,UNITED HEALTHCARE,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,VA,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,VA TRICARE,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,WELLMED,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,HUMANA,MGD,278.6,,,,,,,per diem,278.6,278.6,"Per diem rate, code is bundled with other services"
QUANT OF DRUG NOT ELSE SPEC   ,38299980,CDM,300,RC,80299,CPT,,,,Inpatient,,,278.6,278.6,HUMANA CHOICE PLUS,MGD,278.6,,,,,,,case rate,278.6,278.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,AETNA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,BCBS,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,CIGNA,COM,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,UNITED HEALTHCARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,VA,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,VA TRICARE,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,WELLMED,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,HUMANA,MGD,117.6,,,,,,,per diem,117.6,117.6,"Per diem rate, code is bundled with other services"
GLUTAMINE                     ,38299981,CDM,300,RC,82975,CPT,,,,Inpatient,,,117.6,117.6,HUMANA CHOICE PLUS,MGD,117.6,,,,,,,case rate,117.6,117.6,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,AETNA,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,BCBS,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,CIGNA,COM,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,TRICARE,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,UNITED HEALTHCARE,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,UNITED HEALTHCARE,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,VA,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,VA TRICARE,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,WELLMED,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,HUMANA,MGD,64.05,,,,,,,per diem,64.05,64.05,"Per diem rate, code is bundled with other services"
CULTURE MYCOBACTERIAL DEFIN   ,38299982,CDM,300,RC,87118,CPT,,,,Inpatient,,,64.05,64.05,HUMANA CHOICE PLUS,MGD,64.05,,,,,,,case rate,64.05,64.05,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,AETNA,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,BCBS,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,CIGNA,COM,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,TRICARE,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,UNITED HEALTHCARE,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,UNITED HEALTHCARE,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,VA,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,VA TRICARE,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,WELLMED,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,HUMANA,MGD,90.66,,,,,,,per diem,90.66,90.66,"Per diem rate, code is bundled with other services"
SPUTUM CULTURE & SENSITIVITY  ,38299983,CDM,300,RC,87451,CPT,,,,Inpatient,,,90.66,90.66,HUMANA CHOICE PLUS,MGD,90.66,,,,,,,case rate,90.66,90.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
LAB-UNLISTED TEST             ,38299999,CDM,300,RC,,,,,,Inpatient,,,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,AETNA,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,BCBS,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,CIGNA,COM,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,TRICARE,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,UNITED HEALTHCARE,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,UNITED HEALTHCARE,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,VA,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,VA TRICARE,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,WELLMED,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,HUMANA,MGD,148.73,,,,,,,per diem,148.73,148.73,"Per diem rate, code is bundled with other services"
PROCALCITONIN                 ,38300004,CDM,301,RC,84145,CPT,,,,Inpatient,,,148.73,148.73,HUMANA CHOICE PLUS,MGD,148.73,,,,,,,case rate,148.73,148.73,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,AETNA,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,BCBS,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,CIGNA,COM,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,TRICARE,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,UNITED HEALTHCARE,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,UNITED HEALTHCARE,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,VA,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,VA TRICARE,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,WELLMED,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,HUMANA,MGD,61.2,,,,,,,per diem,61.2,61.2,"Per diem rate, code is bundled with other services"
BK VIRUS PCR QNT              ,38300142,CDM,300,RC,87799,CPT,,,,Inpatient,,,61.2,61.2,HUMANA CHOICE PLUS,MGD,61.2,,,,,,,case rate,61.2,61.2,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,AETNA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,BCBS,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,CIGNA,COM,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,UNITED HEALTHCARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,VA TRICARE,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,WELLMED,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA,MGD,161.63,,,,,,,per diem,161.63,161.63,"Per diem rate, code is bundled with other services"
COVID-19 CORONAVIRUS          ,38300161,CDM,300,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,161.63,161.63,HUMANA CHOICE PLUS,MGD,161.63,,,,,,,case rate,161.63,161.63,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
SARS-COV-2 NAA UNIT PERFORMED ,38300166,CDM,301,RC,87635,CPT,U0002,HCPCS,,Inpatient,,,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,AETNA,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,BCBS,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,CIGNA,COM,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,TRICARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,UNITED HEALTHCARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,UNITED HEALTHCARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,VA,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,VA TRICARE,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,WELLMED,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,HUMANA,MGD,75.81,,,,,,,per diem,75.81,75.81,"Per diem rate, code is bundled with other services"
CALCIUM SERUM                 ,38300370,CDM,301,RC,82310,CPT,,,,Inpatient,,,75.81,75.81,HUMANA CHOICE PLUS,MGD,75.81,,,,,,,case rate,75.81,75.81,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,AETNA,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,BCBS,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,CIGNA,COM,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,TRICARE,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,UNITED HEALTHCARE,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,UNITED HEALTHCARE,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,VA,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,VA TRICARE,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,WELLMED,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,HUMANA,MGD,111.08,,,,,,,per diem,111.08,111.08,"Per diem rate, code is bundled with other services"
CULTURE URINE                 ,38300980,CDM,306,RC,87088,CPT,,,,Inpatient,,,111.08,111.08,HUMANA CHOICE PLUS,MGD,111.08,,,,,,,case rate,111.08,111.08,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,AETNA,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,BCBS,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,CIGNA,COM,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,TRICARE,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,UNITED HEALTHCARE,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,UNITED HEALTHCARE,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,VA,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,VA TRICARE,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,WELLMED,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,HUMANA,MGD,25.38,,,,,,,per diem,25.38,25.38,"Per diem rate, code is bundled with other services"
"GLUCOSE BLOOD, REAGENT STRIP  ",38301320,CDM,301,RC,82948,CPT,,,,Inpatient,,,25.38,25.38,HUMANA CHOICE PLUS,MGD,25.38,,,,,,,case rate,25.38,25.38,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,AETNA,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,BCBS,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,CIGNA,COM,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,TRICARE,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,UNITED HEALTHCARE,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,UNITED HEALTHCARE,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,VA,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,VA TRICARE,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,WELLMED,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,HUMANA,MGD,60.43,,,,,,,per diem,60.43,60.43,"Per diem rate, code is bundled with other services"
GLUC BLOOD NOVA STAT STRIP    ,38301321,CDM,301,RC,82947,CPT,,,,Inpatient,,,60.43,60.43,HUMANA CHOICE PLUS,MGD,60.43,,,,,,,case rate,60.43,60.43,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,AETNA,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,BCBS,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,CIGNA,COM,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,TRICARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,UNITED HEALTHCARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,UNITED HEALTHCARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,VA,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,VA TRICARE,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,WELLMED,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,HUMANA,MGD,33.83,,,,,,,per diem,33.83,33.83,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AB        ,38301460,CDM,302,RC,86706,CPT,,,,Inpatient,,,33.83,33.83,HUMANA CHOICE PLUS,MGD,33.83,,,,,,,case rate,33.83,33.83,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,AETNA,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,BCBS,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,CIGNA,COM,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,TRICARE,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,UNITED HEALTHCARE,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,UNITED HEALTHCARE,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,VA,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,VA TRICARE,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,WELLMED,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,HUMANA,MGD,128.93,,,,,,,per diem,128.93,128.93,"Per diem rate, code is bundled with other services"
HEPATITIS B SURFACE AG (HBSAG),38301470,CDM,306,RC,87340,CPT,,,,Inpatient,,,128.93,128.93,HUMANA CHOICE PLUS,MGD,128.93,,,,,,,case rate,128.93,128.93,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,AETNA,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,BCBS,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,CIGNA,COM,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,TRICARE,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,UNITED HEALTHCARE,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,UNITED HEALTHCARE,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,VA,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,VA TRICARE,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,WELLMED,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,HUMANA,MGD,106.77,,,,,,,per diem,106.77,106.77,"Per diem rate, code is bundled with other services"
HEPATITIS B CORE ANTIBODY     ,38301472,CDM,302,RC,86704,CPT,,,,Inpatient,,,106.77,106.77,HUMANA CHOICE PLUS,MGD,106.77,,,,,,,case rate,106.77,106.77,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,AETNA,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,BCBS,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,CIGNA,COM,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,TRICARE,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,UNITED HEALTHCARE,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,UNITED HEALTHCARE,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,VA,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,VA TRICARE,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,WELLMED,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,HUMANA,MGD,44.95,,,,,,,per diem,44.95,44.95,"Per diem rate, code is bundled with other services"
HEPATITIS C AB                ,38301480,CDM,302,RC,86803,CPT,,,,Inpatient,,,44.95,44.95,HUMANA CHOICE PLUS,MGD,44.95,,,,,,,case rate,44.95,44.95,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,AETNA,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,BCBS,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,CIGNA,COM,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,TRICARE,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,UNITED HEALTHCARE,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,UNITED HEALTHCARE,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,VA,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,VA TRICARE,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,WELLMED,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,HUMANA,MGD,67.77,,,,,,,per diem,67.77,67.77,"Per diem rate, code is bundled with other services"
CHLAMYDOPHILIA PNEYMONIAE     ,38302185,CDM,306,RC,87486,CPT,,,,Inpatient,,,67.77,67.77,HUMANA CHOICE PLUS,MGD,67.77,,,,,,,case rate,67.77,67.77,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,AETNA,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,BCBS,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,CIGNA,COM,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,TRICARE,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,UNITED HEALTHCARE,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,UNITED HEALTHCARE,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,VA,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,VA TRICARE,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,WELLMED,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,HUMANA,MGD,88.92,,,,,,,per diem,88.92,88.92,"Per diem rate, code is bundled with other services"
MYCOPLASMA PNEUMONIAE         ,38302188,CDM,306,RC,87581,CPT,,,,Inpatient,,,88.92,88.92,HUMANA CHOICE PLUS,MGD,88.92,,,,,,,case rate,88.92,88.92,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,AETNA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,CIGNA,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,VA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,VA TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,WELLMED,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,HUMANA,MGD,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
METHADONE SCREEN              ,38303231,CDM,301,RC,80358,CPT,,,,Inpatient,,,220.63,220.63,HUMANA CHOICE PLUS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,AETNA,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,CIGNA,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,TRICARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,UNITED HEALTHCARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,UNITED HEALTHCARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,VA,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,VA TRICARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,WELLMED,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,HUMANA,MGD,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
URINE MICRO                   ,38303580,CDM,307,RC,81015,CPT,,,,Inpatient,,,17.14,17.14,HUMANA CHOICE PLUS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,AETNA,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,BCBS,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,CIGNA,COM,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,TRICARE,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,UNITED HEALTHCARE,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,UNITED HEALTHCARE,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,VA,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,VA TRICARE,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,WELLMED,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,HUMANA,MGD,372.76,,,,,,,per diem,372.76,372.76,"Per diem rate, code is bundled with other services"
RESPIRATORY VIRUS 12-25 TARG  ,38303652,CDM,306,RC,87633,CPT,,,,Inpatient,,,372.76,372.76,HUMANA CHOICE PLUS,MGD,372.76,,,,,,,case rate,372.76,372.76,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,AETNA,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,BCBS,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,CIGNA,COM,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,TRICARE,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,UNITED HEALTHCARE,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,UNITED HEALTHCARE,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,VA,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,VA TRICARE,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,WELLMED,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,HUMANA,MGD,55.8,,,,,,,per diem,55.8,55.8,"Per diem rate, code is bundled with other services"
"ALBUMIN, FLUID                ",38303777,CDM,301,RC,82042,CPT,,,,Inpatient,,,55.8,55.8,HUMANA CHOICE PLUS,MGD,55.8,,,,,,,case rate,55.8,55.8,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,AETNA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,BCBS,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,CIGNA,COM,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,UNITED HEALTHCARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,VA,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,VA TRICARE,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,WELLMED,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,HUMANA,MGD,79.25,,,,,,,per diem,79.25,79.25,"Per diem rate, code is bundled with other services"
TRAMADOL SCREEN               ,38305400,CDM,301,RC,80373,CPT,,,,Inpatient,,,79.25,79.25,HUMANA CHOICE PLUS,MGD,79.25,,,,,,,case rate,79.25,79.25,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,AETNA,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,BCBS,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,CIGNA,COM,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,TRICARE,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,UNITED HEALTHCARE,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,UNITED HEALTHCARE,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,VA,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,VA TRICARE,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,WELLMED,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,HUMANA,MGD,1478.4,,,,,,,per diem,1478.4,1478.4,"Per diem rate, code is bundled with other services"
CVC LINE PLACEMENT (PIC)      ,38500505,CDM,761,RC,36569,CPT,,,,Inpatient,,,1478.4,1478.4,HUMANA CHOICE PLUS,MGD,1478.4,,,,,,,case rate,1478.4,1478.4,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,AETNA,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,BCBS,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,CIGNA,COM,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,TRICARE,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,UNITED HEALTHCARE,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,UNITED HEALTHCARE,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,VA,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,VA TRICARE,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,WELLMED,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,HUMANA,MGD,2106.41,,,,,,,per diem,2106.41,2106.41,"Per diem rate, code is bundled with other services"
THORACENTESIS W/IMG GD        ,38501221,CDM,761,RC,32555,CPT,,,,Inpatient,,,2106.41,2106.41,HUMANA CHOICE PLUS,MGD,2106.41,,,,,,,case rate,2106.41,2106.41,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,AETNA,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,BCBS,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,CIGNA,COM,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,TRICARE,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,UNITED HEALTHCARE,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,UNITED HEALTHCARE,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,VA,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,VA TRICARE,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,WELLMED,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,HUMANA,MGD,1284.15,,,,,,,per diem,1284.15,1284.15,"Per diem rate, code is bundled with other services"
BRONCHOSCOPY DIAGNOSTIC       ,38504019,CDM,361,RC,31622,CPT,,,,Inpatient,,,1284.15,1284.15,HUMANA CHOICE PLUS,MGD,1284.15,,,,,,,case rate,1284.15,1284.15,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,AETNA,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,BCBS,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,CIGNA,COM,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,TRICARE,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,UNITED HEALTHCARE,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,UNITED HEALTHCARE,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,VA,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,VA TRICARE,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,WELLMED,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,HUMANA,MGD,1380.28,,,,,,,per diem,1380.28,1380.28,"Per diem rate, code is bundled with other services"
INSERT PICC LINE              ,38504029,CDM,761,RC,36569,CPT,,,,Inpatient,,,1380.28,1380.28,HUMANA CHOICE PLUS,MGD,1380.28,,,,,,,case rate,1380.28,1380.28,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,AETNA,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,BCBS,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,CIGNA,COM,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,TRICARE,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,UNITED HEALTHCARE,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,UNITED HEALTHCARE,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,VA,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,VA TRICARE,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,WELLMED,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,HUMANA,MGD,5698.6,,,,,,,per diem,5698.6,5698.6,"Per diem rate, code is bundled with other services"
INSERT VENA CAVA FILTER       ,38504035,CDM,761,RC,37191,CPT,,,,Inpatient,,,5698.6,5698.6,HUMANA CHOICE PLUS,MGD,5698.6,,,,,,,case rate,5698.6,5698.6,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,AETNA,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,BCBS,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,CIGNA,COM,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,TRICARE,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,UNITED HEALTHCARE,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,UNITED HEALTHCARE,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,VA,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,VA TRICARE,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,WELLMED,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,HUMANA,MGD,4611.76,,,,,,,per diem,4611.76,4611.76,"Per diem rate, code is bundled with other services"
EGD W/PEG TUBE PLCMT          ,38504061,CDM,750,RC,43246,CPT,,,,Inpatient,,,4611.76,4611.76,HUMANA CHOICE PLUS,MGD,4611.76,,,,,,,case rate,4611.76,4611.76,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,AETNA,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,CIGNA,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,TRICARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,UNITED HEALTHCARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,UNITED HEALTHCARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,VA,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,VA TRICARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,WELLMED,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,HUMANA,MGD,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
PEG PLCMT REQ PHYS/FLUOR      ,38504063,CDM,750,RC,43752,CPT,,,,Inpatient,,,384.3,384.3,HUMANA CHOICE PLUS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,AETNA,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,BCBS,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,CIGNA,COM,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,TRICARE,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,UNITED HEALTHCARE,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,UNITED HEALTHCARE,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,VA,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,VA TRICARE,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,WELLMED,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,HUMANA,MGD,1476.56,,,,,,,per diem,1476.56,1476.56,"Per diem rate, code is bundled with other services"
PEG CHANGE                    ,38504067,CDM,361,RC,43762,CPT,,,,Inpatient,,,1476.56,1476.56,HUMANA CHOICE PLUS,MGD,1476.56,,,,,,,case rate,1476.56,1476.56,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,AETNA,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,BCBS,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,CIGNA,COM,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,TRICARE,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,UNITED HEALTHCARE,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,UNITED HEALTHCARE,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,VA,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,VA TRICARE,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,WELLMED,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,HUMANA,MGD,3200.52,,,,,,,per diem,3200.52,3200.52,"Per diem rate, code is bundled with other services"
PLACE J/G TUBE W/FLUORO       ,38504085,CDM,761,RC,49440,CPT,,,,Inpatient,,,3200.52,3200.52,HUMANA CHOICE PLUS,MGD,3200.52,,,,,,,case rate,3200.52,3200.52,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,AETNA,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,BCBS,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,CIGNA,COM,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,TRICARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,UNITED HEALTHCARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,UNITED HEALTHCARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,VA,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,VA TRICARE,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,WELLMED,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,HUMANA,MGD,349.27,,,,,,,per diem,349.27,349.27,"Per diem rate, code is bundled with other services"
HEMO/COMPOSITE                ,38504086,CDM,761,RC,,,,,,Inpatient,,,349.27,349.27,HUMANA CHOICE PLUS,MGD,349.27,,,,,,,case rate,349.27,349.27,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,AETNA,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,BCBS,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,CIGNA,COM,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,TRICARE,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,UNITED HEALTHCARE,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,UNITED HEALTHCARE,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,VA,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,VA TRICARE,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,WELLMED,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,HUMANA,MGD,721.83,,,,,,,per diem,721.83,721.83,"Per diem rate, code is bundled with other services"
FRACTURE CARE INCL CAST -     ,38504087,CDM,761,RC,,,,,,Inpatient,,,721.83,721.83,HUMANA CHOICE PLUS,MGD,721.83,,,,,,,case rate,721.83,721.83,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,AETNA,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,BCBS,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,CIGNA,COM,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,TRICARE,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,UNITED HEALTHCARE,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,UNITED HEALTHCARE,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,VA,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,VA TRICARE,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,WELLMED,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,HUMANA,MGD,206.39,,,,,,,per diem,206.39,206.39,"Per diem rate, code is bundled with other services"
ESTABLISHED PAT - LEVEL 2     ,38504088,CDM,761,RC,,,,,,Inpatient,,,206.39,206.39,HUMANA CHOICE PLUS,MGD,206.39,,,,,,,case rate,206.39,206.39,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,AETNA,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,BCBS,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,CIGNA,COM,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,TRICARE,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,UNITED HEALTHCARE,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,UNITED HEALTHCARE,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,VA,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,VA TRICARE,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,WELLMED,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,HUMANA,MGD,907.05,,,,,,,per diem,907.05,907.05,"Per diem rate, code is bundled with other services"
DEBR SUBS TISS 1ST 20         ,38504089,CDM,761,RC,,,,,,Inpatient,,,907.05,907.05,HUMANA CHOICE PLUS,MGD,907.05,,,,,,,case rate,907.05,907.05,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,AETNA,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,BCBS,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,CIGNA,COM,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,TRICARE,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,UNITED HEALTHCARE,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,UNITED HEALTHCARE,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,VA,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,VA TRICARE,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,WELLMED,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,HUMANA,MGD,822.38,,,,,,,per diem,822.38,822.38,"Per diem rate, code is bundled with other services"
DEBRID SUBC TISS/ADD 20 S     ,38504090,CDM,761,RC,,,,,,Inpatient,,,822.38,822.38,HUMANA CHOICE PLUS,MGD,822.38,,,,,,,case rate,822.38,822.38,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,AETNA,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,BCBS,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,CIGNA,COM,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,TRICARE,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,UNITED HEALTHCARE,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,UNITED HEALTHCARE,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,VA,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,VA TRICARE,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,WELLMED,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,HUMANA,MGD,2457.61,,,,,,,per diem,2457.61,2457.61,"Per diem rate, code is bundled with other services"
"DEBRIB, BONE, EACH ADD 20     ",38504091,CDM,761,RC,,,,,,Inpatient,,,2457.61,2457.61,HUMANA CHOICE PLUS,MGD,2457.61,,,,,,,case rate,2457.61,2457.61,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,AETNA,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,BCBS,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,CIGNA,COM,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,TRICARE,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,UNITED HEALTHCARE,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,UNITED HEALTHCARE,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,VA,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,VA TRICARE,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,WELLMED,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,HUMANA,MGD,520.8,,,,,,,per diem,520.8,520.8,"Per diem rate, code is bundled with other services"
OP VISIT LEVEL III E          ,38504093,CDM,761,RC,,,,,,Inpatient,,,520.8,520.8,HUMANA CHOICE PLUS,MGD,520.8,,,,,,,case rate,520.8,520.8,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,AETNA,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,BCBS,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,CIGNA,COM,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,TRICARE,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,UNITED HEALTHCARE,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,UNITED HEALTHCARE,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,VA,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,VA TRICARE,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,WELLMED,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,HUMANA,MGD,1575,,,,,,,per diem,1575,1575,"Per diem rate, code is bundled with other services"
RAD MODIFIED BARIUM SWALLOW   ,38504096,CDM,750,RC,,,,,,Inpatient,,,1575,1575,HUMANA CHOICE PLUS,MGD,1575,,,,,,,case rate,1575,1575,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,AETNA,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,BCBS,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,CIGNA,COM,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,TRICARE,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,UNITED HEALTHCARE,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,UNITED HEALTHCARE,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,VA,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,VA TRICARE,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,WELLMED,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,HUMANA,MGD,297.41,,,,,,,per diem,297.41,297.41,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY              ,39200210,CDM,730,RC,93005,CPT,,,,Inpatient,,,297.41,297.41,HUMANA CHOICE PLUS,MGD,297.41,,,,,,,case rate,297.41,297.41,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,AETNA,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,BCBS,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,CIGNA,COM,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,TRICARE,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,UNITED HEALTHCARE,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,UNITED HEALTHCARE,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,VA,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,VA TRICARE,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,WELLMED,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,HUMANA,MGD,2154.89,,,,,,,per diem,2154.89,2154.89,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/DOPPLER     ,39200257,CDM,480,RC,93306,CPT,,,,Inpatient,,,2154.89,2154.89,HUMANA CHOICE PLUS,MGD,2154.89,,,,,,,case rate,2154.89,2154.89,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,AETNA,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,BCBS,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,CIGNA,COM,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,TRICARE,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,UNITED HEALTHCARE,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,UNITED HEALTHCARE,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,VA,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,VA TRICARE,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,WELLMED,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,HUMANA,MGD,1332.64,,,,,,,per diem,1332.64,1332.64,"Per diem rate, code is bundled with other services"
ECHO 2-D&M-MODE W/IMAGE       ,39200259,CDM,483,RC,93350,CPT,,,,Inpatient,,,1332.64,1332.64,HUMANA CHOICE PLUS,MGD,1332.64,,,,,,,case rate,1332.64,1332.64,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,AETNA,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,BCBS,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,CIGNA,COM,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,TRICARE,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,UNITED HEALTHCARE,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,UNITED HEALTHCARE,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,VA,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,VA TRICARE,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,WELLMED,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,HUMANA,MGD,514.29,,,,,,,per diem,514.29,514.29,"Per diem rate, code is bundled with other services"
EKG                           ,39200261,CDM,730,RC,93000,CPT,,,,Inpatient,,,514.29,514.29,HUMANA CHOICE PLUS,MGD,514.29,,,,,,,case rate,514.29,514.29,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,AETNA,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,BCBS,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,CIGNA,COM,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,TRICARE,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,UNITED HEALTHCARE,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,UNITED HEALTHCARE,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,VA,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,VA TRICARE,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,WELLMED,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,HUMANA,MGD,174.76,,,,,,,per diem,174.76,174.76,"Per diem rate, code is bundled with other services"
HC PHASE1 RECOVERY PER 30     ,39200263,CDM,760,RC,,,,,,Inpatient,,,174.76,174.76,HUMANA CHOICE PLUS,MGD,174.76,,,,,,,case rate,174.76,174.76,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,AETNA,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,BCBS,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,CIGNA,COM,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,TRICARE,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,UNITED HEALTHCARE,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,UNITED HEALTHCARE,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,VA,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,VA TRICARE,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,WELLMED,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,HUMANA,MGD,212.14,,,,,,,per diem,212.14,212.14,"Per diem rate, code is bundled with other services"
HC WND EST EVAL/MANAGE LE     ,39200264,CDM,761,RC,,,,,,Inpatient,,,212.14,212.14,HUMANA CHOICE PLUS,MGD,212.14,,,,,,,case rate,212.14,212.14,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,AETNA,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,BCBS,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,CIGNA,COM,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,TRICARE,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,UNITED HEALTHCARE,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,UNITED HEALTHCARE,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,VA,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,VA TRICARE,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,WELLMED,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,HUMANA,MGD,151.73,,,,,,,per diem,151.73,151.73,"Per diem rate, code is bundled with other services"
EKG RHYTHUM STRIP WL RT       ,39200271,CDM,730,RC,,,,,,Inpatient,,,151.73,151.73,HUMANA CHOICE PLUS,MGD,151.73,,,,,,,case rate,151.73,151.73,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,AETNA,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,BCBS,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,CIGNA,COM,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,TRICARE,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,UNITED HEALTHCARE,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,UNITED HEALTHCARE,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,VA,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,VA TRICARE,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,WELLMED,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,HUMANA,MGD,1567.95,,,,,,,per diem,1567.95,1567.95,"Per diem rate, code is bundled with other services"
24 HOUR HOLTER HOOK-UP WL RT  ,39200272,CDM,731,RC,,,,,,Inpatient,,,1567.95,1567.95,HUMANA CHOICE PLUS,MGD,1567.95,,,,,,,case rate,1567.95,1567.95,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,AETNA,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,BCBS,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,CIGNA,COM,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,TRICARE,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,UNITED HEALTHCARE,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,UNITED HEALTHCARE,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,VA,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,VA TRICARE,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,WELLMED,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,HUMANA,MGD,814.98,,,,,,,per diem,814.98,814.98,"Per diem rate, code is bundled with other services"
EKG - 24 HR (HOLTER MONITOR)  ,39200274,CDM,731,RC,93225,CPT,,,,Inpatient,,,814.98,814.98,HUMANA CHOICE PLUS,MGD,814.98,,,,,,,case rate,814.98,814.98,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,AETNA,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,BCBS,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,CIGNA,COM,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,TRICARE,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,UNITED HEALTHCARE,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,UNITED HEALTHCARE,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,VA,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,VA TRICARE,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,WELLMED,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,HUMANA,MGD,2.63,,,,,,,per diem,2.63,2.63,"Per diem rate, code is bundled with other services"
PROPRANOLOL TAB 5MG           ,39228890,CDM,250,RC,,,,,,Inpatient,1,EA,2.63,2.63,HUMANA CHOICE PLUS,MGD,2.63,,,,,,,case rate,2.63,2.63,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,AETNA,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,BCBS,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,CIGNA,COM,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,TRICARE,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,UNITED HEALTHCARE,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,UNITED HEALTHCARE,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,VA,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,VA TRICARE,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,WELLMED,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,HUMANA,MGD,23.12,,,,,,,per diem,23.12,23.12,"Per diem rate, code is bundled with other services"
MENTHOL GEL 118ML 4% GEL      ,39228891,CDM,250,RC,,,,,,Inpatient,1,EA,23.12,23.12,HUMANA CHOICE PLUS,MGD,23.12,,,,,,,case rate,23.12,23.12,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,AETNA,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,BCBS,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,CIGNA,COM,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,TRICARE,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,UNITED HEALTHCARE,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,UNITED HEALTHCARE,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,VA,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,VA TRICARE,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,WELLMED,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,HUMANA,MGD,8276.34,,,,,,,per diem,8276.34,8276.34,"Per diem rate, code is bundled with other services"
CV CATH TUNNEL WO SQ PORT >   ,61010012,CDM,761,RC,36558,CPT,,,,Inpatient,,,8276.34,8276.34,HUMANA CHOICE PLUS,MGD,8276.34,,,,,,,case rate,8276.34,8276.34,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,AETNA,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,BCBS,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,CIGNA,COM,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,TRICARE,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,UNITED HEALTHCARE,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,UNITED HEALTHCARE,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,VA,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,VA TRICARE,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,WELLMED,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,HUMANA,MGD,711.67,,,,,,,per diem,711.67,711.67,"Per diem rate, code is bundled with other services"
DECLOT VASCULAR DEVICE        ,61010205,CDM,761,RC,36593,CPT,,,,Inpatient,,,711.67,711.67,HUMANA CHOICE PLUS,MGD,711.67,,,,,,,case rate,711.67,711.67,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,AETNA,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,CIGNA,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,TRICARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,UNITED HEALTHCARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,UNITED HEALTHCARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,VA,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,VA TRICARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,WELLMED,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,HUMANA,MGD,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REPLACE CENT VEN CATH TUNNELED,61010209,CDM,761,RC,36581,CPT,,,,Inpatient,,,2324.11,2324.11,HUMANA CHOICE PLUS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,AETNA,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,BCBS,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,CIGNA,COM,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,TRICARE,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,UNITED HEALTHCARE,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,UNITED HEALTHCARE,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,VA,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,VA TRICARE,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,WELLMED,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,HUMANA,MGD,669.9,,,,,,,per diem,669.9,669.9,"Per diem rate, code is bundled with other services"
PICC INSERT MIDLINE           ,61010211,CDM,361,RC,36410,CPT,,,,Inpatient,,,669.9,669.9,HUMANA CHOICE PLUS,MGD,669.9,,,,,,,case rate,669.9,669.9,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,AETNA,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,BCBS,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,CIGNA,COM,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,TRICARE,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,UNITED HEALTHCARE,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,UNITED HEALTHCARE,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,VA,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,VA TRICARE,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,WELLMED,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,HUMANA,MGD,499.35,,,,,,,per diem,499.35,499.35,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTIC    ,61010312,CDM,360,RC,62270,CPT,,,,Inpatient,,,499.35,499.35,HUMANA CHOICE PLUS,MGD,499.35,,,,,,,case rate,499.35,499.35,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,AETNA,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,BCBS,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,CIGNA,COM,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,TRICARE,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,UNITED HEALTHCARE,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,UNITED HEALTHCARE,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,VA,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,VA TRICARE,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,WELLMED,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,HUMANA,MGD,929.27,,,,,,,per diem,929.27,929.27,"Per diem rate, code is bundled with other services"
ER - IV                       ,67001001,CDM,450,RC,,,,,,Inpatient,,,929.27,929.27,HUMANA CHOICE PLUS,MGD,929.27,,,,,,,case rate,929.27,929.27,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,AETNA,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,BCBS,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,CIGNA,COM,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,TRICARE,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,UNITED HEALTHCARE,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,UNITED HEALTHCARE,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,VA,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,VA TRICARE,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,WELLMED,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,HUMANA,MGD,1807.16,,,,,,,per diem,1807.16,1807.16,"Per diem rate, code is bundled with other services"
ER - V                        ,67001002,CDM,450,RC,,,,,,Inpatient,,,1807.16,1807.16,HUMANA CHOICE PLUS,MGD,1807.16,,,,,,,case rate,1807.16,1807.16,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,AETNA,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,BCBS,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,CIGNA,COM,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,TRICARE,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,UNITED HEALTHCARE,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,UNITED HEALTHCARE,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,VA,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,VA TRICARE,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,WELLMED,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,HUMANA,MGD,1606.83,,,,,,,per diem,1606.83,1606.83,"Per diem rate, code is bundled with other services"
ER - V                        ,67001003,CDM,450,RC,,,,,,Inpatient,,,1606.83,1606.83,HUMANA CHOICE PLUS,MGD,1606.83,,,,,,,case rate,1606.83,1606.83,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,AETNA,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,BCBS,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,CIGNA,COM,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,TRICARE,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,UNITED HEALTHCARE,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,UNITED HEALTHCARE,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,VA,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,VA TRICARE,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,WELLMED,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,HUMANA,MGD,1092,,,,,,,per diem,1092,1092,"Per diem rate, code is bundled with other services"
EMERGENCY ROOM VISIT          ,67001004,CDM,450,RC,,,,,,Inpatient,,,1092,1092,HUMANA CHOICE PLUS,MGD,1092,,,,,,,case rate,1092,1092,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,AETNA,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,BCBS,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,CIGNA,COM,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,TRICARE,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,UNITED HEALTHCARE,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,UNITED HEALTHCARE,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,VA,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,VA TRICARE,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,WELLMED,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,HUMANA,MGD,1368.15,,,,,,,per diem,1368.15,1368.15,"Per diem rate, code is bundled with other services"
ED VISIT CARE LEVEL           ,67001006,CDM,450,RC,,,,,,Inpatient,,,1368.15,1368.15,HUMANA CHOICE PLUS,MGD,1368.15,,,,,,,case rate,1368.15,1368.15,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,AETNA,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,CIGNA,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,TRICARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,UNITED HEALTHCARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,UNITED HEALTHCARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,VA,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,VA TRICARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,WELLMED,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,HUMANA,MGD,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
RENAL-HEMODIALYSIS            ,68000100,CDM,801,RC,90935,CPT,,,,Inpatient,,,648.9,648.9,HUMANA CHOICE PLUS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,AETNA,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,BCBS,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,CIGNA,COM,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,TRICARE,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,UNITED HEALTHCARE,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,UNITED HEALTHCARE,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,VA,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,VA TRICARE,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,WELLMED,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,HUMANA,MGD,821.65,,,,,,,per diem,821.65,821.65,"Per diem rate, code is bundled with other services"
PERITONEAL DIALYSIS           ,68000300,CDM,802,RC,90945,CPT,,,,Inpatient,,,821.65,821.65,HUMANA CHOICE PLUS,MGD,821.65,,,,,,,case rate,821.65,821.65,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,AETNA,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,BCBS,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,CIGNA,COM,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,TRICARE,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,UNITED HEALTHCARE,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,UNITED HEALTHCARE,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,VA,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,VA TRICARE,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,WELLMED,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,HUMANA,MGD,2054.08,,,,,,,per diem,2054.08,2054.08,"Per diem rate, code is bundled with other services"
ACUTE DIALYSIS INPATIENT      ,68000453,CDM,801,RC,,,,,,Inpatient,,,2054.08,2054.08,HUMANA CHOICE PLUS,MGD,2054.08,,,,,,,case rate,2054.08,2054.08,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,AETNA,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,BCBS,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,CIGNA,COM,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,TRICARE,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,UNITED HEALTHCARE,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,UNITED HEALTHCARE,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,VA,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,VA TRICARE,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,WELLMED,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,HUMANA,MGD,425.99,,,,,,,per diem,425.99,425.99,"Per diem rate, code is bundled with other services"
HEMODIALYSIS MISC CHRGS       ,68000454,CDM,800,RC,,,,,,Inpatient,,,425.99,425.99,HUMANA CHOICE PLUS,MGD,425.99,,,,,,,case rate,425.99,425.99,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,AETNA,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,BCBS,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,CIGNA,COM,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,TRICARE,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,UNITED HEALTHCARE,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,UNITED HEALTHCARE,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,VA,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,VA TRICARE,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,WELLMED,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,HUMANA,MGD,1494.66,,,,,,,per diem,1494.66,1494.66,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000455,CDM,801,RC,,,,,,Inpatient,,,1494.66,1494.66,HUMANA CHOICE PLUS,MGD,1494.66,,,,,,,case rate,1494.66,1494.66,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,AETNA,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,BCBS,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,CIGNA,COM,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,TRICARE,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,UNITED HEALTHCARE,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,UNITED HEALTHCARE,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,VA,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,VA TRICARE,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,WELLMED,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,HUMANA,MGD,663.01,,,,,,,per diem,663.01,663.01,"Per diem rate, code is bundled with other services"
HEMODIALYSIS                  ,68000456,CDM,801,RC,90937,CPT,,,,Inpatient,,,663.01,663.01,HUMANA CHOICE PLUS,MGD,663.01,,,,,,,case rate,663.01,663.01,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,AETNA,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,BCBS,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,CIGNA,COM,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,TRICARE,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,UNITED HEALTHCARE,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,UNITED HEALTHCARE,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,VA,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,VA TRICARE,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,WELLMED,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,HUMANA,MGD,1340.15,,,,,,,per diem,1340.15,1340.15,"Per diem rate, code is bundled with other services"
HEMODIALYSIS BED SIDE         ,68000457,CDM,801,RC,,,,,,Inpatient,,,1340.15,1340.15,HUMANA CHOICE PLUS,MGD,1340.15,,,,,,,case rate,1340.15,1340.15,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,AETNA,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,BCBS,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,CIGNA,COM,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,TRICARE,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,UNITED HEALTHCARE,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,UNITED HEALTHCARE,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,VA,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,VA TRICARE,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,WELLMED,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,HUMANA,MGD,787.9,,,,,,,per diem,787.9,787.9,"Per diem rate, code is bundled with other services"
CCPD                          ,68000458,CDM,804,RC,90947,CPT,,,,Inpatient,,,787.9,787.9,HUMANA CHOICE PLUS,MGD,787.9,,,,,,,case rate,787.9,787.9,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,AETNA,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,BCBS,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,CIGNA,COM,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,TRICARE,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,UNITED HEALTHCARE,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,UNITED HEALTHCARE,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,VA,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,VA TRICARE,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,WELLMED,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,HUMANA,MGD,221.77,,,,,,,per diem,221.77,221.77,"Per diem rate, code is bundled with other services"
HEMODIALYSIS - ADDL CHARGES   ,68000459,CDM,801,RC,,,,,,Inpatient,,,221.77,221.77,HUMANA CHOICE PLUS,MGD,221.77,,,,,,,case rate,221.77,221.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,AETNA,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,BCBS,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,CIGNA,COM,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,TRICARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,UNITED HEALTHCARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,UNITED HEALTHCARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,VA,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,VA TRICARE,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,WELLMED,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,HUMANA,MGD,1701.77,,,,,,,per diem,1701.77,1701.77,"Per diem rate, code is bundled with other services"
HEMO HRS 0700-1900            ,68000460,CDM,801,RC,,,,,,Inpatient,,,1701.77,1701.77,HUMANA CHOICE PLUS,MGD,1701.77,,,,,,,case rate,1701.77,1701.77,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,AETNA,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,BCBS,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,CIGNA,COM,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,TRICARE,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,UNITED HEALTHCARE,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,UNITED HEALTHCARE,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,VA,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,VA TRICARE,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,WELLMED,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,HUMANA,MGD,487.46,,,,,,,per diem,487.46,487.46,"Per diem rate, code is bundled with other services"
HEMO HRS 1900-0700            ,68000461,CDM,801,RC,,,,,,Inpatient,,,487.46,487.46,HUMANA CHOICE PLUS,MGD,487.46,,,,,,,case rate,487.46,487.46,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,AETNA,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,BCBS,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,CIGNA,COM,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,TRICARE,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,UNITED HEALTHCARE,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,UNITED HEALTHCARE,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,VA,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,VA TRICARE,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,WELLMED,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,HUMANA,MGD,360.15,,,,,,,per diem,360.15,360.15,"Per diem rate, code is bundled with other services"
CAPD                          ,68000462,CDM,801,RC,,,,,,Inpatient,,,360.15,360.15,HUMANA CHOICE PLUS,MGD,360.15,,,,,,,case rate,360.15,360.15,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,AETNA,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,CIGNA,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,TRICARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,UNITED HEALTHCARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,UNITED HEALTHCARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,VA,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,VA TRICARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,WELLMED,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,HUMANA,MGD,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
HIGH FLUX DIALYZER            ,68000463,CDM,801,RC,,,,,,Inpatient,,,90.56,90.56,HUMANA CHOICE PLUS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,AETNA,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,BCBS,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,CIGNA,COM,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,TRICARE,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,UNITED HEALTHCARE,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,UNITED HEALTHCARE,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,VA,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,VA TRICARE,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,WELLMED,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,HUMANA,MGD,212.72,,,,,,,per diem,212.72,212.72,"Per diem rate, code is bundled with other services"
HEMO EXCESS TIME (1 OR MORE HR,68000465,CDM,801,RC,,,,,,Inpatient,,,212.72,212.72,HUMANA CHOICE PLUS,MGD,212.72,,,,,,,case rate,212.72,212.72,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,AETNA,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,BCBS,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,CIGNA,COM,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,TRICARE,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,UNITED HEALTHCARE,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,UNITED HEALTHCARE,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,VA,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,VA TRICARE,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,WELLMED,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,HUMANA,MGD,1483.31,,,,,,,per diem,1483.31,1483.31,"Per diem rate, code is bundled with other services"
CCPD-AFTER HOURS SUNDAY HOL   ,68000466,CDM,804,RC,,,,,,Inpatient,,,1483.31,1483.31,HUMANA CHOICE PLUS,MGD,1483.31,,,,,,,case rate,1483.31,1483.31,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,AETNA,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,BCBS,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,CIGNA,COM,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,TRICARE,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,UNITED HEALTHCARE,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,UNITED HEALTHCARE,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,VA,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,VA TRICARE,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,WELLMED,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,HUMANA,MGD,846.29,,,,,,,per diem,846.29,846.29,"Per diem rate, code is bundled with other services"
CCPD CANCELED AFTER SET UP    ,68000467,CDM,804,RC,,,,,,Inpatient,,,846.29,846.29,HUMANA CHOICE PLUS,MGD,846.29,,,,,,,case rate,846.29,846.29,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,AETNA,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,BCBS,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,CIGNA,COM,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,TRICARE,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,UNITED HEALTHCARE,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,UNITED HEALTHCARE,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,VA,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,VA TRICARE,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,WELLMED,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,HUMANA,MGD,390.56,,,,,,,per diem,390.56,390.56,"Per diem rate, code is bundled with other services"
CCPD CANCELLED BEFORE SETUP   ,68000468,CDM,804,RC,,,,,,Inpatient,,,390.56,390.56,HUMANA CHOICE PLUS,MGD,390.56,,,,,,,case rate,390.56,390.56,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,AETNA,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,BCBS,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,CIGNA,COM,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,TRICARE,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,UNITED HEALTHCARE,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,UNITED HEALTHCARE,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,VA,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,VA TRICARE,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,WELLMED,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,HUMANA,MGD,1830.4,,,,,,,per diem,1830.4,1830.4,"Per diem rate, code is bundled with other services"
HEMODIALYSIS AFTER HOURS      ,68000469,CDM,801,RC,90937,CPT,,,,Inpatient,,,1830.4,1830.4,HUMANA CHOICE PLUS,MGD,1830.4,,,,,,,case rate,1830.4,1830.4,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,AETNA,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,BCBS,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,CIGNA,COM,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,TRICARE,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,UNITED HEALTHCARE,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,UNITED HEALTHCARE,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,VA,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,VA TRICARE,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,WELLMED,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,HUMANA,MGD,1771.88,,,,,,,per diem,1771.88,1771.88,"Per diem rate, code is bundled with other services"
DIALYSIS - WEEKEND            ,68000470,CDM,801,RC,,,,,,Inpatient,,,1771.88,1771.88,HUMANA CHOICE PLUS,MGD,1771.88,,,,,,,case rate,1771.88,1771.88,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,AETNA,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,BCBS,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,CIGNA,COM,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,TRICARE,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,UNITED HEALTHCARE,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,UNITED HEALTHCARE,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,VA,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,VA TRICARE,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,WELLMED,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,HUMANA,MGD,2008.13,,,,,,,per diem,2008.13,2008.13,"Per diem rate, code is bundled with other services"
DIALYSIS - HOLIDAY            ,68000471,CDM,801,RC,,,,,,Inpatient,,,2008.13,2008.13,HUMANA CHOICE PLUS,MGD,2008.13,,,,,,,case rate,2008.13,2008.13,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,AETNA,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,BCBS,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,CIGNA,COM,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,TRICARE,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,UNITED HEALTHCARE,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,UNITED HEALTHCARE,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,VA,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,VA TRICARE,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,WELLMED,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,HUMANA,MGD,1890,,,,,,,per diem,1890,1890,"Per diem rate, code is bundled with other services"
TABLO - HEMODIALYSIS          ,68000601,CDM,801,RC,,,,,,Inpatient,,,1890,1890,HUMANA CHOICE PLUS,MGD,1890,,,,,,,case rate,1890,1890,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,AETNA,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,BCBS,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,CIGNA,COM,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,TRICARE,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,UNITED HEALTHCARE,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,UNITED HEALTHCARE,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,VA,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,VA TRICARE,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,WELLMED,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,HUMANA,MGD,1417.5,,,,,,,per diem,1417.5,1417.5,"Per diem rate, code is bundled with other services"
TABLO - PERITONEAL DIALYSIS   ,68000602,CDM,802,RC,,,,,,Inpatient,,,1417.5,1417.5,HUMANA CHOICE PLUS,MGD,1417.5,,,,,,,case rate,1417.5,1417.5,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,AETNA,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,BCBS,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,CIGNA,COM,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,TRICARE,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,UNITED HEALTHCARE,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,UNITED HEALTHCARE,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,VA,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,VA TRICARE,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,WELLMED,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,HUMANA,MGD,243.08,,,,,,,per diem,243.08,243.08,"Per diem rate, code is bundled with other services"
ANTIBODY IDENT EACH PANEL     ,72000020,CDM,300,RC,86870,CPT,,,,Inpatient,,,243.08,243.08,HUMANA CHOICE PLUS,MGD,243.08,,,,,,,case rate,243.08,243.08,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,AETNA,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,BCBS,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,CIGNA,COM,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,TRICARE,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,UNITED HEALTHCARE,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,UNITED HEALTHCARE,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,VA,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,VA TRICARE,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,WELLMED,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,HUMANA,MGD,208.98,,,,,,,per diem,208.98,208.98,"Per diem rate, code is bundled with other services"
ANTIBODY SCREEN               ,72000025,CDM,300,RC,86850,CPT,,,,Inpatient,,,208.98,208.98,HUMANA CHOICE PLUS,MGD,208.98,,,,,,,case rate,208.98,208.98,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,AETNA,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,CIGNA,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,TRICARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,UNITED HEALTHCARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,UNITED HEALTHCARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,VA,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,VA TRICARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,WELLMED,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,HUMANA,MGD,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
COMPONENT POOLING             ,72000085,CDM,300,RC,86965,CPT,,,,Inpatient,,,175.35,175.35,HUMANA CHOICE PLUS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,AETNA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,BCBS,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,CIGNA,COM,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,UNITED HEALTHCARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,VA,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,VA TRICARE,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,WELLMED,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,HUMANA,MGD,88.68,,,,,,,per diem,88.68,88.68,"Per diem rate, code is bundled with other services"
COOMBS DIRECT                 ,72000090,CDM,300,RC,86880,CPT,,,,Inpatient,,,88.68,88.68,HUMANA CHOICE PLUS,MGD,88.68,,,,,,,case rate,88.68,88.68,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,AETNA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,BCBS,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,CIGNA,COM,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,UNITED HEALTHCARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,VA,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,VA TRICARE,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,WELLMED,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,HUMANA,MGD,103.95,,,,,,,per diem,103.95,103.95,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT               ,72000100,CDM,300,RC,86885,CPT,,,,Inpatient,,,103.95,103.95,HUMANA CHOICE PLUS,MGD,103.95,,,,,,,case rate,103.95,103.95,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,AETNA,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,BCBS,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,CIGNA,COM,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,TRICARE,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,UNITED HEALTHCARE,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,UNITED HEALTHCARE,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,VA,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,VA TRICARE,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,WELLMED,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,HUMANA,MGD,79.5,,,,,,,per diem,79.5,79.5,"Per diem rate, code is bundled with other services"
CROSSMATCH ANTIGLOBIN         ,72000120,CDM,300,RC,86922,CPT,,,,Inpatient,,,79.5,79.5,HUMANA CHOICE PLUS,MGD,79.5,,,,,,,case rate,79.5,79.5,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,AETNA,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,BCBS,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,CIGNA,COM,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,TRICARE,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,UNITED HEALTHCARE,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,UNITED HEALTHCARE,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,VA,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,VA TRICARE,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,WELLMED,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,HUMANA,MGD,206.76,,,,,,,per diem,206.76,206.76,"Per diem rate, code is bundled with other services"
FFP THAWING PREP              ,72000140,CDM,300,RC,86927,CPT,,,,Inpatient,,,206.76,206.76,HUMANA CHOICE PLUS,MGD,206.76,,,,,,,case rate,206.76,206.76,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,AETNA,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,BCBS,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,CIGNA,COM,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,TRICARE,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,UNITED HEALTHCARE,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,UNITED HEALTHCARE,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,VA,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,VA TRICARE,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,WELLMED,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,HUMANA,MGD,294.28,,,,,,,per diem,294.28,294.28,"Per diem rate, code is bundled with other services"
TRANS-REACTION INVESTIGAT     ,72000228,CDM,305,RC,86078,CPT,,,,Inpatient,,,294.28,294.28,HUMANA CHOICE PLUS,MGD,294.28,,,,,,,case rate,294.28,294.28,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,AETNA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,BCBS,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,CIGNA,COM,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,UNITED HEALTHCARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,VA,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,VA TRICARE,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,WELLMED,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA,MGD,84,,,,,,,per diem,84,84,"Per diem rate, code is bundled with other services"
TYPE AND SCREEN               ,72000230,CDM,300,RC,86900,CPT,,,,Inpatient,,,84,84,HUMANA CHOICE PLUS,MGD,84,,,,,,,case rate,84,84,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,AETNA,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,BCBS,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,CIGNA,COM,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,TRICARE,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,UNITED HEALTHCARE,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,UNITED HEALTHCARE,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,VA,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,VA TRICARE,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,WELLMED,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,HUMANA,MGD,90.18,,,,,,,per diem,90.18,90.18,"Per diem rate, code is bundled with other services"
RH PHENOTYPING                ,72000280,CDM,300,RC,86906,CPT,,,,Inpatient,,,90.18,90.18,HUMANA CHOICE PLUS,MGD,90.18,,,,,,,case rate,90.18,90.18,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,AETNA,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,BCBS,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,CIGNA,COM,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,TRICARE,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,UNITED HEALTHCARE,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,UNITED HEALTHCARE,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,VA,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,VA TRICARE,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,WELLMED,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,HUMANA,MGD,200.9,,,,,,,per diem,200.9,200.9,"Per diem rate, code is bundled with other services"
ANTIGEN TYPE (RBC)            ,72000300,CDM,300,RC,86905,CPT,,,,Inpatient,,,200.9,200.9,HUMANA CHOICE PLUS,MGD,200.9,,,,,,,case rate,200.9,200.9,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,AETNA,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,BCBS,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,CIGNA,COM,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,TRICARE,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,UNITED HEALTHCARE,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,UNITED HEALTHCARE,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,VA,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,VA TRICARE,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,WELLMED,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,HUMANA,MGD,85.98,,,,,,,per diem,85.98,85.98,"Per diem rate, code is bundled with other services"
RBC ELUTION                   ,72000310,CDM,300,RC,86860,CPT,,,,Inpatient,,,85.98,85.98,HUMANA CHOICE PLUS,MGD,85.98,,,,,,,case rate,85.98,85.98,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,AETNA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,BCBS,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,CIGNA,COM,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,UNITED HEALTHCARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,VA,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,VA TRICARE,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,WELLMED,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,HUMANA,MGD,168.15,,,,,,,per diem,168.15,168.15,"Per diem rate, code is bundled with other services"
RBC PRETREAT DIFF RED CELL ABS,72000355,CDM,300,RC,86978,CPT,,,,Inpatient,,,168.15,168.15,HUMANA CHOICE PLUS,MGD,168.15,,,,,,,case rate,168.15,168.15,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,AETNA,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,BCBS,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,CIGNA,COM,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,TRICARE,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,UNITED HEALTHCARE,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,UNITED HEALTHCARE,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,VA,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,VA TRICARE,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,WELLMED,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,HUMANA,MGD,221.97,,,,,,,per diem,221.97,221.97,"Per diem rate, code is bundled with other services"
BLOOD TYPING ABO              ,72000525,CDM,300,RC,86900,CPT,,,,Inpatient,,,221.97,221.97,HUMANA CHOICE PLUS,MGD,221.97,,,,,,,case rate,221.97,221.97,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,AETNA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,BCBS,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,CIGNA,COM,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,UNITED HEALTHCARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,VA,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,VA TRICARE,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,WELLMED,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,HUMANA,MGD,97.46,,,,,,,per diem,97.46,97.46,"Per diem rate, code is bundled with other services"
ANTIBODY ID/ENZYMES           ,72000535,CDM,300,RC,86971,CPT,,,,Inpatient,,,97.46,97.46,HUMANA CHOICE PLUS,MGD,97.46,,,,,,,case rate,97.46,97.46,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,AETNA,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,BCBS,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,CIGNA,COM,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,TRICARE,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,UNITED HEALTHCARE,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,UNITED HEALTHCARE,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,VA,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,VA TRICARE,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,WELLMED,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,HUMANA,MGD,746.24,,,,,,,per diem,746.24,746.24,"Per diem rate, code is bundled with other services"
ANTIGEN SCREENING (REAGENT)   ,72000540,CDM,300,RC,86902,CPT,,,,Inpatient,,,746.24,746.24,HUMANA CHOICE PLUS,MGD,746.24,,,,,,,case rate,746.24,746.24,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,AETNA,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,BCBS,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,CIGNA,COM,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,TRICARE,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,UNITED HEALTHCARE,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,UNITED HEALTHCARE,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,VA,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,VA TRICARE,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,WELLMED,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,HUMANA,MGD,85.12,,,,,,,per diem,85.12,85.12,"Per diem rate, code is bundled with other services"
RH TYPING                     ,72000615,CDM,300,RC,86901,CPT,,,,Inpatient,,,85.12,85.12,HUMANA CHOICE PLUS,MGD,85.12,,,,,,,case rate,85.12,85.12,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,AETNA,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,BCBS,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,CIGNA,COM,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,TRICARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,UNITED HEALTHCARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,UNITED HEALTHCARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,VA,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,VA TRICARE,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,WELLMED,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,HUMANA,MGD,88.2,,,,,,,per diem,88.2,88.2,"Per diem rate, code is bundled with other services"
IGG COOMBS INT                ,72000745,CDM,302,RC,86880,CPT,,,,Inpatient,,,88.2,88.2,HUMANA CHOICE PLUS,MGD,88.2,,,,,,,case rate,88.2,88.2,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,AETNA,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,BCBS,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,CIGNA,COM,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,TRICARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,UNITED HEALTHCARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,UNITED HEALTHCARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,VA,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,VA TRICARE,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,WELLMED,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,HUMANA,MGD,175.35,,,,,,,per diem,175.35,175.35,"Per diem rate, code is bundled with other services"
CROSSMATCH IMMEDIATE SPIN     ,72000765,CDM,300,RC,86920,CPT,,,,Inpatient,,,175.35,175.35,HUMANA CHOICE PLUS,MGD,175.35,,,,,,,case rate,175.35,175.35,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,AETNA,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,BCBS,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,CIGNA,COM,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,TRICARE,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,UNITED HEALTHCARE,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,UNITED HEALTHCARE,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,VA,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,VA TRICARE,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,WELLMED,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,HUMANA,MGD,109.77,,,,,,,per diem,109.77,109.77,"Per diem rate, code is bundled with other services"
DIRECT ANTIGLOBULIN TEST (EA) ,72000770,CDM,300,RC,86880,CPT,,,,Inpatient,,,109.77,109.77,HUMANA CHOICE PLUS,MGD,109.77,,,,,,,case rate,109.77,109.77,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,AETNA,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,BCBS,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,CIGNA,COM,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,TRICARE,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,UNITED HEALTHCARE,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,UNITED HEALTHCARE,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,VA,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,VA TRICARE,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,WELLMED,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,HUMANA,MGD,45.39,,,,,,,per diem,45.39,45.39,"Per diem rate, code is bundled with other services"
PLATELET ANTIBODY ID          ,72000800,CDM,302,RC,86022,CPT,,,,Inpatient,,,45.39,45.39,HUMANA CHOICE PLUS,MGD,45.39,,,,,,,case rate,45.39,45.39,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,AETNA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,CIGNA,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,VA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,VA TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,WELLMED,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA,MGD,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, WBC    ",72000835,CDM,761,RC,36511,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA CHOICE PLUS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,AETNA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,CIGNA,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,VA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,VA TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,WELLMED,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA,MGD,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
"THERAPEUTIC APHERESIS, RBC    ",72000840,CDM,761,RC,36512,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA CHOICE PLUS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,AETNA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,BCBS,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,CIGNA,COM,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,UNITED HEALTHCARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,VA,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,VA TRICARE,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,WELLMED,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA,MGD,2681.35,,,,,,,per diem,2681.35,2681.35,"Per diem rate, code is bundled with other services"
THERAPEUTIC APHERESIS PLASMA  ,72000842,CDM,761,RC,36514,CPT,,,,Inpatient,,,2681.35,2681.35,HUMANA CHOICE PLUS,MGD,2681.35,,,,,,,case rate,2681.35,2681.35,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,AETNA,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,BCBS,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,CIGNA,COM,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,TRICARE,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,UNITED HEALTHCARE,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,UNITED HEALTHCARE,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,VA,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,VA TRICARE,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,WELLMED,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,HUMANA,MGD,469.43,,,,,,,per diem,469.43,469.43,"Per diem rate, code is bundled with other services"
CROSSMATCH ELECTRONIC         ,72000845,CDM,300,RC,86923,CPT,,,,Inpatient,,,469.43,469.43,HUMANA CHOICE PLUS,MGD,469.43,,,,,,,case rate,469.43,469.43,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,AETNA,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,BCBS,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,CIGNA,COM,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,TRICARE,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,UNITED HEALTHCARE,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,UNITED HEALTHCARE,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,VA,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,VA TRICARE,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,WELLMED,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,HUMANA,MGD,834.39,,,,,,,per diem,834.39,834.39,"Per diem rate, code is bundled with other services"
TRANSFUSION BLOOD/COMPONENT   ,72000900,CDM,391,RC,36430,CPT,,,,Inpatient,,,834.39,834.39,HUMANA CHOICE PLUS,MGD,834.39,,,,,,,case rate,834.39,834.39,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,AETNA,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,BCBS,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,CIGNA,COM,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,TRICARE,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,UNITED HEALTHCARE,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,UNITED HEALTHCARE,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,VA,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,VA TRICARE,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,WELLMED,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,HUMANA,MGD,218.56,,,,,,,per diem,218.56,218.56,"Per diem rate, code is bundled with other services"
COOMBS INDIRECT TITER         ,72000905,CDM,300,RC,86886,CPT,,,,Inpatient,,,218.56,218.56,HUMANA CHOICE PLUS,MGD,218.56,,,,,,,case rate,218.56,218.56,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,AETNA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,CIGNA,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,VA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,VA TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,WELLMED,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,HUMANA,MGD,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
AUTOLOGOUS BLOOD COLLECTION   ,72000910,CDM,300,RC,86890,CPT,,,,Inpatient,,,319.16,319.16,HUMANA CHOICE PLUS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,AETNA,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,BCBS,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,CIGNA,COM,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,TRICARE,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,UNITED HEALTHCARE,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,UNITED HEALTHCARE,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,VA,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,VA TRICARE,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,WELLMED,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,HUMANA,MGD,725.55,,,,,,,per diem,725.55,725.55,"Per diem rate, code is bundled with other services"
LEUKOREDUCED RED BLOOD CELLS  ,72000916,CDM,391,RC,,,,,,Inpatient,,,725.55,725.55,HUMANA CHOICE PLUS,MGD,725.55,,,,,,,case rate,725.55,725.55,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,AETNA,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,BCBS,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,CIGNA,COM,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,TRICARE,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,UNITED HEALTHCARE,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,UNITED HEALTHCARE,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,VA,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,VA TRICARE,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,WELLMED,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,HUMANA,MGD,184.91,,,,,,,per diem,184.91,184.91,"Per diem rate, code is bundled with other services"
ABO - RH                      ,72000917,CDM,391,RC,,,,,,Inpatient,,,184.91,184.91,HUMANA CHOICE PLUS,MGD,184.91,,,,,,,case rate,184.91,184.91,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,AETNA,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,BCBS,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,CIGNA,COM,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,TRICARE,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,UNITED HEALTHCARE,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,UNITED HEALTHCARE,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,VA,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,VA TRICARE,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,WELLMED,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,HUMANA,MGD,295.16,,,,,,,per diem,295.16,295.16,"Per diem rate, code is bundled with other services"
COMPATIBILITY TEST PER UNIT   ,72000918,CDM,391,RC,,,,,,Inpatient,,,295.16,295.16,HUMANA CHOICE PLUS,MGD,295.16,,,,,,,case rate,295.16,295.16,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,AETNA,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,BCBS,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,CIGNA,COM,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,TRICARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,UNITED HEALTHCARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,UNITED HEALTHCARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,VA,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,VA TRICARE,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,WELLMED,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,HUMANA,MGD,230.27,,,,,,,per diem,230.27,230.27,"Per diem rate, code is bundled with other services"
BLOOD COMPONENT PREPARATION   ,72000919,CDM,300,RC,,,,,,Inpatient,,,230.27,230.27,HUMANA CHOICE PLUS,MGD,230.27,,,,,,,case rate,230.27,230.27,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,AETNA,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,BCBS,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,CIGNA,COM,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,TRICARE,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,UNITED HEALTHCARE,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,UNITED HEALTHCARE,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,VA,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,VA TRICARE,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,WELLMED,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,HUMANA,MGD,146.16,,,,,,,per diem,146.16,146.16,"Per diem rate, code is bundled with other services"
SPECIMEN TRANSPORT FEE        ,72000920,CDM,300,RC,,,,,,Inpatient,,,146.16,146.16,HUMANA CHOICE PLUS,MGD,146.16,,,,,,,case rate,146.16,146.16,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,AETNA,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,BCBS,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,CIGNA,COM,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,TRICARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,UNITED HEALTHCARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,UNITED HEALTHCARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,VA,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,VA TRICARE,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,WELLMED,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,HUMANA,MGD,107.1,,,,,,,per diem,107.1,107.1,"Per diem rate, code is bundled with other services"
K ANTIGEN TYPE                ,72000921,CDM,391,RC,,,,,,Inpatient,,,107.1,107.1,HUMANA CHOICE PLUS,MGD,107.1,,,,,,,case rate,107.1,107.1,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,AETNA,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,BCBS,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,CIGNA,COM,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,TRICARE,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,UNITED HEALTHCARE,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,UNITED HEALTHCARE,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,VA,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,VA TRICARE,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,WELLMED,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,HUMANA,MGD,275.94,,,,,,,per diem,275.94,275.94,"Per diem rate, code is bundled with other services"
ADDTL RED CELL ANTIBODY PANEL ,72000922,CDM,391,RC,,,,,,Inpatient,,,275.94,275.94,HUMANA CHOICE PLUS,MGD,275.94,,,,,,,case rate,275.94,275.94,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,AETNA,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,BCBS,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,CIGNA,COM,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,TRICARE,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,UNITED HEALTHCARE,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,UNITED HEALTHCARE,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,VA,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,VA TRICARE,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,WELLMED,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,HUMANA,MGD,392.49,,,,,,,per diem,392.49,392.49,"Per diem rate, code is bundled with other services"
COMPAT TEST FULL CROSSMTCH AHG,72000923,CDM,391,RC,,,,,,Inpatient,,,392.49,392.49,HUMANA CHOICE PLUS,MGD,392.49,,,,,,,case rate,392.49,392.49,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,AETNA,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,BCBS,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,CIGNA,COM,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,TRICARE,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,UNITED HEALTHCARE,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,UNITED HEALTHCARE,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,VA,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,VA TRICARE,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,WELLMED,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,HUMANA,MGD,2088.45,,,,,,,per diem,2088.45,2088.45,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,72020114,CDM,352,RC,,,,,,Inpatient,,,2088.45,2088.45,HUMANA CHOICE PLUS,MGD,2088.45,,,,,,,case rate,2088.45,2088.45,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,AETNA,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,BCBS,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,CIGNA,COM,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,TRICARE,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,UNITED HEALTHCARE,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,UNITED HEALTHCARE,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,VA,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,VA TRICARE,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,WELLMED,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,HUMANA,MGD,4634.7,,,,,,,per diem,4634.7,4634.7,"Per diem rate, code is bundled with other services"
CTA ABD PELVIS WWO C          ,72020115,CDM,352,RC,,,,,,Inpatient,,,4634.7,4634.7,HUMANA CHOICE PLUS,MGD,4634.7,,,,,,,case rate,4634.7,4634.7,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,AETNA,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,BCBS,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,CIGNA,COM,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,TRICARE,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,UNITED HEALTHCARE,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,UNITED HEALTHCARE,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,VA,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,VA TRICARE,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,WELLMED,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,HUMANA,MGD,607.95,,,,,,,per diem,607.95,607.95,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED              ,72050002,CDM,381,RC,P9016,HCPCS,,,,Inpatient,,,607.95,607.95,HUMANA CHOICE PLUS,MGD,607.95,,,,,,,case rate,607.95,607.95,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,AETNA,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,BCBS,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,CIGNA,COM,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,TRICARE,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,UNITED HEALTHCARE,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,UNITED HEALTHCARE,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,VA,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,VA TRICARE,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,WELLMED,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,HUMANA,MGD,426.3,,,,,,,per diem,426.3,426.3,"Per diem rate, code is bundled with other services"
RED BLOOD CELLS               ,72050005,CDM,381,RC,P9021,HCPCS,,,,Inpatient,,,426.3,426.3,HUMANA CHOICE PLUS,MGD,426.3,,,,,,,case rate,426.3,426.3,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,AETNA,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,BCBS,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,CIGNA,COM,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,TRICARE,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,UNITED HEALTHCARE,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,UNITED HEALTHCARE,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,VA,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,VA TRICARE,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,WELLMED,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,HUMANA,MGD,496.65,,,,,,,per diem,496.65,496.65,"Per diem rate, code is bundled with other services"
RBC IRRADIATED                ,72050014,CDM,381,RC,P9038,HCPCS,,,,Inpatient,,,496.65,496.65,HUMANA CHOICE PLUS,MGD,496.65,,,,,,,case rate,496.65,496.65,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,AETNA,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,BCBS,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,CIGNA,COM,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,TRICARE,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,UNITED HEALTHCARE,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,UNITED HEALTHCARE,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,VA,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,VA TRICARE,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,WELLMED,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,HUMANA,MGD,3.58,,,,,,,per diem,3.58,3.58,"Per diem rate, code is bundled with other services"
RBC LEUKOREDUCED-PROC ONLY    ,72060002,CDM,390,RC,P9016,HCPCS,,,,Inpatient,,,3.58,3.58,HUMANA CHOICE PLUS,MGD,3.58,,,,,,,case rate,3.58,3.58,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,AETNA,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,BCBS,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,CIGNA,COM,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,TRICARE,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,UNITED HEALTHCARE,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,UNITED HEALTHCARE,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,VA,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,VA TRICARE,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,WELLMED,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,HUMANA,MGD,460.17,,,,,,,per diem,460.17,460.17,"Per diem rate, code is bundled with other services"
RED BLOOD CELL-PROC ONLY      ,72060005,CDM,390,RC,P9021,HCPCS,,,,Inpatient,,,460.17,460.17,HUMANA CHOICE PLUS,MGD,460.17,,,,,,,case rate,460.17,460.17,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,AETNA,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,BCBS,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,CIGNA,COM,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,TRICARE,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,UNITED HEALTHCARE,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,UNITED HEALTHCARE,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,VA,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,VA TRICARE,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,WELLMED,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,HUMANA,MGD,20.84,,,,,,,per diem,20.84,20.84,"Per diem rate, code is bundled with other services"
PLATELETS LR-PROC ONLY        ,72060007,CDM,390,RC,P9031,HCPCS,,,,Inpatient,,,20.84,20.84,HUMANA CHOICE PLUS,MGD,20.84,,,,,,,case rate,20.84,20.84,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,AETNA,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,BCBS,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,CIGNA,COM,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,TRICARE,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,UNITED HEALTHCARE,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,UNITED HEALTHCARE,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,VA,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,VA TRICARE,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,WELLMED,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,HUMANA,MGD,1035.43,,,,,,,per diem,1035.43,1035.43,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR-PROC ONLY   ,72060011,CDM,390,RC,P9035,HCPCS,,,,Inpatient,,,1035.43,1035.43,HUMANA CHOICE PLUS,MGD,1035.43,,,,,,,case rate,1035.43,1035.43,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,AETNA,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,BCBS,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,CIGNA,COM,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,TRICARE,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,UNITED HEALTHCARE,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,UNITED HEALTHCARE,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,VA,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,VA TRICARE,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,WELLMED,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,HUMANA,MGD,1750.35,,,,,,,per diem,1750.35,1750.35,"Per diem rate, code is bundled with other services"
PLATELETS PHER LR IRRAD-PROC  ,72060013,CDM,390,RC,P9037,CPT,P9037,HCPCS,,Inpatient,,,1750.35,1750.35,HUMANA CHOICE PLUS,MGD,1750.35,,,,,,,case rate,1750.35,1750.35,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,AETNA,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,BCBS,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,CIGNA,COM,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,TRICARE,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,UNITED HEALTHCARE,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,UNITED HEALTHCARE,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,VA,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,VA TRICARE,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,WELLMED,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,HUMANA,MGD,17.68,,,,,,,per diem,17.68,17.68,"Per diem rate, code is bundled with other services"
RBC LR IRRADIATED-PROC ONLY   ,72060016,CDM,390,RC,P9040,HCPCS,,,,Inpatient,,,17.68,17.68,HUMANA CHOICE PLUS,MGD,17.68,,,,,,,case rate,17.68,17.68,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,AETNA,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,BCBS,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,CIGNA,COM,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,TRICARE,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,UNITED HEALTHCARE,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,UNITED HEALTHCARE,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,VA,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,VA TRICARE,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,WELLMED,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,HUMANA,MGD,1184.53,,,,,,,per diem,1184.53,1184.53,"Per diem rate, code is bundled with other services"
EEG DIGITAL ANALYSIS          ,73500050,CDM,740,RC,95957,CPT,,,,Inpatient,,,1184.53,1184.53,HUMANA CHOICE PLUS,MGD,1184.53,,,,,,,case rate,1184.53,1184.53,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,AETNA,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,BCBS,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,CIGNA,COM,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,TRICARE,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,UNITED HEALTHCARE,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,UNITED HEALTHCARE,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,VA,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,VA TRICARE,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,WELLMED,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,HUMANA,MGD,818.24,,,,,,,per diem,818.24,818.24,"Per diem rate, code is bundled with other services"
EEG COMA OR SLEEP ONLY        ,73500070,CDM,740,RC,95822,CPT,,,,Inpatient,,,818.24,818.24,HUMANA CHOICE PLUS,MGD,818.24,,,,,,,case rate,818.24,818.24,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,AETNA,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,BCBS,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,CIGNA,COM,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,TRICARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,UNITED HEALTHCARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,UNITED HEALTHCARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,VA,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,VA TRICARE,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,WELLMED,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,HUMANA,MGD,523.72,,,,,,,per diem,523.72,523.72,"Per diem rate, code is bundled with other services"
EEG CEREBRAL DEATH EVAL       ,73500080,CDM,740,RC,95824,CPT,,,,Inpatient,,,523.72,523.72,HUMANA CHOICE PLUS,MGD,523.72,,,,,,,case rate,523.72,523.72,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,AETNA,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,BCBS,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,CIGNA,COM,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,TRICARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,UNITED HEALTHCARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,UNITED HEALTHCARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,VA,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,VA TRICARE,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,WELLMED,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,HUMANA,MGD,1108.49,,,,,,,per diem,1108.49,1108.49,"Per diem rate, code is bundled with other services"
AUDITORY EVOKED POTENTIAL     ,73500090,CDM,471,RC,92585,CPT,,,,Inpatient,,,1108.49,1108.49,HUMANA CHOICE PLUS,MGD,1108.49,,,,,,,case rate,1108.49,1108.49,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,AETNA,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,BCBS,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,CIGNA,COM,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,TRICARE,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,UNITED HEALTHCARE,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,UNITED HEALTHCARE,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,VA,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,VA TRICARE,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,WELLMED,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,HUMANA,MGD,996.16,,,,,,,per diem,996.16,996.16,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND ASLEEP         ",73500100,CDM,740,RC,95819,CPT,,,,Inpatient,,,996.16,996.16,HUMANA CHOICE PLUS,MGD,996.16,,,,,,,case rate,996.16,996.16,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,AETNA,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,BCBS,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,CIGNA,COM,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,TRICARE,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,UNITED HEALTHCARE,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,UNITED HEALTHCARE,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,VA,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,VA TRICARE,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,WELLMED,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,HUMANA,MGD,1130.21,,,,,,,per diem,1130.21,1130.21,"Per diem rate, code is bundled with other services"
"EEG, AWAKE AND DROWSY         ",73500110,CDM,740,RC,95816,CPT,,,,Inpatient,,,1130.21,1130.21,HUMANA CHOICE PLUS,MGD,1130.21,,,,,,,case rate,1130.21,1130.21,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,AETNA,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,BCBS,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,CIGNA,COM,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,TRICARE,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,UNITED HEALTHCARE,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,UNITED HEALTHCARE,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,VA,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,VA TRICARE,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,WELLMED,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,HUMANA,MGD,840.39,,,,,,,per diem,840.39,840.39,"Per diem rate, code is bundled with other services"
EEG OVER 1 HR                 ,73500180,CDM,740,RC,95813,CPT,,,,Inpatient,,,840.39,840.39,HUMANA CHOICE PLUS,MGD,840.39,,,,,,,case rate,840.39,840.39,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,AETNA,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,BCBS,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,CIGNA,COM,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,TRICARE,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,UNITED HEALTHCARE,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,UNITED HEALTHCARE,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,VA,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,VA TRICARE,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,WELLMED,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,HUMANA,MGD,6221.21,,,,,,,per diem,6221.21,6221.21,"Per diem rate, code is bundled with other services"
NCB EA NERVE MOTOR W FW 7-8   ,73500328,CDM,922,RC,95910,CPT,,,,Inpatient,,,6221.21,6221.21,HUMANA CHOICE PLUS,MGD,6221.21,,,,,,,case rate,6221.21,6221.21,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,AETNA,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,BCBS,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,CIGNA,COM,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,TRICARE,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,UNITED HEALTHCARE,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,UNITED HEALTHCARE,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,VA,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,VA TRICARE,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,WELLMED,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,HUMANA,MGD,762.26,,,,,,,per diem,762.26,762.26,"Per diem rate, code is bundled with other services"
EEG MONITORING 1 HR           ,73510001,CDM,740,RC,95812,CPT,,,,Inpatient,,,762.26,762.26,HUMANA CHOICE PLUS,MGD,762.26,,,,,,,case rate,762.26,762.26,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,AETNA,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,CIGNA,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,TRICARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,UNITED HEALTHCARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,UNITED HEALTHCARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,VA,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,VA TRICARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,WELLMED,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,HUMANA,MGD,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
EEG EIZ EVAL ATTND 16 CHAN    ,73510010,CDM,740,RC,95956,CPT,,,,Inpatient,,,2314.43,2314.43,HUMANA CHOICE PLUS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,AETNA,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,BCBS,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,CIGNA,COM,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,TRICARE,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,UNITED HEALTHCARE,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,UNITED HEALTHCARE,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,VA,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,VA TRICARE,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,WELLMED,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,HUMANA,MGD,1740.38,,,,,,,per diem,1740.38,1740.38,"Per diem rate, code is bundled with other services"
EEG SEIZ EVAL UNATTN 16 CHAN  ,73510011,CDM,740,RC,95953,CPT,,,,Inpatient,,,1740.38,1740.38,HUMANA CHOICE PLUS,MGD,1740.38,,,,,,,case rate,1740.38,1740.38,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,AETNA,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,BCBS,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,CIGNA,COM,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,TRICARE,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,UNITED HEALTHCARE,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,UNITED HEALTHCARE,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,VA,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,VA TRICARE,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,WELLMED,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,HUMANA,MGD,641.53,,,,,,,per diem,641.53,641.53,"Per diem rate, code is bundled with other services"
PF TEE 2D COMPLETE            ,73520000,CDM,983,RC,,,,,,Inpatient,,,641.53,641.53,HUMANA CHOICE PLUS,MGD,641.53,,,,,,,case rate,641.53,641.53,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,AETNA,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,CIGNA,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,TRICARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,UNITED HEALTHCARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,UNITED HEALTHCARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,VA,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,VA TRICARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,WELLMED,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,HUMANA,MGD,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEUROSTM BRAIN 1STHR     ,73520001,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,HUMANA CHOICE PLUS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,AETNA,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,BCBS,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,CIGNA,COM,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,TRICARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,UNITED HEALTHCARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,UNITED HEALTHCARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,VA,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,VA TRICARE,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,WELLMED,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,HUMANA,MGD,703.65,,,,,,,per diem,703.65,703.65,"Per diem rate, code is bundled with other services"
ANLY NEURSTM BRN EA ADD30     ,73520002,CDM,920,RC,,,,,,Inpatient,,,703.65,703.65,HUMANA CHOICE PLUS,MGD,703.65,,,,,,,case rate,703.65,703.65,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
BLINK REFLEX TEST             ,73520003,CDM,920,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,AETNA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,CIGNA,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,VA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,VA TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,WELLMED,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA,MGD,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED LOW EXTREM     ,73520004,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA CHOICE PLUS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,AETNA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,CIGNA,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,VA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,VA TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,WELLMED,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA,MGD,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
C MOTOR EVOKED UPP EXTREM     ,73520005,CDM,920,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA CHOICE PLUS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,AETNA,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,CIGNA,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,TRICARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,UNITED HEALTHCARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,UNITED HEALTHCARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,VA,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,VA TRICARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,WELLMED,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,HUMANA,MGD,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST W RX       ,73520006,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,HUMANA CHOICE PLUS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,AETNA,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,BCBS,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,CIGNA,COM,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,TRICARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,UNITED HEALTHCARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,UNITED HEALTHCARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,VA,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,VA TRICARE,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,WELLMED,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,HUMANA,MGD,1702.89,,,,,,,per diem,1702.89,1702.89,"Per diem rate, code is bundled with other services"
CARDIOVAS STR TEST WO RX      ,73520007,CDM,482,RC,,,,,,Inpatient,,,1702.89,1702.89,HUMANA CHOICE PLUS,MGD,1702.89,,,,,,,case rate,1702.89,1702.89,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,AETNA,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,BCBS,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,CIGNA,COM,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,TRICARE,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,UNITED HEALTHCARE,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,UNITED HEALTHCARE,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,VA,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,VA TRICARE,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,WELLMED,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,HUMANA,MGD,231.34,,,,,,,per diem,231.34,231.34,"Per diem rate, code is bundled with other services"
ECG 1-3 LEAD TRACING ONLY     ,73520008,CDM,730,RC,,,,,,Inpatient,,,231.34,231.34,HUMANA CHOICE PLUS,MGD,231.34,,,,,,,case rate,231.34,231.34,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,AETNA,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,BCBS,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,CIGNA,COM,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,TRICARE,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,UNITED HEALTHCARE,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,UNITED HEALTHCARE,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,VA,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,VA TRICARE,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,WELLMED,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,HUMANA,MGD,1692.6,,,,,,,per diem,1692.6,1692.6,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR COM WOCON     ,73520009,CDM,483,RC,,,,,,Inpatient,,,1692.6,1692.6,HUMANA CHOICE PLUS,MGD,1692.6,,,,,,,case rate,1692.6,1692.6,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,AETNA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,CIGNA,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,WELLMED,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA,MGD,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W ECG      ,73520010,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA CHOICE PLUS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,AETNA,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,BCBS,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,CIGNA,COM,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,TRICARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,UNITED HEALTHCARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,UNITED HEALTHCARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,VA,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,VA TRICARE,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,WELLMED,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,HUMANA,MGD,750.77,,,,,,,per diem,750.77,750.77,"Per diem rate, code is bundled with other services"
EEG DURING NONCRANIA SURG     ,73520011,CDM,740,RC,,,,,,Inpatient,,,750.77,750.77,HUMANA CHOICE PLUS,MGD,750.77,,,,,,,case rate,750.77,750.77,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,AETNA,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,BCBS,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,CIGNA,COM,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,TRICARE,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,UNITED HEALTHCARE,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,UNITED HEALTHCARE,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,VA,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,VA TRICARE,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,WELLMED,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,HUMANA,MGD,2176.27,,,,,,,per diem,2176.27,2176.27,"Per diem rate, code is bundled with other services"
EEG SEIZURE 8-CH/ 24 HR       ,73520012,CDM,740,RC,,,,,,Inpatient,,,2176.27,2176.27,HUMANA CHOICE PLUS,MGD,2176.27,,,,,,,case rate,2176.27,2176.27,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,AETNA,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,BCBS,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,CIGNA,COM,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,TRICARE,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,UNITED HEALTHCARE,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,UNITED HEALTHCARE,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,VA,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,VA TRICARE,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,WELLMED,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,HUMANA,MGD,391.99,,,,,,,per diem,391.99,391.99,"Per diem rate, code is bundled with other services"
EMG CRAN NRV BIL              ,73520013,CDM,922,RC,,,,,,Inpatient,,,391.99,391.99,HUMANA CHOICE PLUS,MGD,391.99,,,,,,,case rate,391.99,391.99,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,AETNA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,CIGNA,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,VA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,VA TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,WELLMED,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA,MGD,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ FOR MICROBUBBLE STUDY     ,73520014,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA CHOICE PLUS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,AETNA,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,BCBS,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,CIGNA,COM,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,TRICARE,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,UNITED HEALTHCARE,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,UNITED HEALTHCARE,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,VA,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,VA TRICARE,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,WELLMED,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,HUMANA,MGD,129.59,,,,,,,per diem,129.59,129.59,"Per diem rate, code is bundled with other services"
INTRAOP MON IN OR EA15MIN     ,73520015,CDM,920,RC,,,,,,Inpatient,,,129.59,129.59,HUMANA CHOICE PLUS,MGD,129.59,,,,,,,case rate,129.59,129.59,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
ISCH LIMB EXERCISE W SPEC     ,73520016,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,AETNA,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,CIGNA,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,TRICARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,UNITED HEALTHCARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,UNITED HEALTHCARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,VA,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,VA TRICARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,WELLMED,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,HUMANA,MGD,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON CMP EA     ,73520017,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,HUMANA CHOICE PLUS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,AETNA,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,BCBS,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,CIGNA,COM,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,TRICARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,UNITED HEALTHCARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,UNITED HEALTHCARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,VA,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,VA TRICARE,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,WELLMED,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,HUMANA,MGD,476.6,,,,,,,per diem,476.6,476.6,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON LTD EA     ,73520018,CDM,922,RC,,,,,,Inpatient,,,476.6,476.6,HUMANA CHOICE PLUS,MGD,476.6,,,,,,,case rate,476.6,476.6,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,AETNA,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,BCBS,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,CIGNA,COM,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,TRICARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,UNITED HEALTHCARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,UNITED HEALTHCARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,VA,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,VA TRICARE,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,WELLMED,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,HUMANA,MGD,250.61,,,,,,,per diem,250.61,250.61,"Per diem rate, code is bundled with other services"
MUSC TST W/NRV CON NONEXT     ,73520019,CDM,922,RC,,,,,,Inpatient,,,250.61,250.61,HUMANA CHOICE PLUS,MGD,250.61,,,,,,,case rate,250.61,250.61,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,AETNA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,BCBS,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,CIGNA,COM,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,UNITED HEALTHCARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,VA,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,VA TRICARE,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,WELLMED,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA,MGD,299.88,,,,,,,per diem,299.88,299.88,"Per diem rate, code is bundled with other services"
NEEDLE EMG 1 EXTREMITY        ,73520020,CDM,922,RC,,,,,,Inpatient,,,299.88,299.88,HUMANA CHOICE PLUS,MGD,299.88,,,,,,,case rate,299.88,299.88,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,AETNA,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,BCBS,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,CIGNA,COM,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,TRICARE,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,UNITED HEALTHCARE,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,UNITED HEALTHCARE,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,VA,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,VA TRICARE,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,WELLMED,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,HUMANA,MGD,485.16,,,,,,,per diem,485.16,485.16,"Per diem rate, code is bundled with other services"
NEEDLE EMG 2 EXTREMITIES      ,73520021,CDM,922,RC,,,,,,Inpatient,,,485.16,485.16,HUMANA CHOICE PLUS,MGD,485.16,,,,,,,case rate,485.16,485.16,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,AETNA,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,BCBS,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,CIGNA,COM,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,TRICARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,UNITED HEALTHCARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,UNITED HEALTHCARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,VA,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,VA TRICARE,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,WELLMED,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,HUMANA,MGD,561.2,,,,,,,per diem,561.2,561.2,"Per diem rate, code is bundled with other services"
NEEDLE EMG 3 EXTREMITIES      ,73520022,CDM,922,RC,,,,,,Inpatient,,,561.2,561.2,HUMANA CHOICE PLUS,MGD,561.2,,,,,,,case rate,561.2,561.2,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,AETNA,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,BCBS,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,CIGNA,COM,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,TRICARE,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,UNITED HEALTHCARE,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,UNITED HEALTHCARE,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,VA,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,VA TRICARE,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,WELLMED,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,HUMANA,MGD,823.6,,,,,,,per diem,823.6,823.6,"Per diem rate, code is bundled with other services"
NEEDLE EMG 4 EXTREMITIES      ,73520023,CDM,922,RC,,,,,,Inpatient,,,823.6,823.6,HUMANA CHOICE PLUS,MGD,823.6,,,,,,,case rate,823.6,823.6,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 1-2 STUDIES     ,73520024,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 3-4 STUDIES     ,73520025,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 5-6 STUDIES     ,73520026,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
NERVE CONDUCT 7-8 STUDIES     ,73520027,CDM,922,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,AETNA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,CIGNA,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,WELLMED,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA,MGD,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT>=13 STUDIES     ,73520028,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA CHOICE PLUS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,AETNA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,CIGNA,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,WELLMED,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA,MGD,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT11-12STUDIES     ,73520029,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA CHOICE PLUS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,AETNA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,BCBS,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,CIGNA,COM,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,UNITED HEALTHCARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,VA TRICARE,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,WELLMED,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA,MGD,453.03,,,,,,,per diem,453.03,453.03,"Per diem rate, code is bundled with other services"
NERVE CONDUCT9-10 STUDIES     ,73520030,CDM,922,RC,,,,,,Inpatient,,,453.03,453.03,HUMANA CHOICE PLUS,MGD,453.03,,,,,,,case rate,453.03,453.03,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,AETNA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,BCBS,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,CIGNA,COM,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,UNITED HEALTHCARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,VA,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,VA TRICARE,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,WELLMED,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA,MGD,189.57,,,,,,,per diem,189.57,189.57,"Per diem rate, code is bundled with other services"
NEUROMSC JNCT TST EA NRVE     ,73520031,CDM,922,RC,,,,,,Inpatient,,,189.57,189.57,HUMANA CHOICE PLUS,MGD,189.57,,,,,,,case rate,189.57,189.57,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,AETNA,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,CIGNA,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,TRICARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,UNITED HEALTHCARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,UNITED HEALTHCARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,VA,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,VA TRICARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,WELLMED,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,HUMANA,MGD,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
PF TEE CONGENITAL ANOMAL      ,73520032,CDM,983,RC,,,,,,Inpatient,,,749.7,749.7,HUMANA CHOICE PLUS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,AETNA,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,BCBS,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,CIGNA,COM,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,TRICARE,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,UNITED HEALTHCARE,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,UNITED HEALTHCARE,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,VA,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,VA TRICARE,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,WELLMED,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,HUMANA,MGD,4356.83,,,,,,,per diem,4356.83,4356.83,"Per diem rate, code is bundled with other services"
PSS W 4/>P W CPAP >=6YRS      ,73520033,CDM,740,RC,,,,,,Inpatient,,,4356.83,4356.83,HUMANA CHOICE PLUS,MGD,4356.83,,,,,,,case rate,4356.83,4356.83,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,AETNA,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,BCBS,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,CIGNA,COM,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,TRICARE,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,UNITED HEALTHCARE,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,UNITED HEALTHCARE,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,VA,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,VA TRICARE,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,WELLMED,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,HUMANA,MGD,4139.42,,,,,,,per diem,4139.42,4139.42,"Per diem rate, code is bundled with other services"
PSS W 4/> PAR W TECH>=6YR     ,73520034,CDM,740,RC,,,,,,Inpatient,,,4139.42,4139.42,HUMANA CHOICE PLUS,MGD,4139.42,,,,,,,case rate,4139.42,4139.42,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,AETNA,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,CIGNA,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,TRICARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,UNITED HEALTHCARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,UNITED HEALTHCARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,VA,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,VA TRICARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,WELLMED,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,HUMANA,MGD,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
SOMATOSEN TSTNG LOW EXT       ,73520035,CDM,920,RC,,,,,,Inpatient,,,1079.57,1079.57,HUMANA CHOICE PLUS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,AETNA,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,BCBS,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,CIGNA,COM,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,TRICARE,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,UNITED HEALTHCARE,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,UNITED HEALTHCARE,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,VA,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,VA TRICARE,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,WELLMED,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,HUMANA,MGD,1864.61,,,,,,,per diem,1864.61,1864.61,"Per diem rate, code is bundled with other services"
TEE CONG SPEC COMP WO CON     ,73520036,CDM,483,RC,,,,,,Inpatient,,,1864.61,1864.61,HUMANA CHOICE PLUS,MGD,1864.61,,,,,,,case rate,1864.61,1864.61,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,AETNA,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,BCBS,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,CIGNA,COM,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,TRICARE,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,UNITED HEALTHCARE,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,UNITED HEALTHCARE,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,VA,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,VA TRICARE,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,WELLMED,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,HUMANA,MGD,1145.97,,,,,,,per diem,1145.97,1145.97,"Per diem rate, code is bundled with other services"
VEP TEST CNS CHECKER/FLAS     ,73520037,CDM,920,RC,,,,,,Inpatient,,,1145.97,1145.97,HUMANA CHOICE PLUS,MGD,1145.97,,,,,,,case rate,1145.97,1145.97,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,AETNA,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,BCBS,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,CIGNA,COM,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,TRICARE,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,UNITED HEALTHCARE,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,UNITED HEALTHCARE,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,VA,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,VA TRICARE,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,WELLMED,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,HUMANA,MGD,2797.25,,,,,,,per diem,2797.25,2797.25,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR COM WCON     ,73520038,CDM,483,RC,,,,,,Inpatient,,,2797.25,2797.25,HUMANA CHOICE PLUS,MGD,2797.25,,,,,,,case rate,2797.25,2797.25,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,AETNA,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,BCBS,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,CIGNA,COM,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,TRICARE,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,UNITED HEALTHCARE,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,UNITED HEALTHCARE,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,VA,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,VA TRICARE,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,WELLMED,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,HUMANA,MGD,3055.56,,,,,,,per diem,3055.56,3055.56,"Per diem rate, code is bundled with other services"
ECHO CNG TRNSTHR LTD WCON     ,73520039,CDM,483,RC,,,,,,Inpatient,,,3055.56,3055.56,HUMANA CHOICE PLUS,MGD,3055.56,,,,,,,case rate,3055.56,3055.56,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,AETNA,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,BCBS,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,CIGNA,COM,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,TRICARE,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,UNITED HEALTHCARE,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,UNITED HEALTHCARE,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,VA,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,VA TRICARE,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,WELLMED,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,HUMANA,MGD,1240.22,,,,,,,per diem,1240.22,1240.22,"Per diem rate, code is bundled with other services"
ECHO 2D COMP W CON            ,73520040,CDM,483,RC,,,,,,Inpatient,,,1240.22,1240.22,HUMANA CHOICE PLUS,MGD,1240.22,,,,,,,case rate,1240.22,1240.22,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,AETNA,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,BCBS,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,CIGNA,COM,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,TRICARE,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,UNITED HEALTHCARE,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,UNITED HEALTHCARE,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,VA,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,VA TRICARE,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,WELLMED,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,HUMANA,MGD,1088.14,,,,,,,per diem,1088.14,1088.14,"Per diem rate, code is bundled with other services"
ECHO 2D LMTD W CON            ,73520041,CDM,483,RC,,,,,,Inpatient,,,1088.14,1088.14,HUMANA CHOICE PLUS,MGD,1088.14,,,,,,,case rate,1088.14,1088.14,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,AETNA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,CIGNA,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,WELLMED,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA,MGD,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TEST COMP W CON      ,73520042,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA CHOICE PLUS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,AETNA,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,BCBS,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,CIGNA,COM,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,TRICARE,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,UNITED HEALTHCARE,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,UNITED HEALTHCARE,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,VA,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,VA TRICARE,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,WELLMED,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,HUMANA,MGD,2773.13,,,,,,,per diem,2773.13,2773.13,"Per diem rate, code is bundled with other services"
TTE COMP W SPEC/CF W CON      ,73520043,CDM,483,RC,,,,,,Inpatient,,,2773.13,2773.13,HUMANA CHOICE PLUS,MGD,2773.13,,,,,,,case rate,2773.13,2773.13,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,AETNA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,BCBS,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,CIGNA,COM,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,UNITED HEALTHCARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,VA TRICARE,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,WELLMED,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA,MGD,1893.53,,,,,,,per diem,1893.53,1893.53,"Per diem rate, code is bundled with other services"
ECHO STR TST COMP ECG CON     ,73520044,CDM,483,RC,,,,,,Inpatient,,,1893.53,1893.53,HUMANA CHOICE PLUS,MGD,1893.53,,,,,,,case rate,1893.53,1893.53,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,AETNA,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,CIGNA,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,TRICARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,UNITED HEALTHCARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,UNITED HEALTHCARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,VA,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,VA TRICARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,WELLMED,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,HUMANA,MGD,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
ECH CNG TRNSTHR LTD WOCON     ,73520045,CDM,483,RC,,,,,,Inpatient,,,1195.24,1195.24,HUMANA CHOICE PLUS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,AETNA,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,BCBS,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,CIGNA,COM,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,TRICARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,UNITED HEALTHCARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,UNITED HEALTHCARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,VA,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,VA TRICARE,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,WELLMED,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,HUMANA,MGD,749.7,,,,,,,per diem,749.7,749.7,"Per diem rate, code is bundled with other services"
TEE PROBE PLACEMENT ONLY      ,73520046,CDM,483,RC,,,,,,Inpatient,,,749.7,749.7,HUMANA CHOICE PLUS,MGD,749.7,,,,,,,case rate,749.7,749.7,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,AETNA,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,BCBS,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,CIGNA,COM,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,TRICARE,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,UNITED HEALTHCARE,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,UNITED HEALTHCARE,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,VA,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,VA TRICARE,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,WELLMED,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,HUMANA,MGD,267.75,,,,,,,per diem,267.75,267.75,"Per diem rate, code is bundled with other services"
DOP ECHO LMTD STUDY ADDON     ,73520047,CDM,483,RC,,,,,,Inpatient,,,267.75,267.75,HUMANA CHOICE PLUS,MGD,267.75,,,,,,,case rate,267.75,267.75,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,AETNA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,CIGNA,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,VA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,VA TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,WELLMED,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA,MGD,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ MICROBUB STDY EXST IV     ,73520048,CDM,480,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA CHOICE PLUS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,AETNA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,CIGNA,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,VA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,VA TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,WELLMED,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA,MGD,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
MYOCARDIAL STRAIN IMAGING     ,73520049,CDM,480,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA CHOICE PLUS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,AETNA,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,BCBS,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,CIGNA,COM,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,TRICARE,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,UNITED HEALTHCARE,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,UNITED HEALTHCARE,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,VA,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,VA TRICARE,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,WELLMED,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,HUMANA,MGD,5965.47,,,,,,,per diem,5965.47,5965.47,"Per diem rate, code is bundled with other services"
TONGUE BASE VOL REDUCTION     ,73520050,CDM,361,RC,,,,,,Inpatient,,,5965.47,5965.47,HUMANA CHOICE PLUS,MGD,5965.47,,,,,,,case rate,5965.47,5965.47,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,AETNA,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,BCBS,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,CIGNA,COM,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,TRICARE,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,UNITED HEALTHCARE,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,UNITED HEALTHCARE,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,VA,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,VA TRICARE,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,WELLMED,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,HUMANA,MGD,404.84,,,,,,,per diem,404.84,404.84,"Per diem rate, code is bundled with other services"
ECHO STR CONTRAST AGENT       ,73520051,CDM,483,RC,,,,,,Inpatient,,,404.84,404.84,HUMANA CHOICE PLUS,MGD,404.84,,,,,,,case rate,404.84,404.84,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,AETNA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,CIGNA,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,VA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,VA TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,WELLMED,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA,MGD,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECT SLVR MACTRO PLUS        ,73520052,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA CHOICE PLUS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,AETNA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,BCBS,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,CIGNA,COM,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,UNITED HEALTHCARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,VA,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,VA TRICARE,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,WELLMED,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA,MGD,46.5,,,,,,,per diem,46.5,46.5,"Per diem rate, code is bundled with other services"
PAPER PREM THERM RED GRID     ,73520053,CDM,730,RC,,,,,,Inpatient,,,46.5,46.5,HUMANA CHOICE PLUS,MGD,46.5,,,,,,,case rate,46.5,46.5,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,AETNA,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,BCBS,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,CIGNA,COM,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,TRICARE,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,UNITED HEALTHCARE,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,UNITED HEALTHCARE,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,VA,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,VA TRICARE,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,WELLMED,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,HUMANA,MGD,1.2,,,,,,,per diem,1.2,1.2,"Per diem rate, code is bundled with other services"
NERVE COND MOTOR W/FWAVE      ,73520054,CDM,920,RC,95903,CPT,,,,Inpatient,,,1.2,1.2,HUMANA CHOICE PLUS,MGD,1.2,,,,,,,case rate,1.2,1.2,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,AETNA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,BCBS,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,CIGNA,COM,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,UNITED HEALTHCARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,VA,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,VA TRICARE,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,WELLMED,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA,MGD,1.63,,,,,,,per diem,1.63,1.63,"Per diem rate, code is bundled with other services"
ELECTRODE SLVR MACTRODE PLUS  ,73520055,CDM,730,RC,,,,,,Inpatient,,,1.63,1.63,HUMANA CHOICE PLUS,MGD,1.63,,,,,,,case rate,1.63,1.63,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,AETNA,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,BCBS,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,CIGNA,COM,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,TRICARE,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,UNITED HEALTHCARE,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,UNITED HEALTHCARE,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,VA,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,VA TRICARE,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,WELLMED,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,HUMANA,MGD,289.7,,,,,,,per diem,289.7,289.7,"Per diem rate, code is bundled with other services"
SET UP FEE                    ,73520056,CDM,920,RC,Q0092,HCPCS,,,,Inpatient,,,289.7,289.7,HUMANA CHOICE PLUS,MGD,289.7,,,,,,,case rate,289.7,289.7,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,AETNA,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,BCBS,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,CIGNA,COM,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,TRICARE,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,UNITED HEALTHCARE,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,UNITED HEALTHCARE,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,VA,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,VA TRICARE,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,WELLMED,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,HUMANA,MGD,491.72,,,,,,,per diem,491.72,491.72,"Per diem rate, code is bundled with other services"
EXTERNAL COUNTERPULS          ,73520063,CDM,480,RC,,,,,,Inpatient,,,491.72,491.72,HUMANA CHOICE PLUS,MGD,491.72,,,,,,,case rate,491.72,491.72,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,AETNA,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,BCBS,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,CIGNA,COM,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,TRICARE,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,UNITED HEALTHCARE,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,UNITED HEALTHCARE,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,VA,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,VA TRICARE,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,WELLMED,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,HUMANA,MGD,673.51,,,,,,,per diem,673.51,673.51,"Per diem rate, code is bundled with other services"
EMG ADD-ON 5 OR MORE MUSCLE   ,73570057,CDM,922,RC,95886,CPT,,,,Inpatient,,,673.51,673.51,HUMANA CHOICE PLUS,MGD,673.51,,,,,,,case rate,673.51,673.51,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EEG EVOKE POT MED             ,73599995,CDM,740,RC,95925,CPT,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,AETNA,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,BCBS,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,CIGNA,COM,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,TRICARE,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,UNITED HEALTHCARE,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,UNITED HEALTHCARE,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,VA,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,VA TRICARE,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,WELLMED,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,HUMANA,MGD,244.97,,,,,,,per diem,244.97,244.97,"Per diem rate, code is bundled with other services"
ABDOMEN W/OBLIQUE & CONE VIEWS,74000005,CDM,320,RC,74010,CPT,,,,Inpatient,,,244.97,244.97,HUMANA CHOICE PLUS,MGD,244.97,,,,,,,case rate,244.97,244.97,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ABDOMEN SINGLE AP VIEW        ,74000006,CDM,320,RC,74018,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,AETNA,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,BCBS,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,CIGNA,COM,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,TRICARE,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,UNITED HEALTHCARE,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,UNITED HEALTHCARE,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,VA,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,VA TRICARE,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,WELLMED,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,HUMANA,MGD,105.99,,,,,,,per diem,105.99,105.99,"Per diem rate, code is bundled with other services"
ABD FLAT & ERECT &/OR DECUB   ,74000010,CDM,320,RC,74020,CPT,,,,Inpatient,,,105.99,105.99,HUMANA CHOICE PLUS,MGD,105.99,,,,,,,case rate,105.99,105.99,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,AETNA,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,BCBS,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,CIGNA,COM,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,TRICARE,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,UNITED HEALTHCARE,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,UNITED HEALTHCARE,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,VA,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,VA TRICARE,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,WELLMED,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,HUMANA,MGD,343.88,,,,,,,per diem,343.88,343.88,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW BILATERAL     ,74000023,CDM,320,RC,73020,CPT,,,50,Inpatient,,,343.88,343.88,HUMANA CHOICE PLUS,MGD,343.88,,,,,,,case rate,343.88,343.88,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,AETNA,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,BCBS,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,CIGNA,COM,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,TRICARE,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,UNITED HEALTHCARE,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,UNITED HEALTHCARE,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,VA,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,VA TRICARE,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,WELLMED,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,HUMANA,MGD,380.94,,,,,,,per diem,380.94,380.94,"Per diem rate, code is bundled with other services"
A-C JOINTS BILATERAL          ,74000030,CDM,320,RC,73050,CPT,,,,Inpatient,,,380.94,380.94,HUMANA CHOICE PLUS,MGD,380.94,,,,,,,case rate,380.94,380.94,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,AETNA,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,BCBS,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,CIGNA,COM,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,TRICARE,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,UNITED HEALTHCARE,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,UNITED HEALTHCARE,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,VA,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,VA TRICARE,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,WELLMED,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,HUMANA,MGD,319.2,,,,,,,per diem,319.2,319.2,"Per diem rate, code is bundled with other services"
ANGIO RENAL UNILATERAL RT     ,74000055,CDM,320,RC,75722,CPT,,,RT,Inpatient,,,319.2,319.2,HUMANA CHOICE PLUS,MGD,319.2,,,,,,,case rate,319.2,319.2,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS BILATERAL       ,74000060,CDM,320,RC,73600,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS BILATERAL      ,74000070,CDM,320,RC,73610,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,AETNA,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,BCBS,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,CIGNA,COM,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,TRICARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,UNITED HEALTHCARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,UNITED HEALTHCARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,VA,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,VA TRICARE,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,WELLMED,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,HUMANA,MGD,1079.57,,,,,,,per diem,1079.57,1079.57,"Per diem rate, code is bundled with other services"
BARIUM ENEMA W/WO KUB         ,74000081,CDM,320,RC,74270,CPT,,,,Inpatient,,,1079.57,1079.57,HUMANA CHOICE PLUS,MGD,1079.57,,,,,,,case rate,1079.57,1079.57,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,AETNA,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,BCBS,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,CIGNA,COM,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,TRICARE,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,UNITED HEALTHCARE,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,UNITED HEALTHCARE,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,VA,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,VA TRICARE,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,WELLMED,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,HUMANA,MGD,483,,,,,,,per diem,483,483,"Per diem rate, code is bundled with other services"
FLUOROSCOPY/C-ARM>1 HOUR      ,74000100,CDM,320,RC,76001,CPT,,,,Inpatient,,,483,483,HUMANA CHOICE PLUS,MGD,483,,,,,,,case rate,483,483,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CERVICAL SP 2 OR 3 VIEWS      ,74000120,CDM,320,RC,72040,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,AETNA,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,BCBS,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,CIGNA,COM,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,TRICARE,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,UNITED HEALTHCARE,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,UNITED HEALTHCARE,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,VA,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,VA TRICARE,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,WELLMED,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,HUMANA,MGD,173.88,,,,,,,per diem,173.88,173.88,"Per diem rate, code is bundled with other services"
CHEST SPECIAL VIEWS           ,74000139,CDM,320,RC,71035,CPT,,,,Inpatient,,,173.88,173.88,HUMANA CHOICE PLUS,MGD,173.88,,,,,,,case rate,173.88,173.88,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS FRONTAL & LAT   ,74000140,CDM,320,RC,71046,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,AETNA,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,BCBS,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,CIGNA,COM,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,TRICARE,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,UNITED HEALTHCARE,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,UNITED HEALTHCARE,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,VA,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,VA TRICARE,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,WELLMED,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,HUMANA,MGD,312.02,,,,,,,per diem,312.02,312.02,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/APICAL LORDOTIC,74000160,CDM,320,RC,71047,CPT,,,,Inpatient,,,312.02,312.02,HUMANA CHOICE PLUS,MGD,312.02,,,,,,,case rate,312.02,312.02,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,AETNA,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,BCBS,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,CIGNA,COM,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,TRICARE,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,UNITED HEALTHCARE,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,UNITED HEALTHCARE,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,VA,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,VA TRICARE,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,WELLMED,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,HUMANA,MGD,247.66,,,,,,,per diem,247.66,247.66,"Per diem rate, code is bundled with other services"
CHEST 2VIEWS W/OBLIQUES       ,74000170,CDM,320,RC,71022,CPT,,,,Inpatient,,,247.66,247.66,HUMANA CHOICE PLUS,MGD,247.66,,,,,,,case rate,247.66,247.66,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,AETNA,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,CIGNA,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,TRICARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,UNITED HEALTHCARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,UNITED HEALTHCARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,VA,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,VA TRICARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,WELLMED,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,HUMANA,MGD,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP         ,74000180,CDM,320,RC,74300,CPT,,,,Inpatient,,,1527.25,1527.25,HUMANA CHOICE PLUS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CLAVICLE BILATERAL            ,74000190,CDM,320,RC,73000,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,AETNA,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,BCBS,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,CIGNA,COM,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,TRICARE,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,UNITED HEALTHCARE,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,UNITED HEALTHCARE,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,VA,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,VA TRICARE,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,WELLMED,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,HUMANA,MGD,1511.18,,,,,,,per diem,1511.18,1511.18,"Per diem rate, code is bundled with other services"
BARIUM ENEMA AIR W/WO KUB     ,74000210,CDM,320,RC,74280,CPT,,,,Inpatient,,,1511.18,1511.18,HUMANA CHOICE PLUS,MGD,1511.18,,,,,,,case rate,1511.18,1511.18,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,AETNA,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,BCBS,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,CIGNA,COM,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,TRICARE,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,UNITED HEALTHCARE,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,UNITED HEALTHCARE,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,VA,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,VA TRICARE,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,WELLMED,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,HUMANA,MGD,812.19,,,,,,,per diem,812.19,812.19,"Per diem rate, code is bundled with other services"
CYSTOGRAM 3+ VIEWS            ,74000220,CDM,320,RC,74430,CPT,,,,Inpatient,,,812.19,812.19,HUMANA CHOICE PLUS,MGD,812.19,,,,,,,case rate,812.19,812.19,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,AETNA,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,BCBS,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,CIGNA,COM,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,TRICARE,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,UNITED HEALTHCARE,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,UNITED HEALTHCARE,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,VA,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,VA TRICARE,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,WELLMED,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,HUMANA,MGD,746.29,,,,,,,per diem,746.29,746.29,"Per diem rate, code is bundled with other services"
GI TUBE PLACEMENT RAD GUIDANCE,74000222,CDM,320,RC,74340,CPT,,,,Inpatient,,,746.29,746.29,HUMANA CHOICE PLUS,MGD,746.29,,,,,,,case rate,746.29,746.29,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
THORACIC SP 3 VIEWS           ,74000239,CDM,320,RC,72072,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,AETNA,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,BCBS,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,CIGNA,COM,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,TRICARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,UNITED HEALTHCARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,UNITED HEALTHCARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,VA,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,VA TRICARE,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,WELLMED,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,HUMANA,MGD,233.1,,,,,,,per diem,233.1,233.1,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS BILATERAL       ,74000260,CDM,320,RC,73070,CPT,,,50,Inpatient,,,233.1,233.1,HUMANA CHOICE PLUS,MGD,233.1,,,,,,,case rate,233.1,233.1,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS BILATERAL      ,74000261,CDM,320,RC,73080,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,AETNA,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,CIGNA,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,TRICARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,UNITED HEALTHCARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,UNITED HEALTHCARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,VA,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,VA TRICARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,WELLMED,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,HUMANA,MGD,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
ESOPHAGUS                     ,74000270,CDM,320,RC,74220,CPT,,,,Inpatient,,,356.36,356.36,HUMANA CHOICE PLUS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,AETNA,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,BCBS,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,CIGNA,COM,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,TRICARE,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,UNITED HEALTHCARE,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,UNITED HEALTHCARE,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,VA,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,VA TRICARE,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,WELLMED,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,HUMANA,MGD,667.96,,,,,,,per diem,667.96,667.96,"Per diem rate, code is bundled with other services"
SWALLOW FUNCTION W/VIDEORAD   ,74000271,CDM,320,RC,74230,CPT,,,,Inpatient,,,667.96,667.96,HUMANA CHOICE PLUS,MGD,667.96,,,,,,,case rate,667.96,667.96,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,AETNA,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,BCBS,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,CIGNA,COM,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,TRICARE,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,UNITED HEALTHCARE,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,UNITED HEALTHCARE,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,VA,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,VA TRICARE,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,WELLMED,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,HUMANA,MGD,547.17,,,,,,,per diem,547.17,547.17,"Per diem rate, code is bundled with other services"
FACIAL BONES < 3 VIEWS        ,74000290,CDM,320,RC,70140,CPT,,,,Inpatient,,,547.17,547.17,HUMANA CHOICE PLUS,MGD,547.17,,,,,,,case rate,547.17,547.17,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,AETNA,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,BCBS,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,CIGNA,COM,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,TRICARE,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,UNITED HEALTHCARE,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,UNITED HEALTHCARE,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,VA,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,VA TRICARE,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,WELLMED,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,HUMANA,MGD,333.36,,,,,,,per diem,333.36,333.36,"Per diem rate, code is bundled with other services"
FACIAL BONES 3+ VIEWS         ,74000300,CDM,320,RC,70150,CPT,,,,Inpatient,,,333.36,333.36,HUMANA CHOICE PLUS,MGD,333.36,,,,,,,case rate,333.36,333.36,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS BILATERAL      ,74000310,CDM,320,RC,73550,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,AETNA,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,BCBS,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,CIGNA,COM,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,TRICARE,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,UNITED HEALTHCARE,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,UNITED HEALTHCARE,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,VA,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,VA TRICARE,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,WELLMED,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,HUMANA,MGD,205.8,,,,,,,per diem,205.8,205.8,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS BILATERAL  ,74000350,CDM,320,RC,73140,CPT,,,50,Inpatient,,,205.8,205.8,HUMANA CHOICE PLUS,MGD,205.8,,,,,,,case rate,205.8,205.8,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,AETNA,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,BCBS,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,CIGNA,COM,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,TRICARE,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,UNITED HEALTHCARE,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,UNITED HEALTHCARE,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,VA,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,VA TRICARE,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,WELLMED,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,HUMANA,MGD,768.96,,,,,,,per diem,768.96,768.96,"Per diem rate, code is bundled with other services"
ABSCESS FISTULA SINUS TRACT ST,74000360,CDM,320,RC,76080,CPT,,,,Inpatient,,,768.96,768.96,HUMANA CHOICE PLUS,MGD,768.96,,,,,,,case rate,768.96,768.96,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,AETNA,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,BCBS,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,CIGNA,COM,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,TRICARE,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,UNITED HEALTHCARE,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,UNITED HEALTHCARE,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,VA,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,VA TRICARE,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,WELLMED,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,HUMANA,MGD,826.86,,,,,,,per diem,826.86,826.86,"Per diem rate, code is bundled with other services"
FLUOROSCOPY 1HR OR LESS       ,74000370,CDM,320,RC,76000,CPT,,,,Inpatient,,,826.86,826.86,HUMANA CHOICE PLUS,MGD,826.86,,,,,,,case rate,826.86,826.86,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,AETNA,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,BCBS,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,CIGNA,COM,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,TRICARE,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,UNITED HEALTHCARE,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,UNITED HEALTHCARE,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,VA,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,VA TRICARE,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,WELLMED,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,HUMANA,MGD,242.9,,,,,,,per diem,242.9,242.9,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS BILATERAL        ,74000390,CDM,320,RC,73620,CPT,,,50,Inpatient,,,242.9,242.9,HUMANA CHOICE PLUS,MGD,242.9,,,,,,,case rate,242.9,242.9,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS BILATERAL       ,74000400,CDM,320,RC,73630,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS BILATERAL     ,74000410,CDM,320,RC,73090,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,AETNA,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,BCBS,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,CIGNA,COM,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,TRICARE,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,UNITED HEALTHCARE,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,UNITED HEALTHCARE,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,VA,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,VA TRICARE,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,WELLMED,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,HUMANA,MGD,773.26,,,,,,,per diem,773.26,773.26,"Per diem rate, code is bundled with other services"
GALLBLADDER W/ ORAL CONTRAST  ,74000420,CDM,320,RC,74290,CPT,,,,Inpatient,,,773.26,773.26,HUMANA CHOICE PLUS,MGD,773.26,,,,,,,case rate,773.26,773.26,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL RT      ,74000421,CDM,320,RC,73500,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,AETNA,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,BCBS,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,CIGNA,COM,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,TRICARE,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,UNITED HEALTHCARE,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,UNITED HEALTHCARE,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,VA,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,VA TRICARE,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,WELLMED,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,HUMANA,MGD,458.01,,,,,,,per diem,458.01,458.01,"Per diem rate, code is bundled with other services"
GASTROGRAFIN                  ,74000430,CDM,255,RC,,,,,,Inpatient,1,EA,458.01,458.01,HUMANA CHOICE PLUS,MGD,458.01,,,,,,,case rate,458.01,458.01,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS BILATERAL        ,74000440,CDM,320,RC,73120,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS BILATERAL       ,74000441,CDM,320,RC,73130,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
PELVIS & LATERAL BOTH HIPS    ,74000450,CDM,320,RC,73520,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS BILATERAL    ,74000470,CDM,320,RC,73060,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS BILATERAL      ,74000480,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS BILATERAL        ,74000481,CDM,320,RC,73562,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 4+ VIEWS BILATERAL       ,74000482,CDM,320,RC,73564,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE               ,74000490,CDM,320,RC,73580,CPT,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 2-3 VIEWS      ,74000500,CDM,320,RC,72100,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
LUMBOSACRAL SP 4+ VIEWS       ,74000501,CDM,320,RC,72110,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SP COMP W FLEX/EXT     ,74000502,CDM,320,RC,72114,CPT,,,,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,AETNA,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,BCBS,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,CIGNA,COM,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,TRICARE,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,UNITED HEALTHCARE,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,UNITED HEALTHCARE,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,VA,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,VA TRICARE,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,WELLMED,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,HUMANA,MGD,480.99,,,,,,,per diem,480.99,480.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM DIAG BILATERAL      ,74000510,CDM,401,RC,77066,CPT,G0204,HCPCS,,Inpatient,,,480.99,480.99,HUMANA CHOICE PLUS,MGD,480.99,,,,,,,case rate,480.99,480.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,AETNA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,CIGNA,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,VA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,VA TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,WELLMED,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,HUMANA,MGD,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MAMMOGRAM SCREEN BILATERAL    ,74000515,CDM,403,RC,77067,CPT,,,,Inpatient,,,210.99,210.99,HUMANA CHOICE PLUS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,AETNA,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,BCBS,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,CIGNA,COM,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,TRICARE,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,UNITED HEALTHCARE,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,UNITED HEALTHCARE,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,VA,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,VA TRICARE,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,WELLMED,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,HUMANA,MGD,947.32,,,,,,,per diem,947.32,947.32,"Per diem rate, code is bundled with other services"
MANDIBLE 4+ VIEWS             ,74000530,CDM,320,RC,70110,CPT,,,,Inpatient,,,947.32,947.32,HUMANA CHOICE PLUS,MGD,947.32,,,,,,,case rate,947.32,947.32,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,AETNA,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,BCBS,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,CIGNA,COM,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,TRICARE,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,UNITED HEALTHCARE,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,UNITED HEALTHCARE,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,VA,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,VA TRICARE,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,WELLMED,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,HUMANA,MGD,196.1,,,,,,,per diem,196.1,196.1,"Per diem rate, code is bundled with other services"
MANDIBLE PARTIAL<4 VIEWS      ,74000540,CDM,320,RC,70100,CPT,,,,Inpatient,,,196.1,196.1,HUMANA CHOICE PLUS,MGD,196.1,,,,,,,case rate,196.1,196.1,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,AETNA,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,BCBS,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,CIGNA,COM,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,TRICARE,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,UNITED HEALTHCARE,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,UNITED HEALTHCARE,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,VA,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,VA TRICARE,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,WELLMED,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,HUMANA,MGD,1914.35,,,,,,,per diem,1914.35,1914.35,"Per diem rate, code is bundled with other services"
MYLEOGRAM LUMBAR              ,74000580,CDM,320,RC,72265,CPT,,,,Inpatient,,,1914.35,1914.35,HUMANA CHOICE PLUS,MGD,1914.35,,,,,,,case rate,1914.35,1914.35,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,AETNA,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,BCBS,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,CIGNA,COM,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,TRICARE,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,UNITED HEALTHCARE,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,UNITED HEALTHCARE,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,VA,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,VA TRICARE,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,WELLMED,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,HUMANA,MGD,1242.58,,,,,,,per diem,1242.58,1242.58,"Per diem rate, code is bundled with other services"
MYELOGRAM THORACIC            ,74000581,CDM,320,RC,72255,CPT,,,,Inpatient,,,1242.58,1242.58,HUMANA CHOICE PLUS,MGD,1242.58,,,,,,,case rate,1242.58,1242.58,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,AETNA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,CIGNA,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,VA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,VA TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,WELLMED,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,HUMANA,MGD,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
MYELOGRAM CERVICAL            ,74000582,CDM,320,RC,72240,CPT,,,,Inpatient,,,1995.27,1995.27,HUMANA CHOICE PLUS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,AETNA,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,BCBS,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,CIGNA,COM,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,TRICARE,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,UNITED HEALTHCARE,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,UNITED HEALTHCARE,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,VA,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,VA TRICARE,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,WELLMED,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,HUMANA,MGD,553.96,,,,,,,per diem,553.96,553.96,"Per diem rate, code is bundled with other services"
NASAL BONES 3+ VIEWS          ,74000590,CDM,320,RC,70160,CPT,,,,Inpatient,,,553.96,553.96,HUMANA CHOICE PLUS,MGD,553.96,,,,,,,case rate,553.96,553.96,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
NECK SOFT TISSUE              ,74000596,CDM,320,RC,70360,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
IVP INFUSION W/ TOMOGRAMS     ,74000600,CDM,320,RC,74415,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,AETNA,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,BCBS,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,CIGNA,COM,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,TRICARE,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,UNITED HEALTHCARE,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,UNITED HEALTHCARE,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,VA,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,VA TRICARE,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,WELLMED,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,HUMANA,MGD,731.58,,,,,,,per diem,731.58,731.58,"Per diem rate, code is bundled with other services"
ORBITS COMP 4+ VIEWS          ,74000605,CDM,320,RC,70200,CPT,,,,Inpatient,,,731.58,731.58,HUMANA CHOICE PLUS,MGD,731.58,,,,,,,case rate,731.58,731.58,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,AETNA,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,BCBS,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,CIGNA,COM,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,TRICARE,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,UNITED HEALTHCARE,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,UNITED HEALTHCARE,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,VA,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,VA TRICARE,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,WELLMED,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,HUMANA,MGD,279.3,,,,,,,per diem,279.3,279.3,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS BILATERAL  ,74000610,CDM,320,RC,73650,CPT,,,50,Inpatient,,,279.3,279.3,HUMANA CHOICE PLUS,MGD,279.3,,,,,,,case rate,279.3,279.3,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
PELVIS 1-2 VIEWS              ,74000630,CDM,320,RC,72170,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,AETNA,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,BCBS,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,CIGNA,COM,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,TRICARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,UNITED HEALTHCARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,UNITED HEALTHCARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,VA,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,VA TRICARE,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,WELLMED,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,HUMANA,MGD,1102.5,,,,,,,per diem,1102.5,1102.5,"Per diem rate, code is bundled with other services"
PELVIS 3+ VIEWS               ,74000631,CDM,320,RC,72190,CPT,,,,Inpatient,,,1102.5,1102.5,HUMANA CHOICE PLUS,MGD,1102.5,,,,,,,case rate,1102.5,1102.5,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,AETNA,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,BCBS,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,CIGNA,COM,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,TRICARE,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,UNITED HEALTHCARE,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,UNITED HEALTHCARE,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,VA,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,VA TRICARE,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,WELLMED,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,HUMANA,MGD,407.19,,,,,,,per diem,407.19,407.19,"Per diem rate, code is bundled with other services"
IVP RETROGRADE                ,74000660,CDM,320,RC,74420,CPT,,,,Inpatient,,,407.19,407.19,HUMANA CHOICE PLUS,MGD,407.19,,,,,,,case rate,407.19,407.19,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS BILATERAL 3 VIEWS        ,74000670,CDM,320,RC,71110,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
RIBS BILATERAL WITH PA CHEST  ,74000671,CDM,320,RC,71111,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,AETNA,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,BCBS,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,CIGNA,COM,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,TRICARE,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,UNITED HEALTHCARE,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,UNITED HEALTHCARE,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,VA,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,VA TRICARE,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,WELLMED,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,HUMANA,MGD,378.53,,,,,,,per diem,378.53,378.53,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS < 3 VIEWS   ,74000688,CDM,320,RC,72200,CPT,,,,Inpatient,,,378.53,378.53,HUMANA CHOICE PLUS,MGD,378.53,,,,,,,case rate,378.53,378.53,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,AETNA,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,BCBS,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,CIGNA,COM,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,TRICARE,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,UNITED HEALTHCARE,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,UNITED HEALTHCARE,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,VA,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,VA TRICARE,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,WELLMED,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,HUMANA,MGD,235.77,,,,,,,per diem,235.77,235.77,"Per diem rate, code is bundled with other services"
SACRUM & COCCYX MIN 2+ VIEWS  ,74000690,CDM,320,RC,72220,CPT,,,,Inpatient,,,235.77,235.77,HUMANA CHOICE PLUS,MGD,235.77,,,,,,,case rate,235.77,235.77,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
SCAPULA BILATERAL             ,74000700,CDM,320,RC,73010,CPT,,,50,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,AETNA,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,BCBS,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,CIGNA,COM,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,TRICARE,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,UNITED HEALTHCARE,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,UNITED HEALTHCARE,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,VA,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,VA TRICARE,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,WELLMED,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,HUMANA,MGD,1190.42,,,,,,,per diem,1190.42,1190.42,"Per diem rate, code is bundled with other services"
SACROILIAC JOINTS 3+ VIEWS    ,74000710,CDM,320,RC,72202,CPT,,,,Inpatient,,,1190.42,1190.42,HUMANA CHOICE PLUS,MGD,1190.42,,,,,,,case rate,1190.42,1190.42,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS BILATERAL   ,74000720,CDM,320,RC,73030,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,AETNA,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,BCBS,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,CIGNA,COM,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,TRICARE,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,UNITED HEALTHCARE,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,UNITED HEALTHCARE,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,VA,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,VA TRICARE,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,WELLMED,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,HUMANA,MGD,461.86,,,,,,,per diem,461.86,461.86,"Per diem rate, code is bundled with other services"
SINUSES < 3 VIEWS             ,74000749,CDM,320,RC,70210,CPT,,,,Inpatient,,,461.86,461.86,HUMANA CHOICE PLUS,MGD,461.86,,,,,,,case rate,461.86,461.86,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,AETNA,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,BCBS,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,CIGNA,COM,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,TRICARE,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,UNITED HEALTHCARE,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,UNITED HEALTHCARE,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,VA,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,VA TRICARE,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,WELLMED,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,HUMANA,MGD,762.23,,,,,,,per diem,762.23,762.23,"Per diem rate, code is bundled with other services"
SINUS COMP MIN 3 VIEWS        ,74000750,CDM,320,RC,70220,CPT,,,,Inpatient,,,762.23,762.23,HUMANA CHOICE PLUS,MGD,762.23,,,,,,,case rate,762.23,762.23,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,AETNA,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,BCBS,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,CIGNA,COM,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,TRICARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,UNITED HEALTHCARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,UNITED HEALTHCARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,VA,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,VA TRICARE,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,WELLMED,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,HUMANA,MGD,659.74,,,,,,,per diem,659.74,659.74,"Per diem rate, code is bundled with other services"
SKELETAL SURVEY COMPLETE      ,74000760,CDM,320,RC,77075,CPT,,,,Inpatient,,,659.74,659.74,HUMANA CHOICE PLUS,MGD,659.74,,,,,,,case rate,659.74,659.74,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,AETNA,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,BCBS,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,CIGNA,COM,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,TRICARE,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,UNITED HEALTHCARE,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,UNITED HEALTHCARE,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,VA,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,VA TRICARE,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,WELLMED,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,HUMANA,MGD,496.25,,,,,,,per diem,496.25,496.25,"Per diem rate, code is bundled with other services"
SKULL 4+ VIEWS                ,74000770,CDM,320,RC,70260,CPT,,,,Inpatient,,,496.25,496.25,HUMANA CHOICE PLUS,MGD,496.25,,,,,,,case rate,496.25,496.25,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,AETNA,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,BCBS,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,CIGNA,COM,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,TRICARE,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,UNITED HEALTHCARE,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,UNITED HEALTHCARE,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,VA,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,VA TRICARE,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,WELLMED,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,HUMANA,MGD,336.35,,,,,,,per diem,336.35,336.35,"Per diem rate, code is bundled with other services"
SKULL < 4 VIEWS               ,74000780,CDM,320,RC,70250,CPT,,,,Inpatient,,,336.35,336.35,HUMANA CHOICE PLUS,MGD,336.35,,,,,,,case rate,336.35,336.35,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,AETNA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,CIGNA,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,VA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,VA TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,WELLMED,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,HUMANA,MGD,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
SMALL BOWEL                   ,74000790,CDM,320,RC,74250,CPT,,,,Inpatient,,,961.76,961.76,HUMANA CHOICE PLUS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,AETNA,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,BCBS,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,CIGNA,COM,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,TRICARE,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,UNITED HEALTHCARE,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,UNITED HEALTHCARE,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,VA,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,VA TRICARE,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,WELLMED,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,HUMANA,MGD,676.03,,,,,,,per diem,676.03,676.03,"Per diem rate, code is bundled with other services"
STERNOCLAVICULAR 3+ VIEWS     ,74000800,CDM,320,RC,71130,CPT,,,,Inpatient,,,676.03,676.03,HUMANA CHOICE PLUS,MGD,676.03,,,,,,,case rate,676.03,676.03,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,AETNA,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,BCBS,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,CIGNA,COM,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,TRICARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,UNITED HEALTHCARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,UNITED HEALTHCARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,VA,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,VA TRICARE,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,WELLMED,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,HUMANA,MGD,340.6,,,,,,,per diem,340.6,340.6,"Per diem rate, code is bundled with other services"
STERNUM MIN 2 VIEW            ,74000810,CDM,320,RC,71120,CPT,,,,Inpatient,,,340.6,340.6,HUMANA CHOICE PLUS,MGD,340.6,,,,,,,case rate,340.6,340.6,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
THORACIC SP 2 VIEWS           ,74000820,CDM,320,RC,72070,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
THORACIC/LUMBAR SP 2 VIEWS    ,74000821,CDM,320,RC,72080,CPT,,,,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,AETNA,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,BCBS,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,CIGNA,COM,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,TRICARE,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,UNITED HEALTHCARE,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,UNITED HEALTHCARE,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,VA,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,VA TRICARE,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,WELLMED,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,HUMANA,MGD,461.01,,,,,,,per diem,461.01,461.01,"Per diem rate, code is bundled with other services"
TMJ BILATERAL                 ,74000825,CDM,320,RC,70330,CPT,,,,Inpatient,,,461.01,461.01,HUMANA CHOICE PLUS,MGD,461.01,,,,,,,case rate,461.01,461.01,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS BILATERAL,74000830,CDM,320,RC,73590,CPT,,,50,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS BILATERAL     ,74000835,CDM,320,RC,73660,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,AETNA,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,BCBS,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,CIGNA,COM,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,TRICARE,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,UNITED HEALTHCARE,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,UNITED HEALTHCARE,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,VA,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,VA TRICARE,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,WELLMED,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,HUMANA,MGD,535.5,,,,,,,per diem,535.5,535.5,"Per diem rate, code is bundled with other services"
TOMOGRAMS                     ,74000840,CDM,320,RC,76100,CPT,,,,Inpatient,,,535.5,535.5,HUMANA CHOICE PLUS,MGD,535.5,,,,,,,case rate,535.5,535.5,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,AETNA,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,BCBS,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,CIGNA,COM,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,TRICARE,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,UNITED HEALTHCARE,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,UNITED HEALTHCARE,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,VA,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,VA TRICARE,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,WELLMED,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,HUMANA,MGD,471.28,,,,,,,per diem,471.28,471.28,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/O KUB      ,74000860,CDM,320,RC,74240,CPT,,,,Inpatient,,,471.28,471.28,HUMANA CHOICE PLUS,MGD,471.28,,,,,,,case rate,471.28,471.28,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
URETHA BLADDER VOIDING CYSTO  ,74000870,CDM,320,RC,74455,CPT,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,AETNA,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,BCBS,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,CIGNA,COM,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,TRICARE,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,UNITED HEALTHCARE,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,UNITED HEALTHCARE,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,VA,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,VA TRICARE,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,WELLMED,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,HUMANA,MGD,2860.64,,,,,,,per diem,2860.64,2860.64,"Per diem rate, code is bundled with other services"
IVP INTRAVENOUS W/WO KUB      ,74000880,CDM,320,RC,74400,CPT,,,,Inpatient,,,2860.64,2860.64,HUMANA CHOICE PLUS,MGD,2860.64,,,,,,,case rate,2860.64,2860.64,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,AETNA,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,BCBS,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,CIGNA,COM,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,TRICARE,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,UNITED HEALTHCARE,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,UNITED HEALTHCARE,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,VA,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,VA TRICARE,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,WELLMED,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,HUMANA,MGD,4094.83,,,,,,,per diem,4094.83,4094.83,"Per diem rate, code is bundled with other services"
VENOGRAM EXT BILATERAL        ,74000892,CDM,320,RC,75822,CPT,,,,Inpatient,,,4094.83,4094.83,HUMANA CHOICE PLUS,MGD,4094.83,,,,,,,case rate,4094.83,4094.83,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS BILATERAL       ,74000900,CDM,320,RC,73100,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS BILATERAL      ,74000901,CDM,320,RC,73110,CPT,,,50,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,AETNA,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,BCBS,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,CIGNA,COM,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,TRICARE,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,UNITED HEALTHCARE,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,UNITED HEALTHCARE,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,VA,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,VA TRICARE,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,WELLMED,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,HUMANA,MGD,3895.23,,,,,,,per diem,3895.23,3895.23,"Per diem rate, code is bundled with other services"
SMALL BOWEL VIA ENTEROCLYSIS  ,74000925,CDM,320,RC,74251,CPT,,,,Inpatient,,,3895.23,3895.23,HUMANA CHOICE PLUS,MGD,3895.23,,,,,,,case rate,3895.23,3895.23,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,AETNA,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,BCBS,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,CIGNA,COM,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,TRICARE,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,UNITED HEALTHCARE,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,UNITED HEALTHCARE,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,VA,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,VA TRICARE,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,WELLMED,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,HUMANA,MGD,340.17,,,,,,,per diem,340.17,340.17,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR WO KUB         ,74000945,CDM,320,RC,74246,CPT,,,,Inpatient,,,340.17,340.17,HUMANA CHOICE PLUS,MGD,340.17,,,,,,,case rate,340.17,340.17,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
CERVICAL SP 4+ VIEWS          ,74000950,CDM,320,RC,72050,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW              ,74000970,CDM,322,RC,73085,CPT,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,AETNA,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,BCBS,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,CIGNA,COM,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,TRICARE,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,UNITED HEALTHCARE,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,UNITED HEALTHCARE,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,VA,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,VA TRICARE,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,WELLMED,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,HUMANA,MGD,1645.06,,,,,,,per diem,1645.06,1645.06,"Per diem rate, code is bundled with other services"
HYSTEROSALPINGOGRAPHY         ,74000982,CDM,320,RC,74740,CPT,,,,Inpatient,,,1645.06,1645.06,HUMANA CHOICE PLUS,MGD,1645.06,,,,,,,case rate,1645.06,1645.06,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,AETNA,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,BCBS,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,CIGNA,COM,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,TRICARE,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,UNITED HEALTHCARE,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,UNITED HEALTHCARE,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,VA,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,VA TRICARE,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,WELLMED,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,HUMANA,MGD,1809.65,,,,,,,per diem,1809.65,1809.65,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR PERCUT DRAIN ,74000995,CDM,320,RC,75989,CPT,,,,Inpatient,,,1809.65,1809.65,HUMANA CHOICE PLUS,MGD,1809.65,,,,,,,case rate,1809.65,1809.65,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,AETNA,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,BCBS,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,CIGNA,COM,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,TRICARE,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,UNITED HEALTHCARE,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,UNITED HEALTHCARE,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,VA,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,VA TRICARE,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,WELLMED,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,HUMANA,MGD,8416.99,,,,,,,per diem,8416.99,8416.99,"Per diem rate, code is bundled with other services"
ANGIO SPINAL SELECTIVE        ,74001011,CDM,323,RC,75705,CPT,,,,Inpatient,,,8416.99,8416.99,HUMANA CHOICE PLUS,MGD,8416.99,,,,,,,case rate,8416.99,8416.99,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,AETNA,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,BCBS,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,CIGNA,COM,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,TRICARE,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,UNITED HEALTHCARE,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,UNITED HEALTHCARE,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,VA,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,VA TRICARE,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,WELLMED,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,HUMANA,MGD,292.43,,,,,,,per diem,292.43,292.43,"Per diem rate, code is bundled with other services"
EKG TRACING ONLY (RAD)        ,74001015,CDM,730,RC,93005,CPT,,,,Inpatient,,,292.43,292.43,HUMANA CHOICE PLUS,MGD,292.43,,,,,,,case rate,292.43,292.43,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,AETNA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,CIGNA,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,VA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,VA TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,WELLMED,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,HUMANA,MGD,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
ANGIO EXTREMITY BILATERAL     ,74001016,CDM,323,RC,75716,CPT,,,,Inpatient,,,5947.26,5947.26,HUMANA CHOICE PLUS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,AETNA,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,BCBS,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,CIGNA,COM,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,TRICARE,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,UNITED HEALTHCARE,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,UNITED HEALTHCARE,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,VA,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,VA TRICARE,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,WELLMED,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,HUMANA,MGD,4752.03,,,,,,,per diem,4752.03,4752.03,"Per diem rate, code is bundled with other services"
ANGIO PELVIC SELECTIVE        ,74001018,CDM,323,RC,75736,CPT,,,,Inpatient,,,4752.03,4752.03,HUMANA CHOICE PLUS,MGD,4752.03,,,,,,,case rate,4752.03,4752.03,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ANGIO PULMONARY SELECT BIL    ,74001019,CDM,323,RC,75743,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,AETNA,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,BCBS,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,CIGNA,COM,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,TRICARE,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,UNITED HEALTHCARE,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,UNITED HEALTHCARE,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,VA,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,VA TRICARE,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,WELLMED,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,HUMANA,MGD,7169.27,,,,,,,per diem,7169.27,7169.27,"Per diem rate, code is bundled with other services"
ANGIO VISCERAL SELECT         ,74001023,CDM,323,RC,75726,CPT,,,,Inpatient,,,7169.27,7169.27,HUMANA CHOICE PLUS,MGD,7169.27,,,,,,,case rate,7169.27,7169.27,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,AETNA,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,BCBS,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,CIGNA,COM,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,TRICARE,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,UNITED HEALTHCARE,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,UNITED HEALTHCARE,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,VA,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,VA TRICARE,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,WELLMED,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,HUMANA,MGD,6815.84,,,,,,,per diem,6815.84,6815.84,"Per diem rate, code is bundled with other services"
AORTOGRAM ABD&BIL FEMORAL EXT ,74001025,CDM,323,RC,75630,CPT,,,,Inpatient,,,6815.84,6815.84,HUMANA CHOICE PLUS,MGD,6815.84,,,,,,,case rate,6815.84,6815.84,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/O SERIAL ,74001051,CDM,323,RC,75600,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
AORTOGRAM THORACIC W/SERIAL   ,74001052,CDM,323,RC,75605,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,AETNA,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,BCBS,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,CIGNA,COM,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,TRICARE,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,UNITED HEALTHCARE,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,UNITED HEALTHCARE,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,VA,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,VA TRICARE,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,WELLMED,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,HUMANA,MGD,1268.06,,,,,,,per diem,1268.06,1268.06,"Per diem rate, code is bundled with other services"
ERCP (ENDO CATH BIL DUCT)     ,74001057,CDM,320,RC,74328,CPT,,,,Inpatient,,,1268.06,1268.06,HUMANA CHOICE PLUS,MGD,1268.06,,,,,,,case rate,1268.06,1268.06,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,AETNA,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,BCBS,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,CIGNA,COM,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,TRICARE,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,UNITED HEALTHCARE,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,UNITED HEALTHCARE,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,VA,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,VA TRICARE,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,WELLMED,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,HUMANA,MGD,1189.85,,,,,,,per diem,1189.85,1189.85,"Per diem rate, code is bundled with other services"
PERC TUBE/DRAIN CATH CHANGE   ,74001072,CDM,320,RC,75984,CPT,,,,Inpatient,,,1189.85,1189.85,HUMANA CHOICE PLUS,MGD,1189.85,,,,,,,case rate,1189.85,1189.85,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,AETNA,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,BCBS,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,CIGNA,COM,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,TRICARE,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,UNITED HEALTHCARE,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,UNITED HEALTHCARE,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,VA,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,VA TRICARE,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,WELLMED,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,HUMANA,MGD,1192.68,,,,,,,per diem,1192.68,1192.68,"Per diem rate, code is bundled with other services"
IVP ANTEGRADE                 ,74001074,CDM,320,RC,74425,CPT,,,,Inpatient,,,1192.68,1192.68,HUMANA CHOICE PLUS,MGD,1192.68,,,,,,,case rate,1192.68,1192.68,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,AETNA,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,BCBS,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,CIGNA,COM,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,TRICARE,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,UNITED HEALTHCARE,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,UNITED HEALTHCARE,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,VA,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,VA TRICARE,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,WELLMED,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,HUMANA,MGD,4686.7,,,,,,,per diem,4686.7,4686.7,"Per diem rate, code is bundled with other services"
VENOGRAM INFERIOR CAVAL       ,74001096,CDM,320,RC,75825,CPT,,,,Inpatient,,,4686.7,4686.7,HUMANA CHOICE PLUS,MGD,4686.7,,,,,,,case rate,4686.7,4686.7,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABD FLAT & UPRIGHT &1V CHEST  ,74001104,CDM,320,RC,74022,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,AETNA,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,BCBS,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,CIGNA,COM,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,TRICARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,UNITED HEALTHCARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,UNITED HEALTHCARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,VA,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,VA TRICARE,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,WELLMED,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,HUMANA,MGD,384.3,,,,,,,per diem,384.3,384.3,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS W/FLUOROSCOPY   ,74001120,CDM,320,RC,71023,CPT,,,,Inpatient,,,384.3,384.3,HUMANA CHOICE PLUS,MGD,384.3,,,,,,,case rate,384.3,384.3,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
DISCOGRAPHY LUMBAR            ,74001124,CDM,320,RC,72295,CPT,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,AETNA,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,BCBS,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,CIGNA,COM,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,TRICARE,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,UNITED HEALTHCARE,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,UNITED HEALTHCARE,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,VA,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,VA TRICARE,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,WELLMED,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,HUMANA,MGD,922.28,,,,,,,per diem,922.28,922.28,"Per diem rate, code is bundled with other services"
URETHRA/BLADDER RETROGRADE    ,74001158,CDM,320,RC,74450,CPT,,,,Inpatient,,,922.28,922.28,HUMANA CHOICE PLUS,MGD,922.28,,,,,,,case rate,922.28,922.28,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,AETNA,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,CIGNA,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,TRICARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,UNITED HEALTHCARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,UNITED HEALTHCARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,VA,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,VA TRICARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,WELLMED,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,HUMANA,MGD,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
BREAST SURGICAL SPECIMEN      ,74001182,CDM,320,RC,76098,CPT,,,,Inpatient,,,755.06,755.06,HUMANA CHOICE PLUS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
LUMBAR SPINE BEND ONLY 4+VIEWS,74001183,CDM,320,RC,72120,CPT,,,,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
SPINE-SINGLE VIEW-SPECIFY LEVL,74001189,CDM,320,RC,72020,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,AETNA,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,BCBS,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,CIGNA,COM,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,TRICARE,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,UNITED HEALTHCARE,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,UNITED HEALTHCARE,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,VA,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,VA TRICARE,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,WELLMED,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,HUMANA,MGD,244.65,,,,,,,per diem,244.65,244.65,"Per diem rate, code is bundled with other services"
SPINE-ENTIRE-AP&LAT           ,74001190,CDM,320,RC,72010,CPT,,,,Inpatient,,,244.65,244.65,HUMANA CHOICE PLUS,MGD,244.65,,,,,,,case rate,244.65,244.65,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CHEST MIN 4 VIEWS             ,74001191,CDM,320,RC,71048,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,AETNA,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,BCBS,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,CIGNA,COM,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,TRICARE,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,UNITED HEALTHCARE,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,UNITED HEALTHCARE,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,VA,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,VA TRICARE,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,WELLMED,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,HUMANA,MGD,438.04,,,,,,,per diem,438.04,438.04,"Per diem rate, code is bundled with other services"
ENTEROCLYSIS TUBE PLACEMENT   ,74001207,CDM,320,RC,74355,CPT,,,,Inpatient,,,438.04,438.04,HUMANA CHOICE PLUS,MGD,438.04,,,,,,,case rate,438.04,438.04,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,AETNA,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,BCBS,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,CIGNA,COM,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,TRICARE,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,UNITED HEALTHCARE,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,UNITED HEALTHCARE,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,VA,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,VA TRICARE,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,WELLMED,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,HUMANA,MGD,888.93,,,,,,,per diem,888.93,888.93,"Per diem rate, code is bundled with other services"
ANGIO ARTERIOVENOUS SHUNT     ,74001223,CDM,323,RC,75791,CPT,,,,Inpatient,,,888.93,888.93,HUMANA CHOICE PLUS,MGD,888.93,,,,,,,case rate,888.93,888.93,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
CERVICAL SP W/OBL & FLEX/EXT  ,74001260,CDM,320,RC,72052,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,AETNA,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,BCBS,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,CIGNA,COM,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,TRICARE,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,UNITED HEALTHCARE,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,UNITED HEALTHCARE,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,VA,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,VA TRICARE,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,WELLMED,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,HUMANA,MGD,778.27,,,,,,,per diem,778.27,778.27,"Per diem rate, code is bundled with other services"
FLOURO NEEDLE GUIDE SPINE     ,74001280,CDM,320,RC,77003,CPT,,,,Inpatient,,,778.27,778.27,HUMANA CHOICE PLUS,MGD,778.27,,,,,,,case rate,778.27,778.27,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SPINE ENTIRE 4 OR 5 VIEWS     ,74001303,CDM,320,RC,72083,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,AETNA,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,BCBS,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,CIGNA,COM,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,TRICARE,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,UNITED HEALTHCARE,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,UNITED HEALTHCARE,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,VA,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,VA TRICARE,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,WELLMED,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,HUMANA,MGD,247.09,,,,,,,per diem,247.09,247.09,"Per diem rate, code is bundled with other services"
SPINE ENTIRE MIN 6 VIEWS      ,74001304,CDM,320,RC,72084,CPT,,,,Inpatient,,,247.09,247.09,HUMANA CHOICE PLUS,MGD,247.09,,,,,,,case rate,247.09,247.09,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
THORACOLUMBAR MIN 2 VIEWS     ,74001307,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,AETNA,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,BCBS,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,CIGNA,COM,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,TRICARE,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,UNITED HEALTHCARE,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,UNITED HEALTHCARE,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,VA,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,VA TRICARE,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,WELLMED,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,HUMANA,MGD,161.09,,,,,,,per diem,161.09,161.09,"Per diem rate, code is bundled with other services"
HIPS MIN 5 VIEWS BILATERAL    ,74001317,CDM,320,RC,73523,CPT,,,,Inpatient,,,161.09,161.09,HUMANA CHOICE PLUS,MGD,161.09,,,,,,,case rate,161.09,161.09,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FEMUR 1 VIEW BILATERAL        ,74001321,CDM,320,RC,73551,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,AETNA,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,BCBS,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,CIGNA,COM,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,TRICARE,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,UNITED HEALTHCARE,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,UNITED HEALTHCARE,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,VA,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,VA TRICARE,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,WELLMED,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,HUMANA,MGD,219.54,,,,,,,per diem,219.54,219.54,"Per diem rate, code is bundled with other services"
HIP 1 VIEW UNILATERAL LT      ,74001411,CDM,320,RC,73500,CPT,,,LT,Inpatient,,,219.54,219.54,HUMANA CHOICE PLUS,MGD,219.54,,,,,,,case rate,219.54,219.54,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,AETNA,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,BCBS,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,CIGNA,COM,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,TRICARE,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,UNITED HEALTHCARE,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,UNITED HEALTHCARE,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,VA,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,VA TRICARE,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,WELLMED,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,HUMANA,MGD,1652.55,,,,,,,per diem,1652.55,1652.55,"Per diem rate, code is bundled with other services"
UGI W/AIR & SMALL BOWEL       ,74001421,CDM,320,RC,74249,CPT,,,,Inpatient,,,1652.55,1652.55,HUMANA CHOICE PLUS,MGD,1652.55,,,,,,,case rate,1652.55,1652.55,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,AETNA,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,BCBS,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,CIGNA,COM,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,TRICARE,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,UNITED HEALTHCARE,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,UNITED HEALTHCARE,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,VA,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,VA TRICARE,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,WELLMED,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,HUMANA,MGD,916.78,,,,,,,per diem,916.78,916.78,"Per diem rate, code is bundled with other services"
CHOLANGIOGRAM INTRAOP ADDL SET,74001422,CDM,320,RC,74301,CPT,,,,Inpatient,,,916.78,916.78,HUMANA CHOICE PLUS,MGD,916.78,,,,,,,case rate,916.78,916.78,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,AETNA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,CIGNA,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,VA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,VA TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,WELLMED,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,HUMANA,MGD,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY HIP/PELV/SP ,74008000,CDM,320,RC,77080,CPT,,,,Inpatient,,,688.65,688.65,HUMANA CHOICE PLUS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
DEXA BONE DENSITY WRIST/HEEL  ,74008100,CDM,320,RC,77081,CPT,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,AETNA,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,BCBS,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,CIGNA,COM,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,TRICARE,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,UNITED HEALTHCARE,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,UNITED HEALTHCARE,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,VA,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,VA TRICARE,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,WELLMED,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,HUMANA,MGD,1499.4,,,,,,,per diem,1499.4,1499.4,"Per diem rate, code is bundled with other services"
VENOGRAM SUPERIOR CAVAL       ,74010002,CDM,320,RC,75827,CPT,,,,Inpatient,,,1499.4,1499.4,HUMANA CHOICE PLUS,MGD,1499.4,,,,,,,case rate,1499.4,1499.4,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS RT              ,74010003,CDM,320,RC,73600,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
ANKLE 2 VIEWS LT              ,74010004,CDM,320,RC,73600,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS RT             ,74010005,CDM,320,RC,73610,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,AETNA,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,BCBS,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,CIGNA,COM,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,TRICARE,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,UNITED HEALTHCARE,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,UNITED HEALTHCARE,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,VA,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,VA TRICARE,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,WELLMED,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,HUMANA,MGD,319.02,,,,,,,per diem,319.02,319.02,"Per diem rate, code is bundled with other services"
ANKLE 3+ VIEWS LT             ,74010006,CDM,320,RC,73610,CPT,,,LT,Inpatient,,,319.02,319.02,HUMANA CHOICE PLUS,MGD,319.02,,,,,,,case rate,319.02,319.02,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,AETNA,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,BCBS,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,CIGNA,COM,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,TRICARE,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,UNITED HEALTHCARE,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,UNITED HEALTHCARE,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,VA,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,VA TRICARE,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,WELLMED,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,HUMANA,MGD,327.6,,,,,,,per diem,327.6,327.6,"Per diem rate, code is bundled with other services"
ANTHROGRAM (LT) ELBOW         ,74010010,CDM,320,RC,73085,CPT,,,LT,Inpatient,,,327.6,327.6,HUMANA CHOICE PLUS,MGD,327.6,,,,,,,case rate,327.6,327.6,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,AETNA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,CIGNA,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,VA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,VA TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,WELLMED,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,HUMANA,MGD,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER RT        ,74010017,CDM,322,RC,73040,CPT,,,RT,Inpatient,,,105,105,HUMANA CHOICE PLUS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,AETNA,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,CIGNA,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,TRICARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,UNITED HEALTHCARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,UNITED HEALTHCARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,VA,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,VA TRICARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,WELLMED,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,HUMANA,MGD,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS RT         ,74010029,CDM,320,RC,73650,CPT,,,RT,Inpatient,,,171.86,171.86,HUMANA CHOICE PLUS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
CALCANEUS 2+ VIEWS LT         ,74010030,CDM,320,RC,73650,CPT,,,LT,Inpatient,,,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,AETNA,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,BCBS,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,CIGNA,COM,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,TRICARE,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,UNITED HEALTHCARE,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,UNITED HEALTHCARE,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,VA,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,VA TRICARE,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,WELLMED,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,HUMANA,MGD,231.53,,,,,,,per diem,231.53,231.53,"Per diem rate, code is bundled with other services"
CLAVICLE RT                   ,74010035,CDM,320,RC,73000,CPT,,,RT,Inpatient,,,231.53,231.53,HUMANA CHOICE PLUS,MGD,231.53,,,,,,,case rate,231.53,231.53,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,AETNA,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,CIGNA,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,TRICARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,UNITED HEALTHCARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,UNITED HEALTHCARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,VA,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,VA TRICARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,WELLMED,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,HUMANA,MGD,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS RT             ,74010037,CDM,320,RC,73080,CPT,,,RT,Inpatient,,,143.33,143.33,HUMANA CHOICE PLUS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,AETNA,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,BCBS,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,CIGNA,COM,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,TRICARE,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,UNITED HEALTHCARE,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,UNITED HEALTHCARE,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,VA,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,VA TRICARE,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,WELLMED,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,HUMANA,MGD,237.83,,,,,,,per diem,237.83,237.83,"Per diem rate, code is bundled with other services"
ELBOW 3+ VIEWS LT             ,74010038,CDM,320,RC,73080,CPT,,,LT,Inpatient,,,237.83,237.83,HUMANA CHOICE PLUS,MGD,237.83,,,,,,,case rate,237.83,237.83,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,AETNA,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,BCBS,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,CIGNA,COM,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,TRICARE,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,UNITED HEALTHCARE,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,UNITED HEALTHCARE,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,VA,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,VA TRICARE,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,WELLMED,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,HUMANA,MGD,329.55,,,,,,,per diem,329.55,329.55,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS RT              ,74010039,CDM,320,RC,73070,CPT,,,RT,Inpatient,,,329.55,329.55,HUMANA CHOICE PLUS,MGD,329.55,,,,,,,case rate,329.55,329.55,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,AETNA,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,BCBS,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,CIGNA,COM,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,TRICARE,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,UNITED HEALTHCARE,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,UNITED HEALTHCARE,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,VA,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,VA TRICARE,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,WELLMED,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,HUMANA,MGD,445.2,,,,,,,per diem,445.2,445.2,"Per diem rate, code is bundled with other services"
ELBOW 2 VIEWS LT              ,74010040,CDM,320,RC,73070,CPT,,,LT,Inpatient,,,445.2,445.2,HUMANA CHOICE PLUS,MGD,445.2,,,,,,,case rate,445.2,445.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,AETNA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,CIGNA,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,VA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,VA TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,WELLMED,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,HUMANA,MGD,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
VENOGRAM EXT UNIL LT          ,74010044,CDM,320,RC,75820,CPT,,,LT,Inpatient,,,105,105,HUMANA CHOICE PLUS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,AETNA,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,BCBS,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,CIGNA,COM,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,TRICARE,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,UNITED HEALTHCARE,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,UNITED HEALTHCARE,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,VA,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,VA TRICARE,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,WELLMED,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,HUMANA,MGD,324.35,,,,,,,per diem,324.35,324.35,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS RT             ,74010045,CDM,320,RC,73550,CPT,,,RT,Inpatient,,,324.35,324.35,HUMANA CHOICE PLUS,MGD,324.35,,,,,,,case rate,324.35,324.35,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,AETNA,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,BCBS,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,CIGNA,COM,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,TRICARE,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,UNITED HEALTHCARE,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,UNITED HEALTHCARE,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,VA,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,VA TRICARE,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,WELLMED,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,HUMANA,MGD,338.84,,,,,,,per diem,338.84,338.84,"Per diem rate, code is bundled with other services"
FEMUR 2+ VIEWS LT             ,74010046,CDM,320,RC,73550,CPT,,,LT,Inpatient,,,338.84,338.84,HUMANA CHOICE PLUS,MGD,338.84,,,,,,,case rate,338.84,338.84,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FINGER(S) 2+ VIEWS LT         ,74010051,CDM,320,RC,73140,CPT,,,LT,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS RT               ,74010057,CDM,320,RC,73620,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOOT 2 VIEWS LT               ,74010058,CDM,320,RC,73620,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS RT              ,74010059,CDM,320,RC,73630,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FOOT 3+ VIEWS LT              ,74010060,CDM,320,RC,73630,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS RT            ,74010061,CDM,320,RC,73090,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,AETNA,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,BCBS,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,CIGNA,COM,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,TRICARE,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,UNITED HEALTHCARE,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,UNITED HEALTHCARE,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,VA,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,VA TRICARE,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,WELLMED,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,HUMANA,MGD,372.75,,,,,,,per diem,372.75,372.75,"Per diem rate, code is bundled with other services"
FOREARM 2 VIEWS LT            ,74010062,CDM,320,RC,73090,CPT,,,LT,Inpatient,,,372.75,372.75,HUMANA CHOICE PLUS,MGD,372.75,,,,,,,case rate,372.75,372.75,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,AETNA,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,BCBS,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,CIGNA,COM,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,TRICARE,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,UNITED HEALTHCARE,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,UNITED HEALTHCARE,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,VA,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,VA TRICARE,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,WELLMED,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,HUMANA,MGD,236.81,,,,,,,per diem,236.81,236.81,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS RT              ,74010063,CDM,320,RC,73130,CPT,,,RT,Inpatient,,,236.81,236.81,HUMANA CHOICE PLUS,MGD,236.81,,,,,,,case rate,236.81,236.81,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,AETNA,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,BCBS,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,CIGNA,COM,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,TRICARE,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,UNITED HEALTHCARE,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,UNITED HEALTHCARE,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,VA,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,VA TRICARE,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,WELLMED,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,HUMANA,MGD,273.19,,,,,,,per diem,273.19,273.19,"Per diem rate, code is bundled with other services"
HAND 3+ VIEWS LT              ,74010064,CDM,320,RC,73130,CPT,,,LT,Inpatient,,,273.19,273.19,HUMANA CHOICE PLUS,MGD,273.19,,,,,,,case rate,273.19,273.19,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,AETNA,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,BCBS,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,CIGNA,COM,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,TRICARE,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,UNITED HEALTHCARE,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,UNITED HEALTHCARE,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,VA,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,VA TRICARE,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,WELLMED,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,HUMANA,MGD,185.48,,,,,,,per diem,185.48,185.48,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS RT               ,74010065,CDM,320,RC,73120,CPT,,,RT,Inpatient,,,185.48,185.48,HUMANA CHOICE PLUS,MGD,185.48,,,,,,,case rate,185.48,185.48,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS LT               ,74010066,CDM,320,RC,73120,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL RT    ,74010069,CDM,320,RC,73502,CPT,,,RT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP 2+ VIEWS UNILATERAL LT    ,74010070,CDM,320,RC,73502,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,AETNA,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,BCBS,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,CIGNA,COM,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,TRICARE,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,UNITED HEALTHCARE,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,UNITED HEALTHCARE,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,VA,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,VA TRICARE,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,WELLMED,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,HUMANA,MGD,295.35,,,,,,,per diem,295.35,295.35,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS RT           ,74010071,CDM,320,RC,73060,CPT,,,RT,Inpatient,,,295.35,295.35,HUMANA CHOICE PLUS,MGD,295.35,,,,,,,case rate,295.35,295.35,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
HUMERUS 2+ VIEWS LT           ,74010072,CDM,320,RC,73060,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS RT             ,74010073,CDM,320,RC,73560,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 1-2 VIEWS LT             ,74010074,CDM,320,RC,73560,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS RT               ,74010077,CDM,320,RC,73562,CPT,,,RT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,AETNA,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,BCBS,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,CIGNA,COM,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,TRICARE,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,UNITED HEALTHCARE,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,UNITED HEALTHCARE,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,VA,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,VA TRICARE,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,WELLMED,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,HUMANA,MGD,309.04,,,,,,,per diem,309.04,309.04,"Per diem rate, code is bundled with other services"
KNEE 3 VIEWS LT               ,74010078,CDM,320,RC,73562,CPT,,,LT,Inpatient,,,309.04,309.04,HUMANA CHOICE PLUS,MGD,309.04,,,,,,,case rate,309.04,309.04,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS RT    ,74010086,CDM,320,RC,71100,CPT,,,RT,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL 2 VIEWS LT    ,74010087,CDM,320,RC,71100,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,AETNA,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,BCBS,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,CIGNA,COM,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,TRICARE,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,UNITED HEALTHCARE,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,UNITED HEALTHCARE,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,VA,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,VA TRICARE,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,WELLMED,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,HUMANA,MGD,338.63,,,,,,,per diem,338.63,338.63,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST RT ,74010088,CDM,320,RC,71101,CPT,,,RT,Inpatient,,,338.63,338.63,HUMANA CHOICE PLUS,MGD,338.63,,,,,,,case rate,338.63,338.63,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,AETNA,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,BCBS,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,CIGNA,COM,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,TRICARE,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,UNITED HEALTHCARE,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,UNITED HEALTHCARE,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,VA,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,VA TRICARE,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,WELLMED,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,HUMANA,MGD,349.65,,,,,,,per diem,349.65,349.65,"Per diem rate, code is bundled with other services"
RIBS UNILATERAL W/PA CHEST LT ,74010089,CDM,320,RC,71101,CPT,,,LT,Inpatient,,,349.65,349.65,HUMANA CHOICE PLUS,MGD,349.65,,,,,,,case rate,349.65,349.65,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,AETNA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,CIGNA,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,VA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,VA TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,WELLMED,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,HUMANA,MGD,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
SCAPULA RT                    ,74010090,CDM,320,RC,73010,CPT,,,RT,Inpatient,,,28.35,28.35,HUMANA CHOICE PLUS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW RT            ,74010092,CDM,320,RC,73020,CPT,,,RT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
SHOULDER 1 VIEW LT            ,74010093,CDM,320,RC,73020,CPT,,,LT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,AETNA,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,BCBS,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,CIGNA,COM,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,TRICARE,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,UNITED HEALTHCARE,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,UNITED HEALTHCARE,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,VA,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,VA TRICARE,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,WELLMED,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,HUMANA,MGD,630,,,,,,,per diem,630,630,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS RT          ,74010094,CDM,320,RC,73030,CPT,,,RT,Inpatient,,,630,630,HUMANA CHOICE PLUS,MGD,630,,,,,,,case rate,630,630,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
SHOULDER 2+ VIEWS LT          ,74010095,CDM,320,RC,73030,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA RT               ,74010096,CDM,320,RC,73590,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA LT               ,74010097,CDM,320,RC,73590,CPT,,,LT,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS LT            ,74010100,CDM,320,RC,73660,CPT,,,LT,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TOE(S) 2+ VIEWS RT            ,74010105,CDM,320,RC,73660,CPT,,,RT,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS RT              ,74010110,CDM,320,RC,73100,CPT,,,RT,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
WRIST 2 VIEWS LT              ,74010111,CDM,320,RC,73100,CPT,,,LT,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,AETNA,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,CIGNA,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,TRICARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,UNITED HEALTHCARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,UNITED HEALTHCARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,VA,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,VA TRICARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,WELLMED,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,HUMANA,MGD,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS RT             ,74010112,CDM,320,RC,73110,CPT,,,RT,Inpatient,,,283.5,283.5,HUMANA CHOICE PLUS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,AETNA,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,BCBS,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,CIGNA,COM,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,TRICARE,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,UNITED HEALTHCARE,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,UNITED HEALTHCARE,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,VA,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,VA TRICARE,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,WELLMED,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,HUMANA,MGD,172.58,,,,,,,per diem,172.58,172.58,"Per diem rate, code is bundled with other services"
WRIST 3+ VIEWS LT             ,74010113,CDM,320,RC,73110,CPT,,,LT,Inpatient,,,172.58,172.58,HUMANA CHOICE PLUS,MGD,172.58,,,,,,,case rate,172.58,172.58,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,AETNA,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,BCBS,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,CIGNA,COM,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,TRICARE,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,UNITED HEALTHCARE,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,UNITED HEALTHCARE,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,VA,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,VA TRICARE,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,WELLMED,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,HUMANA,MGD,295.29,,,,,,,per diem,295.29,295.29,"Per diem rate, code is bundled with other services"
CLAVICLE COMPLETE LT          ,74010114,CDM,320,RC,,,,,,Inpatient,,,295.29,295.29,HUMANA CHOICE PLUS,MGD,295.29,,,,,,,case rate,295.29,295.29,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,AETNA,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,CIGNA,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,TRICARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,UNITED HEALTHCARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,UNITED HEALTHCARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,VA,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,VA TRICARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,WELLMED,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,HUMANA,MGD,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST 2  VIEW LT              ,74010115,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,HUMANA CHOICE PLUS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,AETNA,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,BCBS,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,CIGNA,COM,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,TRICARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,UNITED HEALTHCARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,UNITED HEALTHCARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,VA,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,VA TRICARE,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,WELLMED,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,HUMANA,MGD,241.31,,,,,,,per diem,241.31,241.31,"Per diem rate, code is bundled with other services"
WRIST LESS THAN 3 VIEW LT     ,74010116,CDM,320,RC,,,,,,Inpatient,,,241.31,241.31,HUMANA CHOICE PLUS,MGD,241.31,,,,,,,case rate,241.31,241.31,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,AETNA,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,BCBS,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,CIGNA,COM,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,TRICARE,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,UNITED HEALTHCARE,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,UNITED HEALTHCARE,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,VA,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,VA TRICARE,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,WELLMED,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,HUMANA,MGD,189.61,,,,,,,per diem,189.61,189.61,"Per diem rate, code is bundled with other services"
HIP UNILATERAL WITH PELVI     ,74010117,CDM,320,RC,,,,,,Inpatient,,,189.61,189.61,HUMANA CHOICE PLUS,MGD,189.61,,,,,,,case rate,189.61,189.61,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,AETNA,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,BCBS,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,CIGNA,COM,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,TRICARE,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,UNITED HEALTHCARE,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,UNITED HEALTHCARE,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,VA,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,VA TRICARE,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,WELLMED,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,HUMANA,MGD,273.06,,,,,,,per diem,273.06,273.06,"Per diem rate, code is bundled with other services"
KNEE LESS THAN 3 VIEWS RT     ,74010118,CDM,320,RC,,,,,,Inpatient,,,273.06,273.06,HUMANA CHOICE PLUS,MGD,273.06,,,,,,,case rate,273.06,273.06,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,AETNA,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,BCBS,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,CIGNA,COM,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,TRICARE,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,UNITED HEALTHCARE,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,UNITED HEALTHCARE,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,VA,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,VA TRICARE,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,WELLMED,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,HUMANA,MGD,238.48,,,,,,,per diem,238.48,238.48,"Per diem rate, code is bundled with other services"
Femur 2 views                 ,74010119,CDM,320,RC,,,,,,Inpatient,,,238.48,238.48,HUMANA CHOICE PLUS,MGD,238.48,,,,,,,case rate,238.48,238.48,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,AETNA,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,BCBS,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,CIGNA,COM,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,TRICARE,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,UNITED HEALTHCARE,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,UNITED HEALTHCARE,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,VA,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,VA TRICARE,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,WELLMED,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,HUMANA,MGD,242.59,,,,,,,per diem,242.59,242.59,"Per diem rate, code is bundled with other services"
Knee 1 Or 2 Views             ,74010120,CDM,320,RC,,,,,,Inpatient,,,242.59,242.59,HUMANA CHOICE PLUS,MGD,242.59,,,,,,,case rate,242.59,242.59,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
Hip Unilate cmplt 2 Vws       ,74010121,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
Shoulder Cmplt 2 Vws          ,74010122,CDM,320,RC,73030,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,AETNA,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,BCBS,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,CIGNA,COM,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,TRICARE,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,UNITED HEALTHCARE,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,UNITED HEALTHCARE,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,VA,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,VA TRICARE,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,WELLMED,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,HUMANA,MGD,190.34,,,,,,,per diem,190.34,190.34,"Per diem rate, code is bundled with other services"
Hand Min 3 Views              ,74010123,CDM,320,RC,73130,CPT,,,,Inpatient,,,190.34,190.34,HUMANA CHOICE PLUS,MGD,190.34,,,,,,,case rate,190.34,190.34,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,AETNA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,CIGNA,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,VA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,VA TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,WELLMED,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,HUMANA,MGD,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
XRAY WRIST 3+ VIEWS           ,74010124,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,HUMANA CHOICE PLUS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
FOOT COMPLETE RT              ,74010125,CDM,320,RC,73630,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
73600 ANKLE AP&LAT 2V         ,74010126,CDM,320,RC,73600,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
73620 FOOT AP&LAT 2V          ,74010127,CDM,320,RC,73620,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,74010150,CDM,921,RC,93970,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,AETNA,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,BCBS,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,CIGNA,COM,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,TRICARE,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,UNITED HEALTHCARE,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,UNITED HEALTHCARE,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,VA,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,VA TRICARE,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,WELLMED,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,HUMANA,MGD,463.9,,,,,,,per diem,463.9,463.9,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,74010160,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,463.9,463.9,HUMANA CHOICE PLUS,MGD,463.9,,,,,,,case rate,463.9,463.9,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,AETNA,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,BCBS,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,CIGNA,COM,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,TRICARE,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,UNITED HEALTHCARE,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,UNITED HEALTHCARE,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,VA,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,VA TRICARE,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,WELLMED,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,HUMANA,MGD,543.46,,,,,,,per diem,543.46,543.46,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,74010170,CDM,402,RC,76770,CPT,,,,Inpatient,,,543.46,543.46,HUMANA CHOICE PLUS,MGD,543.46,,,,,,,case rate,543.46,543.46,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,74010171,CDM,921,RC,93975,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,AETNA,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,BCBS,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,CIGNA,COM,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,TRICARE,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,UNITED HEALTHCARE,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,UNITED HEALTHCARE,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,VA,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,VA TRICARE,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,WELLMED,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,HUMANA,MGD,389.34,,,,,,,per diem,389.34,389.34,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,74010172,CDM,402,RC,76705,CPT,,,,Inpatient,,,389.34,389.34,HUMANA CHOICE PLUS,MGD,389.34,,,,,,,case rate,389.34,389.34,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,AETNA,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,BCBS,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,CIGNA,COM,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,TRICARE,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,UNITED HEALTHCARE,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,UNITED HEALTHCARE,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,VA,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,VA TRICARE,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,WELLMED,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,HUMANA,MGD,221.17,,,,,,,per diem,221.17,221.17,"Per diem rate, code is bundled with other services"
US CHEST                      ,74010173,CDM,402,RC,76604,CPT,,,,Inpatient,,,221.17,221.17,HUMANA CHOICE PLUS,MGD,221.17,,,,,,,case rate,221.17,221.17,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,AETNA,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,BCBS,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,CIGNA,COM,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,TRICARE,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,UNITED HEALTHCARE,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,UNITED HEALTHCARE,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,VA,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,VA TRICARE,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,WELLMED,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,HUMANA,MGD,2.92,,,,,,,per diem,2.92,2.92,"Per diem rate, code is bundled with other services"
LOCM 200-299MG/ML IODINE/1ML  ,74020008,CDM,255,RC,Q9966,HCPCS,,,,Inpatient,1,EA,2.92,2.92,HUMANA CHOICE PLUS,MGD,2.92,,,,,,,case rate,2.92,2.92,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,AETNA,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,BCBS,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,CIGNA,COM,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,TRICARE,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,UNITED HEALTHCARE,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,UNITED HEALTHCARE,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,VA,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,VA TRICARE,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,WELLMED,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,HUMANA,MGD,207.38,,,,,,,per diem,207.38,207.38,"Per diem rate, code is bundled with other services"
LOCM 300-399MG/ML IODINE/1ML  ,74020009,CDM,255,RC,Q9967,HCPCS,,,,Inpatient,1,EA,207.38,207.38,HUMANA CHOICE PLUS,MGD,207.38,,,,,,,case rate,207.38,207.38,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,AETNA,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,BCBS,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,CIGNA,COM,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,TRICARE,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,UNITED HEALTHCARE,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,UNITED HEALTHCARE,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,VA,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,VA TRICARE,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,WELLMED,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,HUMANA,MGD,469.37,,,,,,,per diem,469.37,469.37,"Per diem rate, code is bundled with other services"
XRAY UNILAT RIBS/CHEST        ,74020010,CDM,320,RC,71101,CPT,,,,Inpatient,,,469.37,469.37,HUMANA CHOICE PLUS,MGD,469.37,,,,,,,case rate,469.37,469.37,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
XRAY FOREARM                  ,74020011,CDM,320,RC,73090,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
"XRAY ANKLE, COMPLETE          ",74020012,CDM,320,RC,73610,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE EXAM MIN 3 VIEWS         ,74020013,CDM,320,RC,73562,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
CLAVICLE X RAY                ,74020014,CDM,320,RC,73000,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,AETNA,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,BCBS,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,CIGNA,COM,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,TRICARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,UNITED HEALTHCARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,UNITED HEALTHCARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,VA,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,VA TRICARE,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,WELLMED,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,HUMANA,MGD,142.76,,,,,,,per diem,142.76,142.76,"Per diem rate, code is bundled with other services"
X-RAY FINGERS 2 VIEW          ,74020015,CDM,320,RC,73140,CPT,,,,Inpatient,,,142.76,142.76,HUMANA CHOICE PLUS,MGD,142.76,,,,,,,case rate,142.76,142.76,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
X-RAY WRIST 2 VIEWS           ,74020016,CDM,320,RC,73100,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,AETNA,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,BCBS,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,CIGNA,COM,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,TRICARE,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,UNITED HEALTHCARE,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,UNITED HEALTHCARE,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,VA,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,VA TRICARE,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,WELLMED,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,HUMANA,MGD,183.52,,,,,,,per diem,183.52,183.52,"Per diem rate, code is bundled with other services"
73660 RT TOE(S) 2VW MIN       ,74020017,CDM,320,RC,73660,CPT,,,,Inpatient,,,183.52,183.52,HUMANA CHOICE PLUS,MGD,183.52,,,,,,,case rate,183.52,183.52,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,AETNA,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,BCBS,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,CIGNA,COM,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,TRICARE,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,UNITED HEALTHCARE,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,UNITED HEALTHCARE,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,VA,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,VA TRICARE,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,WELLMED,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,HUMANA,MGD,259.63,,,,,,,per diem,259.63,259.63,"Per diem rate, code is bundled with other services"
71100 RIBS UNI-LAT 2V         ,74020018,CDM,320,RC,71100,CPT,,,,Inpatient,,,259.63,259.63,HUMANA CHOICE PLUS,MGD,259.63,,,,,,,case rate,259.63,259.63,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,AETNA,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,BCBS,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,CIGNA,COM,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,TRICARE,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,UNITED HEALTHCARE,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,UNITED HEALTHCARE,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,VA,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,VA TRICARE,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,WELLMED,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,HUMANA,MGD,672.35,,,,,,,per diem,672.35,672.35,"Per diem rate, code is bundled with other services"
MID LINE                      ,74020020,CDM,320,RC,,,,,,Inpatient,,,672.35,672.35,HUMANA CHOICE PLUS,MGD,672.35,,,,,,,case rate,672.35,672.35,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
SHOULDER RIGHT                ,74020021,CDM,320,RC,73020,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
HIP RGHT                      ,74020022,CDM,320,RC,73502,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,AETNA,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,CIGNA,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,TRICARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,UNITED HEALTHCARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,UNITED HEALTHCARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,VA,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,VA TRICARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,WELLMED,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,HUMANA,MGD,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
MID LINE PROCEDURE ALL INCLUS ,74020023,CDM,320,RC,,,,,,Inpatient,,,1392.3,1392.3,HUMANA CHOICE PLUS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
HIP ARTHROGRAM LEFT           ,74020024,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,AETNA,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,BCBS,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,CIGNA,COM,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,TRICARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,UNITED HEALTHCARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,UNITED HEALTHCARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,VA,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,VA TRICARE,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,WELLMED,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,HUMANA,MGD,176.72,,,,,,,per diem,176.72,176.72,"Per diem rate, code is bundled with other services"
MRI THORACIC SPINE W/O CO     ,74020027,CDM,320,RC,,,,,,Inpatient,,,176.72,176.72,HUMANA CHOICE PLUS,MGD,176.72,,,,,,,case rate,176.72,176.72,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,AETNA,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,BCBS,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,CIGNA,COM,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,TRICARE,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,UNITED HEALTHCARE,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,UNITED HEALTHCARE,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,VA,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,VA TRICARE,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,WELLMED,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,HUMANA,MGD,1956.13,,,,,,,per diem,1956.13,1956.13,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/O CONT     ,74020028,CDM,320,RC,,,,,,Inpatient,,,1956.13,1956.13,HUMANA CHOICE PLUS,MGD,1956.13,,,,,,,case rate,1956.13,1956.13,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
"HUMERUS, 2 VIEWS              ",74020029,CDM,320,RC,73060,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,AETNA,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,BCBS,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,CIGNA,COM,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,TRICARE,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,UNITED HEALTHCARE,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,UNITED HEALTHCARE,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,VA,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,VA TRICARE,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,WELLMED,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,HUMANA,MGD,216.85,,,,,,,per diem,216.85,216.85,"Per diem rate, code is bundled with other services"
ELBOW AP/LAT LEFT             ,74020030,CDM,320,RC,73070,CPT,,,,Inpatient,,,216.85,216.85,HUMANA CHOICE PLUS,MGD,216.85,,,,,,,case rate,216.85,216.85,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
ELBOW COMPLETE RIGHT          ,74020031,CDM,320,RC,73080,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
MRI EXTREM UPPER JT W/CON     ,74020032,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,AETNA,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,BCBS,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,CIGNA,COM,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,TRICARE,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,UNITED HEALTHCARE,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,UNITED HEALTHCARE,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,VA,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,VA TRICARE,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,WELLMED,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,HUMANA,MGD,118.97,,,,,,,per diem,118.97,118.97,"Per diem rate, code is bundled with other services"
KNEE 4 VIEWS LEFT             ,74020033,CDM,320,RC,73564,CPT,,,,Inpatient,,,118.97,118.97,HUMANA CHOICE PLUS,MGD,118.97,,,,,,,case rate,118.97,118.97,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,AETNA,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,BCBS,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,CIGNA,COM,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,TRICARE,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,UNITED HEALTHCARE,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,UNITED HEALTHCARE,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,VA,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,VA TRICARE,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,WELLMED,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,HUMANA,MGD,84.36,,,,,,,per diem,84.36,84.36,"Per diem rate, code is bundled with other services"
DEBRIDEMENT OF NAILS >5       ,74020034,CDM,360,RC,,,,,,Inpatient,,,84.36,84.36,HUMANA CHOICE PLUS,MGD,84.36,,,,,,,case rate,84.36,84.36,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
HAND 2 VIEWS                  ,74020035,CDM,320,RC,73120,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
TIBIA/FIBULA 2 VIEWS          ,74020036,CDM,320,RC,73590,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX           ,74020037,CDM,921,RC,93971,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
FEMUR                         ,74020038,CDM,402,RC,73552,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,AETNA,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,BCBS,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,CIGNA,COM,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,TRICARE,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,UNITED HEALTHCARE,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,UNITED HEALTHCARE,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,VA,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,VA TRICARE,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,WELLMED,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,HUMANA,MGD,230.14,,,,,,,per diem,230.14,230.14,"Per diem rate, code is bundled with other services"
HIP BILAT W/PELVIS 2 VIEW     ,74020039,CDM,320,RC,73521,CPT,,,,Inpatient,,,230.14,230.14,HUMANA CHOICE PLUS,MGD,230.14,,,,,,,case rate,230.14,230.14,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,AETNA,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,BCBS,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,CIGNA,COM,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,TRICARE,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,UNITED HEALTHCARE,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,UNITED HEALTHCARE,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,VA,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,VA TRICARE,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,WELLMED,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,HUMANA,MGD,479.17,,,,,,,per diem,479.17,479.17,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,74020040,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,479.17,479.17,HUMANA CHOICE PLUS,MGD,479.17,,,,,,,case rate,479.17,479.17,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,AETNA,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,CIGNA,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,TRICARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,UNITED HEALTHCARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,UNITED HEALTHCARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,VA,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,VA TRICARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,WELLMED,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,HUMANA,MGD,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX RT        ,74020041,CDM,921,RC,97971,CPT,,,RT,Inpatient,,,310.59,310.59,HUMANA CHOICE PLUS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,AETNA,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,BCBS,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,CIGNA,COM,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,TRICARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,UNITED HEALTHCARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,UNITED HEALTHCARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,VA,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,VA TRICARE,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,WELLMED,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,HUMANA,MGD,310.59,,,,,,,per diem,310.59,310.59,"Per diem rate, code is bundled with other services"
RAD US DUPLEX UP EX LT        ,74020042,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,310.59,310.59,HUMANA CHOICE PLUS,MGD,310.59,,,,,,,case rate,310.59,310.59,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,AETNA,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,BCBS,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,CIGNA,COM,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,TRICARE,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,UNITED HEALTHCARE,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,UNITED HEALTHCARE,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,VA,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,VA TRICARE,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,WELLMED,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,HUMANA,MGD,1152.88,,,,,,,per diem,1152.88,1152.88,"Per diem rate, code is bundled with other services"
SP/OR ANGIO VERT/CERV/INT RT  ,74020043,CDM,320,RC,,,,,,Inpatient,,,1152.88,1152.88,HUMANA CHOICE PLUS,MGD,1152.88,,,,,,,case rate,1152.88,1152.88,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,AETNA,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,BCBS,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,CIGNA,COM,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,TRICARE,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,UNITED HEALTHCARE,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,UNITED HEALTHCARE,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,VA,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,VA TRICARE,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,WELLMED,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,HUMANA,MGD,402.5,,,,,,,per diem,402.5,402.5,"Per diem rate, code is bundled with other services"
CERVICAL SPINE FLEX/EXT ONLY  ,74020044,CDM,320,RC,,,,,,Inpatient,,,402.5,402.5,HUMANA CHOICE PLUS,MGD,402.5,,,,,,,case rate,402.5,402.5,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,AETNA,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,BCBS,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,CIGNA,COM,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,TRICARE,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,UNITED HEALTHCARE,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,UNITED HEALTHCARE,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,VA,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,VA TRICARE,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,WELLMED,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,HUMANA,MGD,208.16,,,,,,,per diem,208.16,208.16,"Per diem rate, code is bundled with other services"
OBSTRUCTION SERIES W/ CXR     ,74020045,CDM,320,RC,,,,,,Inpatient,,,208.16,208.16,HUMANA CHOICE PLUS,MGD,208.16,,,,,,,case rate,208.16,208.16,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR HIP 1 VIEW LT              ,74020046,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,AETNA,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,BCBS,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,CIGNA,COM,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,TRICARE,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,UNITED HEALTHCARE,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,UNITED HEALTHCARE,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,VA,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,VA TRICARE,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,WELLMED,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,HUMANA,MGD,421.52,,,,,,,per diem,421.52,421.52,"Per diem rate, code is bundled with other services"
XR HIP 1 VW LEFT              ,74020047,CDM,320,RC,,,,,,Inpatient,,,421.52,421.52,HUMANA CHOICE PLUS,MGD,421.52,,,,,,,case rate,421.52,421.52,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,AETNA,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,BCBS,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,CIGNA,COM,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,TRICARE,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,UNITED HEALTHCARE,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,UNITED HEALTHCARE,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,VA,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,VA TRICARE,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,WELLMED,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,HUMANA,MGD,324.9,,,,,,,per diem,324.9,324.9,"Per diem rate, code is bundled with other services"
XR HIP 1 VW RIGHT             ,74020048,CDM,320,RC,,,,,,Inpatient,,,324.9,324.9,HUMANA CHOICE PLUS,MGD,324.9,,,,,,,case rate,324.9,324.9,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,AETNA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,CIGNA,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,WELLMED,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA,MGD,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RIG          ,74020049,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA CHOICE PLUS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,AETNA,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,BCBS,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,CIGNA,COM,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,TRICARE,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,UNITED HEALTHCARE,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,UNITED HEALTHCARE,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,VA,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,VA TRICARE,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,WELLMED,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,HUMANA,MGD,187.05,,,,,,,per diem,187.05,187.05,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW LEFT            ,74020051,CDM,320,RC,,,,,,Inpatient,,,187.05,187.05,HUMANA CHOICE PLUS,MGD,187.05,,,,,,,case rate,187.05,187.05,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,AETNA,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,BCBS,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,CIGNA,COM,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,TRICARE,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,UNITED HEALTHCARE,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,UNITED HEALTHCARE,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,VA,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,VA TRICARE,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,WELLMED,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,HUMANA,MGD,948.15,,,,,,,per diem,948.15,948.15,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VW RIGHT           ,74020052,CDM,320,RC,,,,,,Inpatient,,,948.15,948.15,HUMANA CHOICE PLUS,MGD,948.15,,,,,,,case rate,948.15,948.15,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LEFT     ,74020053,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RIGH     ,74020054,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,AETNA,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,BCBS,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,CIGNA,COM,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,TRICARE,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,UNITED HEALTHCARE,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,UNITED HEALTHCARE,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,VA,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,VA TRICARE,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,WELLMED,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,HUMANA,MGD,375.9,,,,,,,per diem,375.9,375.9,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS          ,74020055,CDM,320,RC,,,,,,Inpatient,,,375.9,375.9,HUMANA CHOICE PLUS,MGD,375.9,,,,,,,case rate,375.9,375.9,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020056,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BILA          ,74020058,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,AETNA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,CIGNA,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,WELLMED,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA,MGD,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LEFT          ,74020059,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA CHOICE PLUS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RIGH          ,74020060,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR TIBIA AND FIBULA           ,74020062,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEFT         ,74020063,CDM,320,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS LEF          ,74020064,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,AETNA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,BCBS,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,CIGNA,COM,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,UNITED HEALTHCARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,VA TRICARE,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,WELLMED,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA,MGD,172.2,,,,,,,per diem,172.2,172.2,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS RIG          ,74020065,CDM,320,RC,,,,,,Inpatient,,,172.2,172.2,HUMANA CHOICE PLUS,MGD,172.2,,,,,,,case rate,172.2,172.2,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,AETNA,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,BCBS,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,CIGNA,COM,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,TRICARE,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,UNITED HEALTHCARE,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,UNITED HEALTHCARE,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,VA,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,VA TRICARE,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,WELLMED,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,HUMANA,MGD,321.83,,,,,,,per diem,321.83,321.83,"Per diem rate, code is bundled with other services"
XR ANKLE COMPLETE MI          ,74020069,CDM,320,RC,,,,,,Inpatient,,,321.83,321.83,HUMANA CHOICE PLUS,MGD,321.83,,,,,,,case rate,321.83,321.83,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,AETNA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,CIGNA,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,VA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,VA TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,WELLMED,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,HUMANA,MGD,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RIGHT         ,74020070,CDM,320,RC,,,,,,Inpatient,,,105,105,HUMANA CHOICE PLUS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,AETNA,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,BCBS,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,CIGNA,COM,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,TRICARE,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,UNITED HEALTHCARE,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,UNITED HEALTHCARE,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,VA,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,VA TRICARE,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,WELLMED,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,HUMANA,MGD,243.6,,,,,,,per diem,243.6,243.6,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LEFT          ,74020071,CDM,320,RC,,,,,,Inpatient,,,243.6,243.6,HUMANA CHOICE PLUS,MGD,243.6,,,,,,,case rate,243.6,243.6,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,AETNA,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,BCBS,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,CIGNA,COM,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,TRICARE,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,UNITED HEALTHCARE,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,UNITED HEALTHCARE,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,VA,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,VA TRICARE,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,WELLMED,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,HUMANA,MGD,223.65,,,,,,,per diem,223.65,223.65,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN 3V R     ,74020074,CDM,320,RC,,,,,,Inpatient,,,223.65,223.65,HUMANA CHOICE PLUS,MGD,223.65,,,,,,,case rate,223.65,223.65,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,AETNA,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,BCBS,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,CIGNA,COM,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,TRICARE,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,UNITED HEALTHCARE,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,UNITED HEALTHCARE,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,VA,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,VA TRICARE,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,WELLMED,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,HUMANA,MGD,285.08,,,,,,,per diem,285.08,285.08,"Per diem rate, code is bundled with other services"
XR FOOT COMPLETE MIN          ,74020075,CDM,320,RC,,,,,,Inpatient,,,285.08,285.08,HUMANA CHOICE PLUS,MGD,285.08,,,,,,,case rate,285.08,285.08,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP VIEW     ,74020076,CDM,320,RC,,,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,AETNA,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,BCBS,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,CIGNA,COM,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,TRICARE,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,UNITED HEALTHCARE,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,UNITED HEALTHCARE,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,VA,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,VA TRICARE,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,WELLMED,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,HUMANA,MGD,313.24,,,,,,,per diem,313.24,313.24,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020077,CDM,320,RC,,,,,,Inpatient,,,313.24,313.24,HUMANA CHOICE PLUS,MGD,313.24,,,,,,,case rate,313.24,313.24,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,AETNA,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,BCBS,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,CIGNA,COM,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,TRICARE,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,UNITED HEALTHCARE,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,UNITED HEALTHCARE,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,VA,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,VA TRICARE,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,WELLMED,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,HUMANA,MGD,120.72,,,,,,,per diem,120.72,120.72,"Per diem rate, code is bundled with other services"
XR ABDOMEN SINGLE AP          ,74020078,CDM,320,RC,,,,,,Inpatient,,,120.72,120.72,HUMANA CHOICE PLUS,MGD,120.72,,,,,,,case rate,120.72,120.72,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,AETNA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,BCBS,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,CIGNA,COM,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,UNITED HEALTHCARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,VA TRICARE,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,WELLMED,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA,MGD,179.55,,,,,,,per diem,179.55,179.55,"Per diem rate, code is bundled with other services"
XR ABD W DECUBITUS A          ,74020080,CDM,320,RC,,,,,,Inpatient,,,179.55,179.55,HUMANA CHOICE PLUS,MGD,179.55,,,,,,,case rate,179.55,179.55,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,AETNA,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,BCBS,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,CIGNA,COM,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,TRICARE,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,UNITED HEALTHCARE,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,UNITED HEALTHCARE,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,VA,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,VA TRICARE,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,WELLMED,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,HUMANA,MGD,297.15,,,,,,,per diem,297.15,297.15,"Per diem rate, code is bundled with other services"
XR ABD ACUTE SERIES           ,74020082,CDM,320,RC,,,,,,Inpatient,,,297.15,297.15,HUMANA CHOICE PLUS,MGD,297.15,,,,,,,case rate,297.15,297.15,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,AETNA,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,BCBS,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,CIGNA,COM,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,TRICARE,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,UNITED HEALTHCARE,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,UNITED HEALTHCARE,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,VA,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,VA TRICARE,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,WELLMED,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,HUMANA,MGD,306.6,,,,,,,per diem,306.6,306.6,"Per diem rate, code is bundled with other services"
XR SWALLOWING FUNCTI          ,74020085,CDM,320,RC,,,,,,Inpatient,,,306.6,306.6,HUMANA CHOICE PLUS,MGD,306.6,,,,,,,case rate,306.6,306.6,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,AETNA,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,BCBS,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,CIGNA,COM,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,TRICARE,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,UNITED HEALTHCARE,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,UNITED HEALTHCARE,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,VA,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,VA TRICARE,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,WELLMED,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,HUMANA,MGD,462,,,,,,,per diem,462,462,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT COMP BI      ,74020087,CDM,320,RC,,,,,,Inpatient,,,462,462,HUMANA CHOICE PLUS,MGD,462,,,,,,,case rate,462,462,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,AETNA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,CIGNA,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,WELLMED,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA,MGD,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD LT       ,74020088,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA CHOICE PLUS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,AETNA,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,BCBS,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,CIGNA,COM,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,TRICARE,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,UNITED HEALTHCARE,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,UNITED HEALTHCARE,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,VA,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,VA TRICARE,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,WELLMED,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,HUMANA,MGD,369.78,,,,,,,per diem,369.78,369.78,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT LTD RT       ,74020089,CDM,320,RC,,,,,,Inpatient,,,369.78,369.78,HUMANA CHOICE PLUS,MGD,369.78,,,,,,,case rate,369.78,369.78,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,AETNA,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,BCBS,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,CIGNA,COM,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,TRICARE,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,UNITED HEALTHCARE,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,UNITED HEALTHCARE,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,VA,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,VA TRICARE,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,WELLMED,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,HUMANA,MGD,1229.08,,,,,,,per diem,1229.08,1229.08,"Per diem rate, code is bundled with other services"
DUPLEX LOWER EXT Bi           ,74020090,CDM,320,RC,,,,,,Inpatient,,,1229.08,1229.08,HUMANA CHOICE PLUS,MGD,1229.08,,,,,,,case rate,1229.08,1229.08,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,AETNA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,CIGNA,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,WELLMED,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA,MGD,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD LT       ,74020091,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA CHOICE PLUS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,AETNA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,BCBS,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,CIGNA,COM,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,UNITED HEALTHCARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,VA TRICARE,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,WELLMED,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA,MGD,425.25,,,,,,,per diem,425.25,425.25,"Per diem rate, code is bundled with other services"
DUPLEX UPPER EXT LTD RT       ,74020092,CDM,320,RC,,,,,,Inpatient,,,425.25,425.25,HUMANA CHOICE PLUS,MGD,425.25,,,,,,,case rate,425.25,425.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,AETNA,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,BCBS,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,CIGNA,COM,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,TRICARE,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,UNITED HEALTHCARE,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,UNITED HEALTHCARE,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,VA,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,VA TRICARE,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,WELLMED,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,HUMANA,MGD,3859.25,,,,,,,per diem,3859.25,3859.25,"Per diem rate, code is bundled with other services"
Diagnostic Radiology          ,74020093,CDM,320,RC,,,,,,Inpatient,,,3859.25,3859.25,HUMANA CHOICE PLUS,MGD,3859.25,,,,,,,case rate,3859.25,3859.25,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,AETNA,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,BCBS,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,CIGNA,COM,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,TRICARE,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,UNITED HEALTHCARE,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,UNITED HEALTHCARE,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,VA,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,VA TRICARE,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,WELLMED,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,HUMANA,MGD,2875.95,,,,,,,per diem,2875.95,2875.95,"Per diem rate, code is bundled with other services"
THORACENTESIS PLEURA          ,74020094,CDM,360,RC,,,,,,Inpatient,,,2875.95,2875.95,HUMANA CHOICE PLUS,MGD,2875.95,,,,,,,case rate,2875.95,2875.95,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,AETNA,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,BCBS,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,CIGNA,COM,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,TRICARE,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,UNITED HEALTHCARE,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,UNITED HEALTHCARE,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,VA,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,VA TRICARE,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,WELLMED,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,HUMANA,MGD,702.98,,,,,,,per diem,702.98,702.98,"Per diem rate, code is bundled with other services"
INSERT GASTRO TUBE P          ,74020097,CDM,360,RC,,,,,,Inpatient,,,702.98,702.98,HUMANA CHOICE PLUS,MGD,702.98,,,,,,,case rate,702.98,702.98,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,AETNA,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,BCBS,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,CIGNA,COM,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,TRICARE,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,UNITED HEALTHCARE,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,UNITED HEALTHCARE,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,VA,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,VA TRICARE,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,WELLMED,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,HUMANA,MGD,399.49,,,,,,,per diem,399.49,399.49,"Per diem rate, code is bundled with other services"
PRE OP CARE MINIMAL           ,74020101,CDM,360,RC,,,,,,Inpatient,,,399.49,399.49,HUMANA CHOICE PLUS,MGD,399.49,,,,,,,case rate,399.49,399.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,AETNA,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,BCBS,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,CIGNA,COM,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,TRICARE,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,UNITED HEALTHCARE,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,UNITED HEALTHCARE,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,VA,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,VA TRICARE,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,WELLMED,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,HUMANA,MGD,351.49,,,,,,,per diem,351.49,351.49,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULA          ,74020103,CDM,402,RC,,,,,,Inpatient,,,351.49,351.49,HUMANA CHOICE PLUS,MGD,351.49,,,,,,,case rate,351.49,351.49,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,AETNA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,BCBS,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,CIGNA,COM,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,UNITED HEALTHCARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,VA,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,VA TRICARE,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,WELLMED,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,HUMANA,MGD,472.5,,,,,,,per diem,472.5,472.5,"Per diem rate, code is bundled with other services"
ECHO 2D W/M MODE DOPPL        ,74020104,CDM,402,RC,,,,,,Inpatient,,,472.5,472.5,HUMANA CHOICE PLUS,MGD,472.5,,,,,,,case rate,472.5,472.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
HIP 1 VW LEFT                 ,74020110,CDM,320,RC,73501,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,AETNA,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,BCBS,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,CIGNA,COM,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,TRICARE,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,UNITED HEALTHCARE,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,UNITED HEALTHCARE,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,VA,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,VA TRICARE,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,WELLMED,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,HUMANA,MGD,1764.12,,,,,,,per diem,1764.12,1764.12,"Per diem rate, code is bundled with other services"
HC IR REMOVE TNL CV CATH      ,74020112,CDM,361,RC,,,,,,Inpatient,,,1764.12,1764.12,HUMANA CHOICE PLUS,MGD,1764.12,,,,,,,case rate,1764.12,1764.12,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,AETNA,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,BCBS,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,CIGNA,COM,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,TRICARE,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,UNITED HEALTHCARE,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,UNITED HEALTHCARE,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,VA,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,VA TRICARE,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,WELLMED,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,HUMANA,MGD,7164.15,,,,,,,per diem,7164.15,7164.15,"Per diem rate, code is bundled with other services"
HC IR REPLACE TNL CV CATH     ,74020114,CDM,361,RC,,,,,,Inpatient,,,7164.15,7164.15,HUMANA CHOICE PLUS,MGD,7164.15,,,,,,,case rate,7164.15,7164.15,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,AETNA,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,BCBS,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,CIGNA,COM,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,TRICARE,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,UNITED HEALTHCARE,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,UNITED HEALTHCARE,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,VA,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,VA TRICARE,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,WELLMED,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,HUMANA,MGD,1045.29,,,,,,,per diem,1045.29,1045.29,"Per diem rate, code is bundled with other services"
HC 103314 PRE OP CARE NEW     ,74020115,CDM,369,RC,,,,,,Inpatient,,,1045.29,1045.29,HUMANA CHOICE PLUS,MGD,1045.29,,,,,,,case rate,1045.29,1045.29,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,AETNA,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,BCBS,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,CIGNA,COM,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,TRICARE,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,UNITED HEALTHCARE,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,UNITED HEALTHCARE,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,VA,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,VA TRICARE,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,WELLMED,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,HUMANA,MGD,1813.35,,,,,,,per diem,1813.35,1813.35,"Per diem rate, code is bundled with other services"
HCHG ABD PARACENTESIS WIT     ,74020116,CDM,360,RC,,,,,,Inpatient,,,1813.35,1813.35,HUMANA CHOICE PLUS,MGD,1813.35,,,,,,,case rate,1813.35,1813.35,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,AETNA,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,BCBS,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,CIGNA,COM,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,TRICARE,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,UNITED HEALTHCARE,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,UNITED HEALTHCARE,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,VA,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,VA TRICARE,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,WELLMED,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,HUMANA,MGD,2100,,,,,,,per diem,2100,2100,"Per diem rate, code is bundled with other services"
HCHG DRAINAGE CATH VISCER     ,74020117,CDM,360,RC,,,,,,Inpatient,,,2100,2100,HUMANA CHOICE PLUS,MGD,2100,,,,,,,case rate,2100,2100,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,AETNA,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,BCBS,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,CIGNA,COM,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,TRICARE,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,UNITED HEALTHCARE,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,UNITED HEALTHCARE,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,VA,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,VA TRICARE,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,WELLMED,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,HUMANA,MGD,574.35,,,,,,,per diem,574.35,574.35,"Per diem rate, code is bundled with other services"
HCHG ART/VEN DUPLEX ABD/P     ,74020120,CDM,921,RC,,,,,,Inpatient,,,574.35,574.35,HUMANA CHOICE PLUS,MGD,574.35,,,,,,,case rate,574.35,574.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,AETNA,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,BCBS,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,CIGNA,COM,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,TRICARE,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,UNITED HEALTHCARE,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,UNITED HEALTHCARE,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,VA,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,VA TRICARE,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,WELLMED,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,HUMANA,MGD,406.35,,,,,,,per diem,406.35,406.35,"Per diem rate, code is bundled with other services"
ST MOTION FLUORO SWALLOW      ,74020130,CDM,320,RC,,,,,,Inpatient,,,406.35,406.35,HUMANA CHOICE PLUS,MGD,406.35,,,,,,,case rate,406.35,406.35,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,AETNA,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,BCBS,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,CIGNA,COM,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,TRICARE,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,UNITED HEALTHCARE,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,UNITED HEALTHCARE,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,VA,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,VA TRICARE,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,WELLMED,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,HUMANA,MGD,1275.75,,,,,,,per diem,1275.75,1275.75,"Per diem rate, code is bundled with other services"
RAD DYSPHAGIA EVAL - OUTSIDE  ,74020131,CDM,320,RC,92610,CPT,,,,Inpatient,,,1275.75,1275.75,HUMANA CHOICE PLUS,MGD,1275.75,,,,,,,case rate,1275.75,1275.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW                  ,74020132,CDM,324,RC,71045,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 2 VIEWS                 ,74020133,CDM,320,RC,71046,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,AETNA,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,BCBS,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,CIGNA,COM,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,TRICARE,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,UNITED HEALTHCARE,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,UNITED HEALTHCARE,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,VA,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,VA TRICARE,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,WELLMED,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,HUMANA,MGD,226.26,,,,,,,per diem,226.26,226.26,"Per diem rate, code is bundled with other services"
"HIPS, BILAT W/PELVIS 3-4 VIEWS",74020134,CDM,320,RC,73522,CPT,,,,Inpatient,,,226.26,226.26,HUMANA CHOICE PLUS,MGD,226.26,,,,,,,case rate,226.26,226.26,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"SPINE, THORACIC, 1 VIEW       ",74020135,CDM,320,RC,,,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
"ABDOMEN, 1 VIEW               ",74020136,CDM,320,RC,74018,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,AETNA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,BCBS,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,CIGNA,COM,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,UNITED HEALTHCARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,VA,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,VA TRICARE,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,WELLMED,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,HUMANA,MGD,393.75,,,,,,,per diem,393.75,393.75,"Per diem rate, code is bundled with other services"
"ABDOMEN, 2 VIEWS              ",74020137,CDM,320,RC,74019,CPT,,,,Inpatient,,,393.75,393.75,HUMANA CHOICE PLUS,MGD,393.75,,,,,,,case rate,393.75,393.75,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,AETNA,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,BCBS,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,CIGNA,COM,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,TRICARE,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,UNITED HEALTHCARE,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,UNITED HEALTHCARE,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,VA,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,VA TRICARE,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,WELLMED,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,HUMANA,MGD,673.55,,,,,,,per diem,673.55,673.55,"Per diem rate, code is bundled with other services"
INTRO CATH DIALYSIS CIRCUIT   ,74020138,CDM,360,RC,,,,,,Inpatient,,,673.55,673.55,HUMANA CHOICE PLUS,MGD,673.55,,,,,,,case rate,673.55,673.55,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,AETNA,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,BCBS,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,CIGNA,COM,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,TRICARE,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,UNITED HEALTHCARE,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,UNITED HEALTHCARE,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,VA,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,VA TRICARE,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,WELLMED,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,HUMANA,MGD,2020.66,,,,,,,per diem,2020.66,2020.66,"Per diem rate, code is bundled with other services"
DIALYSIS CIRCUIT EMBOLIZATION ,74020139,CDM,360,RC,,,,,,Inpatient,,,2020.66,2020.66,HUMANA CHOICE PLUS,MGD,2020.66,,,,,,,case rate,2020.66,2020.66,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,AETNA,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,BCBS,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,CIGNA,COM,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,TRICARE,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,UNITED HEALTHCARE,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,UNITED HEALTHCARE,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,VA,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,VA TRICARE,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,WELLMED,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,HUMANA,MGD,1414.59,,,,,,,per diem,1414.59,1414.59,"Per diem rate, code is bundled with other services"
FNA W IMA GUIDE               ,74020140,CDM,361,RC,,,,,,Inpatient,,,1414.59,1414.59,HUMANA CHOICE PLUS,MGD,1414.59,,,,,,,case rate,1414.59,1414.59,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,AETNA,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,BCBS,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,CIGNA,COM,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,TRICARE,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,UNITED HEALTHCARE,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,UNITED HEALTHCARE,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,VA,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,VA TRICARE,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,WELLMED,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,HUMANA,MGD,28319.15,,,,,,,per diem,28319.15,28319.15,"Per diem rate, code is bundled with other services"
INTRO DIAL GRAFT              ,74020141,CDM,361,RC,36901,CPT,,,,Inpatient,,,28319.15,28319.15,HUMANA CHOICE PLUS,MGD,28319.15,,,,,,,case rate,28319.15,28319.15,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,AETNA,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,BCBS,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,CIGNA,COM,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,TRICARE,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,UNITED HEALTHCARE,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,UNITED HEALTHCARE,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,VA,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,VA TRICARE,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,WELLMED,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,HUMANA,MGD,35853.69,,,,,,,per diem,35853.69,35853.69,"Per diem rate, code is bundled with other services"
PLACE CATH INT CAROTID ART BI ,74020142,CDM,360,RC,36224,CPT,,,,Inpatient,,,35853.69,35853.69,HUMANA CHOICE PLUS,MGD,35853.69,,,,,,,case rate,35853.69,35853.69,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,AETNA,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,BCBS,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,CIGNA,COM,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,TRICARE,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,UNITED HEALTHCARE,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,UNITED HEALTHCARE,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,VA,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,VA TRICARE,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,WELLMED,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,HUMANA,MGD,29036.88,,,,,,,per diem,29036.88,29036.88,"Per diem rate, code is bundled with other services"
PLACE CATH VERTEBRAL ART BI   ,74020143,CDM,360,RC,36226,CPT,,,,Inpatient,,,29036.88,29036.88,HUMANA CHOICE PLUS,MGD,29036.88,,,,,,,case rate,29036.88,29036.88,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,AETNA,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,BCBS,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,CIGNA,COM,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,TRICARE,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,UNITED HEALTHCARE,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,UNITED HEALTHCARE,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,VA,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,VA TRICARE,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,WELLMED,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,HUMANA,MGD,22581.68,,,,,,,per diem,22581.68,22581.68,"Per diem rate, code is bundled with other services"
PTA CENTRAL DIAL SEG ADD ON   ,74020144,CDM,361,RC,36907,CPT,,,,Inpatient,,,22581.68,22581.68,HUMANA CHOICE PLUS,MGD,22581.68,,,,,,,case rate,22581.68,22581.68,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,AETNA,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,BCBS,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,CIGNA,COM,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,TRICARE,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,UNITED HEALTHCARE,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,UNITED HEALTHCARE,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,VA,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,VA TRICARE,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,WELLMED,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,HUMANA,MGD,3170.24,,,,,,,per diem,3170.24,3170.24,"Per diem rate, code is bundled with other services"
MANIP REPO PERIT DIAL CATH    ,74020146,CDM,361,RC,49999,CPT,,,,Inpatient,,,3170.24,3170.24,HUMANA CHOICE PLUS,MGD,3170.24,,,,,,,case rate,3170.24,3170.24,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,AETNA,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,BCBS,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,CIGNA,COM,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,TRICARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,UNITED HEALTHCARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,UNITED HEALTHCARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,VA,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,VA TRICARE,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,WELLMED,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,HUMANA,MGD,2324.11,,,,,,,per diem,2324.11,2324.11,"Per diem rate, code is bundled with other services"
REMOVE INTRAVAS VENA CATA FILT,74020147,CDM,360,RC,37193,CPT,,,,Inpatient,,,2324.11,2324.11,HUMANA CHOICE PLUS,MGD,2324.11,,,,,,,case rate,2324.11,2324.11,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,AETNA,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,BCBS,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,CIGNA,COM,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,TRICARE,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,UNITED HEALTHCARE,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,UNITED HEALTHCARE,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,VA,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,VA TRICARE,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,WELLMED,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,HUMANA,MGD,117.72,,,,,,,per diem,117.72,117.72,"Per diem rate, code is bundled with other services"
ORBITS COMP MIN 4 VIEWS       ,74020149,CDM,320,RC,70190,CPT,,,,Inpatient,,,117.72,117.72,HUMANA CHOICE PLUS,MGD,117.72,,,,,,,case rate,117.72,117.72,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,AETNA,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,BCBS,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,CIGNA,COM,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,TRICARE,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,UNITED HEALTHCARE,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,UNITED HEALTHCARE,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,VA,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,VA TRICARE,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,WELLMED,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,HUMANA,MGD,100.55,,,,,,,per diem,100.55,100.55,"Per diem rate, code is bundled with other services"
CALCANEUS 2 PLUS VIEW BILATER ,74020150,CDM,320,RC,73650,CPT,,,,Inpatient,,,100.55,100.55,HUMANA CHOICE PLUS,MGD,100.55,,,,,,,case rate,100.55,100.55,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,AETNA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,BCBS,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,CIGNA,COM,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,UNITED HEALTHCARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,VA,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,VA TRICARE,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,WELLMED,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,HUMANA,MGD,305.74,,,,,,,per diem,305.74,305.74,"Per diem rate, code is bundled with other services"
ABDOMEN 3 OR MORE VIEWS       ,74020151,CDM,320,RC,74021,CPT,,,,Inpatient,,,305.74,305.74,HUMANA CHOICE PLUS,MGD,305.74,,,,,,,case rate,305.74,305.74,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,AETNA,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,BCBS,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,CIGNA,COM,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,TRICARE,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,UNITED HEALTHCARE,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,UNITED HEALTHCARE,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,VA,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,VA TRICARE,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,WELLMED,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,HUMANA,MGD,556.38,,,,,,,per diem,556.38,556.38,"Per diem rate, code is bundled with other services"
SWALLOW STUDY FEES            ,74020156,CDM,320,RC,,,,,,Inpatient,,,556.38,556.38,HUMANA CHOICE PLUS,MGD,556.38,,,,,,,case rate,556.38,556.38,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,AETNA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,BCBS,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,CIGNA,COM,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,UNITED HEALTHCARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,VA,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,VA TRICARE,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,WELLMED,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,HUMANA,MGD,248.5,,,,,,,per diem,248.5,248.5,"Per diem rate, code is bundled with other services"
KNEE LT 1-2 VWS               ,74020157,CDM,320,RC,73560,CPT,,,,Inpatient,,,248.5,248.5,HUMANA CHOICE PLUS,MGD,248.5,,,,,,,case rate,248.5,248.5,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,AETNA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,BCBS,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,CIGNA,COM,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,UNITED HEALTHCARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,VA,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,VA TRICARE,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,WELLMED,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,HUMANA,MGD,93.56,,,,,,,per diem,93.56,93.56,"Per diem rate, code is bundled with other services"
WRIST COMPLETE LT             ,74020158,CDM,320,RC,73110,CPT,,,,Inpatient,,,93.56,93.56,HUMANA CHOICE PLUS,MGD,93.56,,,,,,,case rate,93.56,93.56,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,AETNA,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,BCBS,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,CIGNA,COM,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,TRICARE,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,UNITED HEALTHCARE,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,UNITED HEALTHCARE,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,VA,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,VA TRICARE,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,WELLMED,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,HUMANA,MGD,162.77,,,,,,,per diem,162.77,162.77,"Per diem rate, code is bundled with other services"
FOOT LT AP & LAT              ,74020159,CDM,320,RC,73620,CPT,,,,Inpatient,,,162.77,162.77,HUMANA CHOICE PLUS,MGD,162.77,,,,,,,case rate,162.77,162.77,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
ANKLE 3+ VWS RT               ,74020160,CDM,320,RC,73610,CPT,,,,Inpatient,,,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,AETNA,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,BCBS,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,CIGNA,COM,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,TRICARE,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,UNITED HEALTHCARE,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,UNITED HEALTHCARE,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,VA,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,VA TRICARE,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,WELLMED,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,HUMANA,MGD,525.61,,,,,,,per diem,525.61,525.61,"Per diem rate, code is bundled with other services"
PICC LINE INSERTION           ,74070025,CDM,360,RC,,,,,,Inpatient,,,525.61,525.61,HUMANA CHOICE PLUS,MGD,525.61,,,,,,,case rate,525.61,525.61,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,AETNA,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,BCBS,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,CIGNA,COM,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,TRICARE,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,UNITED HEALTHCARE,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,UNITED HEALTHCARE,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,VA,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,VA TRICARE,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,WELLMED,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,HUMANA,MGD,469.92,,,,,,,per diem,469.92,469.92,"Per diem rate, code is bundled with other services"
US RENAL BX PERC              ,74070026,CDM,360,RC,,,,,,Inpatient,,,469.92,469.92,HUMANA CHOICE PLUS,MGD,469.92,,,,,,,case rate,469.92,469.92,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,AETNA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,BCBS,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,CIGNA,COM,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,UNITED HEALTHCARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,VA,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,VA TRICARE,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,WELLMED,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,HUMANA,MGD,204.75,,,,,,,per diem,204.75,204.75,"Per diem rate, code is bundled with other services"
CHEST 1 VIEW FRONTAL          ,74071010,CDM,320,RC,71045,CPT,,,,Inpatient,,,204.75,204.75,HUMANA CHOICE PLUS,MGD,204.75,,,,,,,case rate,204.75,204.75,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,AETNA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,CIGNA,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,VA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,VA TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,WELLMED,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,HUMANA,MGD,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
SHUNTOGRAM                    ,74075809,CDM,320,RC,75809,CPT,,,,Inpatient,,,436.97,436.97,HUMANA CHOICE PLUS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,AETNA,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,BCBS,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,CIGNA,COM,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,TRICARE,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,UNITED HEALTHCARE,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,UNITED HEALTHCARE,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,VA,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,VA TRICARE,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,WELLMED,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,HUMANA,MGD,3367.22,,,,,,,per diem,3367.22,3367.22,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74075970,CDM,320,RC,75970,CPT,,,,Inpatient,,,3367.22,3367.22,HUMANA CHOICE PLUS,MGD,3367.22,,,,,,,case rate,3367.22,3367.22,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,AETNA,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,BCBS,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,CIGNA,COM,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,TRICARE,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,UNITED HEALTHCARE,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,UNITED HEALTHCARE,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,VA,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,VA TRICARE,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,WELLMED,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,HUMANA,MGD,600.36,,,,,,,per diem,600.36,600.36,"Per diem rate, code is bundled with other services"
UPPER GI STOMACH W/ KUB       ,74076002,CDM,320,RC,74241,CPT,,,,Inpatient,,,600.36,600.36,HUMANA CHOICE PLUS,MGD,600.36,,,,,,,case rate,600.36,600.36,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,AETNA,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,BCBS,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,CIGNA,COM,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,TRICARE,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,UNITED HEALTHCARE,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,UNITED HEALTHCARE,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,VA,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,VA TRICARE,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,WELLMED,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,HUMANA,MGD,1256.28,,,,,,,per diem,1256.28,1256.28,"Per diem rate, code is bundled with other services"
UPPER GI W/AIR W/KUB          ,74076003,CDM,320,RC,74247,CPT,,,,Inpatient,,,1256.28,1256.28,HUMANA CHOICE PLUS,MGD,1256.28,,,,,,,case rate,1256.28,1256.28,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,AETNA,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,BCBS,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,CIGNA,COM,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,TRICARE,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,UNITED HEALTHCARE,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,UNITED HEALTHCARE,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,VA,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,VA TRICARE,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,WELLMED,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,HUMANA,MGD,351.38,,,,,,,per diem,351.38,351.38,"Per diem rate, code is bundled with other services"
FLUORO GUIDANCE NEEDLE PLACE  ,74076006,CDM,320,RC,77002,CPT,,,,Inpatient,,,351.38,351.38,HUMANA CHOICE PLUS,MGD,351.38,,,,,,,case rate,351.38,351.38,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,AETNA,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,BCBS,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,CIGNA,COM,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,TRICARE,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,UNITED HEALTHCARE,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,UNITED HEALTHCARE,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,VA,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,VA TRICARE,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,WELLMED,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,HUMANA,MGD,882.46,,,,,,,per diem,882.46,882.46,"Per diem rate, code is bundled with other services"
FLUORO GUIDE FOR CV ACCESS    ,74076010,CDM,320,RC,77001,CPT,,,,Inpatient,,,882.46,882.46,HUMANA CHOICE PLUS,MGD,882.46,,,,,,,case rate,882.46,882.46,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,AETNA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,CIGNA,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,VA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,VA TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,WELLMED,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,HUMANA,MGD,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
EYE FOR FOREIGN BODY          ,74076012,CDM,320,RC,70030,CPT,,,,Inpatient,,,544.07,544.07,HUMANA CHOICE PLUS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,AETNA,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,BCBS,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,CIGNA,COM,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,TRICARE,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,UNITED HEALTHCARE,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,UNITED HEALTHCARE,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,VA,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,VA TRICARE,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,WELLMED,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,HUMANA,MGD,692.46,,,,,,,per diem,692.46,692.46,"Per diem rate, code is bundled with other services"
KNEE STANDING-BOTH KNEES      ,74077000,CDM,320,RC,73565,CPT,,,,Inpatient,,,692.46,692.46,HUMANA CHOICE PLUS,MGD,692.46,,,,,,,case rate,692.46,692.46,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,AETNA,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,BCBS,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,CIGNA,COM,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,TRICARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,UNITED HEALTHCARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,UNITED HEALTHCARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,VA,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,VA TRICARE,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,WELLMED,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,HUMANA,MGD,1527.25,,,,,,,per diem,1527.25,1527.25,"Per diem rate, code is bundled with other services"
IR CHOLANGIO/PANC INTRAOP     ,74080000,CDM,320,RC,,,,,,Inpatient,,,1527.25,1527.25,HUMANA CHOICE PLUS,MGD,1527.25,,,,,,,case rate,1527.25,1527.25,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,AETNA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,CIGNA,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,VA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,VA TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,WELLMED,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA,MGD,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
IR GI TUBE LONG INTRO         ,74080001,CDM,320,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA CHOICE PLUS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,AETNA,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,BCBS,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,CIGNA,COM,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,TRICARE,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,UNITED HEALTHCARE,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,UNITED HEALTHCARE,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,VA,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,VA TRICARE,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,WELLMED,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,HUMANA,MGD,1272.35,,,,,,,per diem,1272.35,1272.35,"Per diem rate, code is bundled with other services"
IR SINUS TRACT/FIST/ABSC      ,74080002,CDM,320,RC,,,,,,Inpatient,,,1272.35,1272.35,HUMANA CHOICE PLUS,MGD,1272.35,,,,,,,case rate,1272.35,1272.35,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,AETNA,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,CIGNA,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,TRICARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,UNITED HEALTHCARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,UNITED HEALTHCARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,VA,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,VA TRICARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,WELLMED,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,HUMANA,MGD,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
IR FLUORO < 1 HR              ,74080003,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,HUMANA CHOICE PLUS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE LT         ,74080004,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM KNEE RT         ,74080005,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,AETNA,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,BCBS,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,CIGNA,COM,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,TRICARE,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,UNITED HEALTHCARE,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,UNITED HEALTHCARE,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,VA,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,VA TRICARE,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,WELLMED,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,HUMANA,MGD,2800.67,,,,,,,per diem,2800.67,2800.67,"Per diem rate, code is bundled with other services"
IR MYELOGRAM LUMBAR           ,74080006,CDM,320,RC,,,,,,Inpatient,,,2800.67,2800.67,HUMANA CHOICE PLUS,MGD,2800.67,,,,,,,case rate,2800.67,2800.67,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,AETNA,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,BCBS,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,CIGNA,COM,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,TRICARE,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,UNITED HEALTHCARE,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,UNITED HEALTHCARE,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,VA,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,VA TRICARE,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,WELLMED,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,HUMANA,MGD,1950.29,,,,,,,per diem,1950.29,1950.29,"Per diem rate, code is bundled with other services"
IR MYELOGRAM THORACIC         ,74080007,CDM,320,RC,,,,,,Inpatient,,,1950.29,1950.29,HUMANA CHOICE PLUS,MGD,1950.29,,,,,,,case rate,1950.29,1950.29,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,AETNA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,CIGNA,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,VA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,VA TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,WELLMED,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,HUMANA,MGD,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
IR MYELOGRAM CERVICAL         ,74080008,CDM,320,RC,,,,,,Inpatient,,,1995.27,1995.27,HUMANA CHOICE PLUS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,AETNA,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,BCBS,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,CIGNA,COM,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,TRICARE,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,UNITED HEALTHCARE,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,UNITED HEALTHCARE,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,VA,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,VA TRICARE,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,WELLMED,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,HUMANA,MGD,5984.75,,,,,,,per diem,5984.75,5984.75,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY BIL     ,74080010,CDM,320,RC,,,,,,Inpatient,,,5984.75,5984.75,HUMANA CHOICE PLUS,MGD,5984.75,,,,,,,case rate,5984.75,5984.75,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW LT        ,74080011,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM ELBOW RT        ,74080012,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,AETNA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,CIGNA,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,VA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,VA TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,WELLMED,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,HUMANA,MGD,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY BIL        ,74080013,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,HUMANA CHOICE PLUS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,AETNA,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,BCBS,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,CIGNA,COM,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,TRICARE,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,UNITED HEALTHCARE,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,UNITED HEALTHCARE,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,VA,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,VA TRICARE,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,WELLMED,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,HUMANA,MGD,7222.82,,,,,,,per diem,7222.82,7222.82,"Per diem rate, code is bundled with other services"
IR AORTOGRM ABD W ILIOFEM     ,74080014,CDM,323,RC,,,,,,Inpatient,,,7222.82,7222.82,HUMANA CHOICE PLUS,MGD,7222.82,,,,,,,case rate,7222.82,7222.82,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,AETNA,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,BCBS,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,CIGNA,COM,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,TRICARE,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,UNITED HEALTHCARE,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,UNITED HEALTHCARE,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,VA,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,VA TRICARE,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,WELLMED,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,HUMANA,MGD,1437.28,,,,,,,per diem,1437.28,1437.28,"Per diem rate, code is bundled with other services"
IR UROGRAM ANTEGRADE RT       ,74080015,CDM,320,RC,,,,,,Inpatient,,,1437.28,1437.28,HUMANA CHOICE PLUS,MGD,1437.28,,,,,,,case rate,1437.28,1437.28,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
IR CYSTOURETHROGR RETRO       ,74080016,CDM,320,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,AETNA,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,BCBS,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,CIGNA,COM,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,TRICARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,UNITED HEALTHCARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,UNITED HEALTHCARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,VA,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,VA TRICARE,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,WELLMED,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,HUMANA,MGD,716.5,,,,,,,per diem,716.5,716.5,"Per diem rate, code is bundled with other services"
IR ANGIO AV DIAL SHUNT        ,74080017,CDM,323,RC,,,,,,Inpatient,,,716.5,716.5,HUMANA CHOICE PLUS,MGD,716.5,,,,,,,case rate,716.5,716.5,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,AETNA,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,CIGNA,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,TRICARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,UNITED HEALTHCARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,UNITED HEALTHCARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,VA,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,VA TRICARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,WELLMED,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,HUMANA,MGD,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
IR FLUORO NDL LOCAL SPINE     ,74080018,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,HUMANA CHOICE PLUS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,AETNA,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,BCBS,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,CIGNA,COM,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,TRICARE,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,UNITED HEALTHCARE,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,UNITED HEALTHCARE,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,VA,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,VA TRICARE,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,WELLMED,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,HUMANA,MGD,585.84,,,,,,,per diem,585.84,585.84,"Per diem rate, code is bundled with other services"
IR CHEST 1 VIEW               ,74080019,CDM,324,RC,,,,,,Inpatient,,,585.84,585.84,HUMANA CHOICE PLUS,MGD,585.84,,,,,,,case rate,585.84,585.84,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,AETNA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,CIGNA,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,VA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,VA TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,WELLMED,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,HUMANA,MGD,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IR SHUNTOGRAM NONVASCULAR     ,74080020,CDM,320,RC,,,,,,Inpatient,,,436.97,436.97,HUMANA CHOICE PLUS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,AETNA,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,CIGNA,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,TRICARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,UNITED HEALTHCARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,UNITED HEALTHCARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,VA,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,VA TRICARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,WELLMED,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,HUMANA,MGD,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
IR FLUORO GUIDE NDL PLCMT     ,74080021,CDM,320,RC,,,,,,Inpatient,,,454.1,454.1,HUMANA CHOICE PLUS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,AETNA,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,BCBS,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,CIGNA,COM,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,TRICARE,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,UNITED HEALTHCARE,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,UNITED HEALTHCARE,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,VA,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,VA TRICARE,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,WELLMED,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,HUMANA,MGD,1414.13,,,,,,,per diem,1414.13,1414.13,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,74080022,CDM,402,RC,,,,,,Inpatient,,,1414.13,1414.13,HUMANA CHOICE PLUS,MGD,1414.13,,,,,,,case rate,1414.13,1414.13,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,AETNA,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,BCBS,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,CIGNA,COM,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,TRICARE,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,UNITED HEALTHCARE,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,UNITED HEALTHCARE,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,VA,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,VA TRICARE,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,WELLMED,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,HUMANA,MGD,919.53,,,,,,,per diem,919.53,919.53,"Per diem rate, code is bundled with other services"
US GUIDED VASCULAR ACCESS     ,74080023,CDM,402,RC,,,,,,Inpatient,,,919.53,919.53,HUMANA CHOICE PLUS,MGD,919.53,,,,,,,case rate,919.53,919.53,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,AETNA,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,BCBS,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,CIGNA,COM,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,TRICARE,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,UNITED HEALTHCARE,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,UNITED HEALTHCARE,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,VA,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,VA TRICARE,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,WELLMED,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,HUMANA,MGD,3200.15,,,,,,,per diem,3200.15,3200.15,"Per diem rate, code is bundled with other services"
ARTHROGRAM SACROIL JT INJ     ,74080024,CDM,361,RC,,,,,,Inpatient,,,3200.15,3200.15,HUMANA CHOICE PLUS,MGD,3200.15,,,,,,,case rate,3200.15,3200.15,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,AETNA,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,CIGNA,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,TRICARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,UNITED HEALTHCARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,UNITED HEALTHCARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,VA,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,VA TRICARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,WELLMED,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,HUMANA,MGD,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080025,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,HUMANA CHOICE PLUS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,AETNA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,BCBS,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,CIGNA,COM,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,UNITED HEALTHCARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,VA,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,VA TRICARE,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,WELLMED,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,HUMANA,MGD,89.96,,,,,,,per diem,89.96,89.96,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080026,CDM,636,RC,,,,,,Inpatient,1,EA,89.96,89.96,HUMANA CHOICE PLUS,MGD,89.96,,,,,,,case rate,89.96,89.96,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,AETNA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,CIGNA,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,WELLMED,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA,MGD,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO INTRA-ARTER     ,74080027,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA CHOICE PLUS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,AETNA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,CIGNA,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,WELLMED,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA,MGD,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IV PUSH SEQ     ,74080028,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA CHOICE PLUS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,AETNA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,BCBS,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,CIGNA,COM,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,UNITED HEALTHCARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,VA TRICARE,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,WELLMED,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA,MGD,676.87,,,,,,,per diem,676.87,676.87,"Per diem rate, code is bundled with other services"
INJ TX/DX/PRO IVPUSH INIT     ,74080029,CDM,940,RC,,,,,,Inpatient,,,676.87,676.87,HUMANA CHOICE PLUS,MGD,676.87,,,,,,,case rate,676.87,676.87,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL BIL          ,74080030,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL LT           ,74080031,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO ADRENAL RT           ,74080032,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO BRACHIAL RETRO       ,74080033,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,AETNA,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,BCBS,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,CIGNA,COM,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,TRICARE,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,UNITED HEALTHCARE,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,UNITED HEALTHCARE,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,VA,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,VA TRICARE,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,WELLMED,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,HUMANA,MGD,3006.3,,,,,,,per diem,3006.3,3006.3,"Per diem rate, code is bundled with other services"
IR ANGIO EA ADD VESSEL        ,74080034,CDM,323,RC,,,,,,Inpatient,,,3006.3,3006.3,HUMANA CHOICE PLUS,MGD,3006.3,,,,,,,case rate,3006.3,3006.3,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,AETNA,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,BCBS,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,CIGNA,COM,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,TRICARE,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,UNITED HEALTHCARE,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,UNITED HEALTHCARE,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,VA,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,VA TRICARE,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,WELLMED,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,HUMANA,MGD,3925.22,,,,,,,per diem,3925.22,3925.22,"Per diem rate, code is bundled with other services"
IR ANGIO INTERNAL MAMMARY     ,74080035,CDM,323,RC,,,,,,Inpatient,,,3925.22,3925.22,HUMANA CHOICE PLUS,MGD,3925.22,,,,,,,case rate,3925.22,3925.22,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULM NON SELECT      ,74080036,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY LT         ,74080037,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR ANGIO PULMONARY RT         ,74080038,CDM,323,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,AETNA,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,CIGNA,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,TRICARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,UNITED HEALTHCARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,UNITED HEALTHCARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,VA,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,VA TRICARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,WELLMED,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,HUMANA,MGD,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
IR AORTOGRAM ABD W SERIAL     ,74080039,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,HUMANA CHOICE PLUS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,AETNA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,CIGNA,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,VA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,VA TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,WELLMED,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA,MGD,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM HIP UNI         ,74080040,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA CHOICE PLUS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,AETNA,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,BCBS,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,CIGNA,COM,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,TRICARE,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,UNITED HEALTHCARE,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,UNITED HEALTHCARE,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,VA,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,VA TRICARE,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,WELLMED,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,HUMANA,MGD,4162.98,,,,,,,per diem,4162.98,4162.98,"Per diem rate, code is bundled with other services"
ir bile duct dil wwo stnt     ,74080041,CDM,320,RC,,,,,,Inpatient,,,4162.98,4162.98,HUMANA CHOICE PLUS,MGD,4162.98,,,,,,,case rate,4162.98,4162.98,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,AETNA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,BCBS,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,CIGNA,COM,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,UNITED HEALTHCARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,VA,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,VA TRICARE,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,WELLMED,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA,MGD,308.45,,,,,,,per diem,308.45,308.45,"Per diem rate, code is bundled with other services"
ir bone age studies           ,74080042,CDM,320,RC,,,,,,Inpatient,,,308.45,308.45,HUMANA CHOICE PLUS,MGD,308.45,,,,,,,case rate,308.45,308.45,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,AETNA,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,BCBS,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,CIGNA,COM,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,TRICARE,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,UNITED HEALTHCARE,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,UNITED HEALTHCARE,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,VA,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,VA TRICARE,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,WELLMED,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,HUMANA,MGD,417.69,,,,,,,per diem,417.69,417.69,"Per diem rate, code is bundled with other services"
ir bone length studies        ,74080043,CDM,320,RC,,,,,,Inpatient,,,417.69,417.69,HUMANA CHOICE PLUS,MGD,417.69,,,,,,,case rate,417.69,417.69,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,AETNA,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,CIGNA,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,TRICARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,UNITED HEALTHCARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,UNITED HEALTHCARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,VA,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,VA TRICARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,WELLMED,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,HUMANA,MGD,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
ir bone survey limited        ,74080044,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,HUMANA CHOICE PLUS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
ir diskogram c/t spine        ,74080045,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,AETNA,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,CIGNA,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,TRICARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,UNITED HEALTHCARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,UNITED HEALTHCARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,VA,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,VA TRICARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,WELLMED,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,HUMANA,MGD,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
ir envas rep infraren aaa     ,74080046,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,HUMANA CHOICE PLUS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,AETNA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,CIGNA,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,WELLMED,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA,MGD,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
IR FALLOPIAN TUBE CATH        ,74080047,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA CHOICE PLUS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,AETNA,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,BCBS,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,CIGNA,COM,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,TRICARE,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,UNITED HEALTHCARE,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,UNITED HEALTHCARE,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,VA,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,VA TRICARE,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,WELLMED,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,HUMANA,MGD,1751.09,,,,,,,per diem,1751.09,1751.09,"Per diem rate, code is bundled with other services"
IR INTRALUMINL STRICT DIL     ,74080048,CDM,320,RC,,,,,,Inpatient,,,1751.09,1751.09,HUMANA CHOICE PLUS,MGD,1751.09,,,,,,,case rate,1751.09,1751.09,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,AETNA,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,BCBS,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,CIGNA,COM,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,TRICARE,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,UNITED HEALTHCARE,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,UNITED HEALTHCARE,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,VA,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,VA TRICARE,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,WELLMED,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,HUMANA,MGD,1615.07,,,,,,,per diem,1615.07,1615.07,"Per diem rate, code is bundled with other services"
IR NEPHRO/URET/URTHRA DIL     ,74080049,CDM,320,RC,,,,,,Inpatient,,,1615.07,1615.07,HUMANA CHOICE PLUS,MGD,1615.07,,,,,,,case rate,1615.07,1615.07,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,AETNA,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,BCBS,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,CIGNA,COM,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,TRICARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,UNITED HEALTHCARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,UNITED HEALTHCARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,VA,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,VA TRICARE,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,WELLMED,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,HUMANA,MGD,711.14,,,,,,,per diem,711.14,711.14,"Per diem rate, code is bundled with other services"
IR PERITONEOGRAM              ,74080050,CDM,320,RC,,,,,,Inpatient,,,711.14,711.14,HUMANA CHOICE PLUS,MGD,711.14,,,,,,,case rate,711.14,711.14,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR PORTOGRAM W HEMODYNAMC     ,74080051,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,AETNA,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,BCBS,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,CIGNA,COM,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,TRICARE,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,UNITED HEALTHCARE,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,UNITED HEALTHCARE,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,VA,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,VA TRICARE,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,WELLMED,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,HUMANA,MGD,8151.38,,,,,,,per diem,8151.38,8151.38,"Per diem rate, code is bundled with other services"
IR PORTOGRAM WO HEMODYNAM     ,74080052,CDM,320,RC,,,,,,Inpatient,,,8151.38,8151.38,HUMANA CHOICE PLUS,MGD,8151.38,,,,,,,case rate,8151.38,8151.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,AETNA,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,BCBS,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,CIGNA,COM,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,TRICARE,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,UNITED HEALTHCARE,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,UNITED HEALTHCARE,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,VA,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,VA TRICARE,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,WELLMED,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,HUMANA,MGD,3501.1,,,,,,,per diem,3501.1,3501.1,"Per diem rate, code is bundled with other services"
IR PTA PERIPH ART EA ADD      ,74080053,CDM,320,RC,,,,,,Inpatient,,,3501.1,3501.1,HUMANA CHOICE PLUS,MGD,3501.1,,,,,,,case rate,3501.1,3501.1,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,AETNA,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,CIGNA,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,TRICARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,UNITED HEALTHCARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,UNITED HEALTHCARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,VA,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,VA TRICARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,WELLMED,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,HUMANA,MGD,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
IR PTA PERIPHERAL ARTERY      ,74080054,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,HUMANA CHOICE PLUS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,AETNA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,CIGNA,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,VA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,VA TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,WELLMED,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA,MGD,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISC EA ADD      ,74080055,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA CHOICE PLUS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,AETNA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,BCBS,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,CIGNA,COM,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,UNITED HEALTHCARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,VA,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,VA TRICARE,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,WELLMED,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA,MGD,2830.65,,,,,,,per diem,2830.65,2830.65,"Per diem rate, code is bundled with other services"
IR PTA RENAL/VISCERAL         ,74080056,CDM,320,RC,,,,,,Inpatient,,,2830.65,2830.65,HUMANA CHOICE PLUS,MGD,2830.65,,,,,,,case rate,2830.65,2830.65,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,AETNA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,CIGNA,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,WELLMED,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA,MGD,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
IR PTA VENOUS                 ,74080057,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA CHOICE PLUS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,AETNA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,BCBS,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,CIGNA,COM,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,UNITED HEALTHCARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,VA,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,VA TRICARE,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,WELLMED,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA,MGD,849.3,,,,,,,per diem,849.3,849.3,"Per diem rate, code is bundled with other services"
IR REMOV INTRACATH MATER      ,74080058,CDM,320,RC,,,,,,Inpatient,,,849.3,849.3,HUMANA CHOICE PLUS,MGD,849.3,,,,,,,case rate,849.3,849.3,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,AETNA,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,BCBS,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,CIGNA,COM,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,TRICARE,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,UNITED HEALTHCARE,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,UNITED HEALTHCARE,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,VA,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,VA TRICARE,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,WELLMED,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,HUMANA,MGD,854.66,,,,,,,per diem,854.66,854.66,"Per diem rate, code is bundled with other services"
IR SIALOGRAM UNI              ,74080059,CDM,320,RC,,,,,,Inpatient,,,854.66,854.66,HUMANA CHOICE PLUS,MGD,854.66,,,,,,,case rate,854.66,854.66,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR SPLENOPORTOGRAM            ,74080060,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,AETNA,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,BCBS,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,CIGNA,COM,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,TRICARE,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,UNITED HEALTHCARE,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,UNITED HEALTHCARE,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,VA,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,VA TRICARE,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,WELLMED,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,HUMANA,MGD,5049.77,,,,,,,per diem,5049.77,5049.77,"Per diem rate, code is bundled with other services"
IR TRANSCATH THRPY EMBOLZ     ,74080061,CDM,320,RC,,,,,,Inpatient,,,5049.77,5049.77,HUMANA CHOICE PLUS,MGD,5049.77,,,,,,,case rate,5049.77,5049.77,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,AETNA,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,BCBS,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,CIGNA,COM,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,TRICARE,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,UNITED HEALTHCARE,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,UNITED HEALTHCARE,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,VA,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,VA TRICARE,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,WELLMED,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,HUMANA,MGD,1180.24,,,,,,,per diem,1180.24,1180.24,"Per diem rate, code is bundled with other services"
IR TRNSCTH ANG EXIST CATH     ,74080062,CDM,320,RC,,,,,,Inpatient,,,1180.24,1180.24,HUMANA CHOICE PLUS,MGD,1180.24,,,,,,,case rate,1180.24,1180.24,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,AETNA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,CIGNA,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,WELLMED,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA,MGD,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL BIL       ,74080063,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA CHOICE PLUS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,AETNA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,CIGNA,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,WELLMED,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA,MGD,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL LT        ,74080064,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA CHOICE PLUS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,AETNA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,BCBS,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,CIGNA,COM,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,UNITED HEALTHCARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,VA TRICARE,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,WELLMED,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA,MGD,3119.82,,,,,,,per diem,3119.82,3119.82,"Per diem rate, code is bundled with other services"
IR VENOGRAM ADRENAL RT        ,74080065,CDM,320,RC,,,,,,Inpatient,,,3119.82,3119.82,HUMANA CHOICE PLUS,MGD,3119.82,,,,,,,case rate,3119.82,3119.82,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,AETNA,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,CIGNA,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,TRICARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,UNITED HEALTHCARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,UNITED HEALTHCARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,VA,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,VA TRICARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,WELLMED,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,HUMANA,MGD,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM EPIDURAL          ,74080066,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,HUMANA CHOICE PLUS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,AETNA,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,BCBS,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,CIGNA,COM,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,TRICARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,UNITED HEALTHCARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,UNITED HEALTHCARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,VA,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,VA TRICARE,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,WELLMED,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,HUMANA,MGD,3198.01,,,,,,,per diem,3198.01,3198.01,"Per diem rate, code is bundled with other services"
IR VENOGRAM ORBITAL           ,74080067,CDM,320,RC,,,,,,Inpatient,,,3198.01,3198.01,HUMANA CHOICE PLUS,MGD,3198.01,,,,,,,case rate,3198.01,3198.01,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL BIL         ,74080068,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL RT          ,74080069,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRAM RENAL LT          ,74080070,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,AETNA,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,BCBS,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,CIGNA,COM,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,TRICARE,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,UNITED HEALTHCARE,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,UNITED HEALTHCARE,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,VA,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,VA TRICARE,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,WELLMED,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,HUMANA,MGD,3359.73,,,,,,,per diem,3359.73,3359.73,"Per diem rate, code is bundled with other services"
IR VENOGRAM SINUS/JUGULAR     ,74080071,CDM,320,RC,,,,,,Inpatient,,,3359.73,3359.73,HUMANA CHOICE PLUS,MGD,3359.73,,,,,,,case rate,3359.73,3359.73,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,AETNA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,CIGNA,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,VA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,VA TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,WELLMED,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA,MGD,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
IR VENOGRAM SUP SAGITTAL      ,74080072,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA CHOICE PLUS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,AETNA,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,BCBS,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,CIGNA,COM,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,TRICARE,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,UNITED HEALTHCARE,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,UNITED HEALTHCARE,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,VA,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,VA TRICARE,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,WELLMED,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,HUMANA,MGD,3603.92,,,,,,,per diem,3603.92,3603.92,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT W HEMODY     ,74080073,CDM,320,RC,,,,,,Inpatient,,,3603.92,3603.92,HUMANA CHOICE PLUS,MGD,3603.92,,,,,,,case rate,3603.92,3603.92,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOGRM HEPAT WO HEMOD     ,74080074,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,AETNA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,BCBS,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,CIGNA,COM,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,UNITED HEALTHCARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,VA TRICARE,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,WELLMED,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA,MGD,2913.12,,,,,,,per diem,2913.12,2913.12,"Per diem rate, code is bundled with other services"
IR VENOUS SAMPLE WWO ANG      ,74080075,CDM,320,RC,,,,,,Inpatient,,,2913.12,2913.12,HUMANA CHOICE PLUS,MGD,2913.12,,,,,,,case rate,2913.12,2913.12,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,AETNA,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,CIGNA,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,TRICARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,UNITED HEALTHCARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,UNITED HEALTHCARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,VA,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,VA TRICARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,WELLMED,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,HUMANA,MGD,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT RT      ,74080076,CDM,320,RC,,,,,,Inpatient,,,1780,1780,HUMANA CHOICE PLUS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,AETNA,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,BCBS,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,CIGNA,COM,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,TRICARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,UNITED HEALTHCARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,UNITED HEALTHCARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,VA,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,VA TRICARE,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,WELLMED,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,HUMANA,MGD,1780,,,,,,,per diem,1780,1780,"Per diem rate, code is bundled with other services"
MA MAMMARY DUCTO MULT LT      ,74080077,CDM,320,RC,,,,,,Inpatient,,,1780,1780,HUMANA CHOICE PLUS,MGD,1780,,,,,,,case rate,1780,1780,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,AETNA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,CIGNA,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,WELLMED,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA,MGD,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74080078,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA CHOICE PLUS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,AETNA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,CIGNA,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,WELLMED,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA,MGD,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74080079,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA CHOICE PLUS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74080080,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74080081,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,AETNA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,CIGNA,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,WELLMED,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA,MGD,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74080082,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA CHOICE PLUS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,AETNA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,CIGNA,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,VA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,VA TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,WELLMED,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA,MGD,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
OCCLUSIVE DEVICE ART/VEIN     ,74080083,CDM,361,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA CHOICE PLUS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,AETNA,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,CIGNA,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,TRICARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,UNITED HEALTHCARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,UNITED HEALTHCARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,VA,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,VA TRICARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,WELLMED,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,HUMANA,MGD,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080084,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,HUMANA CHOICE PLUS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,AETNA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,CIGNA,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,WELLMED,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA,MGD,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,74080085,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA CHOICE PLUS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,AETNA,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,BCBS,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,CIGNA,COM,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,TRICARE,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,UNITED HEALTHCARE,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,UNITED HEALTHCARE,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,VA,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,VA TRICARE,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,WELLMED,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,HUMANA,MGD,872.87,,,,,,,per diem,872.87,872.87,"Per diem rate, code is bundled with other services"
VASC ACCES THROMBL DECLOT     ,74080086,CDM,361,RC,,,,,,Inpatient,,,872.87,872.87,HUMANA CHOICE PLUS,MGD,872.87,,,,,,,case rate,872.87,872.87,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,AETNA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,CIGNA,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,WELLMED,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA,MGD,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER LT     ,74080087,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA CHOICE PLUS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,AETNA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,CIGNA,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,WELLMED,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA,MGD,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM SHOULDER RT     ,74080088,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA CHOICE PLUS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST LT        ,74080089,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,AETNA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,BCBS,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,CIGNA,COM,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,UNITED HEALTHCARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,VA TRICARE,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,WELLMED,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA,MGD,1051.72,,,,,,,per diem,1051.72,1051.72,"Per diem rate, code is bundled with other services"
IR ARTHROGRAM WRIST RT        ,74080090,CDM,322,RC,,,,,,Inpatient,,,1051.72,1051.72,HUMANA CHOICE PLUS,MGD,1051.72,,,,,,,case rate,1051.72,1051.72,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,AETNA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,CIGNA,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,WELLMED,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA,MGD,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY RT      ,74080091,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA CHOICE PLUS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,AETNA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,CIGNA,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,WELLMED,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA,MGD,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
IR VENOGRAM EXTREMITY LT      ,74080092,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA CHOICE PLUS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,AETNA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,CIGNA,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,WELLMED,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA,MGD,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY RT         ,74080093,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA CHOICE PLUS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,AETNA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,CIGNA,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,WELLMED,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA,MGD,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
IR ANGIO EXTREMITY LT         ,74080094,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA CHOICE PLUS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,AETNA,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,CIGNA,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,TRICARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,UNITED HEALTHCARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,UNITED HEALTHCARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,VA,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,VA TRICARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,WELLMED,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,HUMANA,MGD,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
IR MYELOGRAM 2 OR>REGIONS     ,74080095,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,HUMANA CHOICE PLUS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,AETNA,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,CIGNA,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,TRICARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,UNITED HEALTHCARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,UNITED HEALTHCARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,VA,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,VA TRICARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,WELLMED,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,HUMANA,MGD,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080096,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,HUMANA CHOICE PLUS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080097,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,AETNA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,CIGNA,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,WELLMED,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA,MGD,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080098,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA CHOICE PLUS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,AETNA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,BCBS,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,CIGNA,COM,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,UNITED HEALTHCARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,VA,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,VA TRICARE,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,WELLMED,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,HUMANA,MGD,436.97,,,,,,,per diem,436.97,436.97,"Per diem rate, code is bundled with other services"
IOPAMIDOL 55.5GM/150MLINJ     ,74080099,CDM,636,RC,,,,,,Inpatient,1,EA,436.97,436.97,HUMANA CHOICE PLUS,MGD,436.97,,,,,,,case rate,436.97,436.97,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,AETNA,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,BCBS,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,CIGNA,COM,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,TRICARE,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,UNITED HEALTHCARE,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,UNITED HEALTHCARE,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,VA,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,VA TRICARE,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,WELLMED,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,HUMANA,MGD,1494.05,,,,,,,per diem,1494.05,1494.05,"Per diem rate, code is bundled with other services"
IR RADIO RX THPY IA Y90       ,74080100,CDM,342,RC,,,,,,Inpatient,,,1494.05,1494.05,HUMANA CHOICE PLUS,MGD,1494.05,,,,,,,case rate,1494.05,1494.05,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,AETNA,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,BCBS,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,CIGNA,COM,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,TRICARE,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,UNITED HEALTHCARE,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,UNITED HEALTHCARE,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,VA,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,VA TRICARE,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,WELLMED,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,HUMANA,MGD,413.87,,,,,,,per diem,413.87,413.87,"Per diem rate, code is bundled with other services"
REMOVE DRAINAGE CATH/TUBE     ,74080101,CDM,761,RC,,,,,,Inpatient,,,413.87,413.87,HUMANA CHOICE PLUS,MGD,413.87,,,,,,,case rate,413.87,413.87,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,AETNA,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,BCBS,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,CIGNA,COM,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,TRICARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,UNITED HEALTHCARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,UNITED HEALTHCARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,VA,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,VA TRICARE,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,WELLMED,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,HUMANA,MGD,1449.06,,,,,,,per diem,1449.06,1449.06,"Per diem rate, code is bundled with other services"
XR FLUORO < 1 HR              ,74080102,CDM,320,RC,,,,,,Inpatient,,,1449.06,1449.06,HUMANA CHOICE PLUS,MGD,1449.06,,,,,,,case rate,1449.06,1449.06,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM KNEE RT         ,74080103,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,AETNA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,CIGNA,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,VA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,VA TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,WELLMED,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA,MGD,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG BIL             ,74080104,CDM,401,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA CHOICE PLUS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,AETNA,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,BCBS,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,CIGNA,COM,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,TRICARE,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,UNITED HEALTHCARE,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,UNITED HEALTHCARE,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,VA,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,VA TRICARE,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,WELLMED,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,HUMANA,MGD,444.47,,,,,,,per diem,444.47,444.47,"Per diem rate, code is bundled with other services"
MA MAMMO SCREENING BIL        ,74080105,CDM,403,RC,,,,,,Inpatient,,,444.47,444.47,HUMANA CHOICE PLUS,MGD,444.47,,,,,,,case rate,444.47,444.47,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,AETNA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,CIGNA,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,WELLMED,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA,MGD,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080106,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA CHOICE PLUS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ELBOW RT        ,74080107,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,AETNA,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,BCBS,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,CIGNA,COM,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,TRICARE,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,UNITED HEALTHCARE,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,UNITED HEALTHCARE,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,VA,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,VA TRICARE,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,WELLMED,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,HUMANA,MGD,1000.71,,,,,,,per diem,1000.71,1000.71,"Per diem rate, code is bundled with other services"
XR UROGRAM ANTEGRADE          ,74080108,CDM,320,RC,,,,,,Inpatient,,,1000.71,1000.71,HUMANA CHOICE PLUS,MGD,1000.71,,,,,,,case rate,1000.71,1000.71,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,AETNA,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,BCBS,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,CIGNA,COM,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,TRICARE,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,UNITED HEALTHCARE,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,UNITED HEALTHCARE,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,VA,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,VA TRICARE,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,WELLMED,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,HUMANA,MGD,261.72,,,,,,,per diem,261.72,261.72,"Per diem rate, code is bundled with other services"
XR LUMBAR SPINE 1 VIEW        ,74080109,CDM,320,RC,,,,,,Inpatient,,,261.72,261.72,HUMANA CHOICE PLUS,MGD,261.72,,,,,,,case rate,261.72,261.72,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,AETNA,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,BCBS,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,CIGNA,COM,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,TRICARE,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,UNITED HEALTHCARE,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,UNITED HEALTHCARE,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,VA,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,VA TRICARE,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,WELLMED,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,HUMANA,MGD,275.05,,,,,,,per diem,275.05,275.05,"Per diem rate, code is bundled with other services"
XR THORACIC SPINE 1 VIEW      ,74080110,CDM,320,RC,,,,,,Inpatient,,,275.05,275.05,HUMANA CHOICE PLUS,MGD,275.05,,,,,,,case rate,275.05,275.05,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,AETNA,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,BCBS,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,CIGNA,COM,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,TRICARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,UNITED HEALTHCARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,UNITED HEALTHCARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,VA,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,VA TRICARE,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,WELLMED,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,HUMANA,MGD,547.28,,,,,,,per diem,547.28,547.28,"Per diem rate, code is bundled with other services"
CHEMO ADMIN INTRATHECAL       ,74080111,CDM,331,RC,,,,,,Inpatient,,,547.28,547.28,HUMANA CHOICE PLUS,MGD,547.28,,,,,,,case rate,547.28,547.28,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,AETNA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,BCBS,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,CIGNA,COM,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,UNITED HEALTHCARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,VA,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,VA TRICARE,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,WELLMED,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,HUMANA,MGD,87.82,,,,,,,per diem,87.82,87.82,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,74080112,CDM,636,RC,,,,,,Inpatient,1,EA,87.82,87.82,HUMANA CHOICE PLUS,MGD,87.82,,,,,,,case rate,87.82,87.82,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,AETNA,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,BCBS,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,CIGNA,COM,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,TRICARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,UNITED HEALTHCARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,UNITED HEALTHCARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,VA,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,VA TRICARE,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,WELLMED,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,HUMANA,MGD,1561.52,,,,,,,per diem,1561.52,1561.52,"Per diem rate, code is bundled with other services"
XR MYELOGRAM 2 OR>REGIONS     ,74080113,CDM,320,RC,,,,,,Inpatient,,,1561.52,1561.52,HUMANA CHOICE PLUS,MGD,1561.52,,,,,,,case rate,1561.52,1561.52,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,AETNA,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,BCBS,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,CIGNA,COM,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,TRICARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,UNITED HEALTHCARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,UNITED HEALTHCARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,VA,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,VA TRICARE,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,WELLMED,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,HUMANA,MGD,324.51,,,,,,,per diem,324.51,324.51,"Per diem rate, code is bundled with other services"
IOPAMIDL 200MG 20ML INTH      ,74080114,CDM,636,RC,,,,,,Inpatient,1,EA,324.51,324.51,HUMANA CHOICE PLUS,MGD,324.51,,,,,,,case rate,324.51,324.51,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,AETNA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,CIGNA,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,VA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,VA TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,WELLMED,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,HUMANA,MGD,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
IOPAMIDOL 300MG 15ML INTH     ,74080115,CDM,636,RC,,,,,,Inpatient,1,EA,139.23,139.23,HUMANA CHOICE PLUS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,AETNA,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,BCBS,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,CIGNA,COM,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,TRICARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,UNITED HEALTHCARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,UNITED HEALTHCARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,VA,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,VA TRICARE,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,WELLMED,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,HUMANA,MGD,134.95,,,,,,,per diem,134.95,134.95,"Per diem rate, code is bundled with other services"
IOPAMIDOL 15GM/50ML INJ       ,74080116,CDM,636,RC,,,,,,Inpatient,1,EA,134.95,134.95,HUMANA CHOICE PLUS,MGD,134.95,,,,,,,case rate,134.95,134.95,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,AETNA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,CIGNA,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,WELLMED,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA,MGD,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOHEXOL 300MG/ML 50ML INJ     ,74080117,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA CHOICE PLUS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,AETNA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,CIGNA,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,VA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,VA TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,WELLMED,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA,MGD,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT DIAG     ,74080118,CDM,401,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA CHOICE PLUS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,AETNA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,BCBS,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,CIGNA,COM,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,UNITED HEALTHCARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,VA,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,VA TRICARE,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,WELLMED,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA,MGD,177.79,,,,,,,per diem,177.79,177.79,"Per diem rate, code is bundled with other services"
MA COMP AIDED DETECT SCRN     ,74080119,CDM,403,RC,,,,,,Inpatient,,,177.79,177.79,HUMANA CHOICE PLUS,MGD,177.79,,,,,,,case rate,177.79,177.79,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,AETNA,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,BCBS,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,CIGNA,COM,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,TRICARE,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,UNITED HEALTHCARE,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,UNITED HEALTHCARE,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,VA,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,VA TRICARE,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,WELLMED,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,HUMANA,MGD,690.8,,,,,,,per diem,690.8,690.8,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGIT BIL      ,74080120,CDM,401,RC,,,,,,Inpatient,,,690.8,690.8,HUMANA CHOICE PLUS,MGD,690.8,,,,,,,case rate,690.8,690.8,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,AETNA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,CIGNA,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,VA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,VA TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,WELLMED,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA,MGD,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
MA MAMMO DX 2D DIGITAL UN     ,74080121,CDM,401,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA CHOICE PLUS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,AETNA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,CIGNA,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,VA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,VA TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,WELLMED,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA,MGD,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG LT              ,74080122,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA CHOICE PLUS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,AETNA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,CIGNA,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,VA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,VA TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,WELLMED,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA,MGD,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
MA MAMMO DIAG RT              ,74080123,CDM,401,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA CHOICE PLUS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,AETNA,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,BCBS,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,CIGNA,COM,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,TRICARE,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,UNITED HEALTHCARE,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,UNITED HEALTHCARE,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,VA,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,VA TRICARE,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,WELLMED,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,HUMANA,MGD,728.28,,,,,,,per diem,728.28,728.28,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG BIL       ,74080124,CDM,403,RC,,,,,,Inpatient,,,728.28,728.28,HUMANA CHOICE PLUS,MGD,728.28,,,,,,,case rate,728.28,728.28,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,AETNA,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,BCBS,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,CIGNA,COM,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,TRICARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,UNITED HEALTHCARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,UNITED HEALTHCARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,VA,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,VA TRICARE,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,WELLMED,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,HUMANA,MGD,1859.26,,,,,,,per diem,1859.26,1859.26,"Per diem rate, code is bundled with other services"
TILT TABLE EVALUATION         ,74080131,CDM,480,RC,,,,,,Inpatient,,,1859.26,1859.26,HUMANA CHOICE PLUS,MGD,1859.26,,,,,,,case rate,1859.26,1859.26,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,AETNA,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,BCBS,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,CIGNA,COM,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,TRICARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,UNITED HEALTHCARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,UNITED HEALTHCARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,VA,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,VA TRICARE,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,WELLMED,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,HUMANA,MGD,1195.24,,,,,,,per diem,1195.24,1195.24,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,74080132,CDM,402,RC,,,,,,Inpatient,,,1195.24,1195.24,HUMANA CHOICE PLUS,MGD,1195.24,,,,,,,case rate,1195.24,1195.24,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,AETNA,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,BCBS,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,CIGNA,COM,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,TRICARE,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,UNITED HEALTHCARE,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,UNITED HEALTHCARE,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,VA,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,VA TRICARE,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,WELLMED,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,HUMANA,MGD,1193.09,,,,,,,per diem,1193.09,1193.09,"Per diem rate, code is bundled with other services"
XR ANKLE 2 VIEWS UNI          ,74080133,CDM,320,RC,,,,,,Inpatient,,,1193.09,1193.09,HUMANA CHOICE PLUS,MGD,1193.09,,,,,,,case rate,1193.09,1193.09,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,AETNA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,CIGNA,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,WELLMED,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA,MGD,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS BIL          ,74080134,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA CHOICE PLUS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,AETNA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,CIGNA,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,WELLMED,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA,MGD,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS LT           ,74080135,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA CHOICE PLUS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,AETNA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,BCBS,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,CIGNA,COM,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,UNITED HEALTHCARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,VA TRICARE,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,WELLMED,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA,MGD,1386.95,,,,,,,per diem,1386.95,1386.95,"Per diem rate, code is bundled with other services"
XR ANKLE 3 VIEWS RT           ,74080136,CDM,320,RC,,,,,,Inpatient,,,1386.95,1386.95,HUMANA CHOICE PLUS,MGD,1386.95,,,,,,,case rate,1386.95,1386.95,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,AETNA,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,BCBS,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,CIGNA,COM,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,TRICARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,UNITED HEALTHCARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,UNITED HEALTHCARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,VA,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,VA TRICARE,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,WELLMED,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,HUMANA,MGD,5825.17,,,,,,,per diem,5825.17,5825.17,"Per diem rate, code is bundled with other services"
XR AORTOGRAM ABD W SERIAL     ,74080137,CDM,323,RC,,,,,,Inpatient,,,5825.17,5825.17,HUMANA CHOICE PLUS,MGD,5825.17,,,,,,,case rate,5825.17,5825.17,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,AETNA,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,CIGNA,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,TRICARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,UNITED HEALTHCARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,UNITED HEALTHCARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,VA,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,VA TRICARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,WELLMED,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,HUMANA,MGD,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE LT        ,74080138,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,HUMANA CHOICE PLUS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,AETNA,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,BCBS,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,CIGNA,COM,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,TRICARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,UNITED HEALTHCARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,UNITED HEALTHCARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,VA,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,VA TRICARE,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,WELLMED,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,HUMANA,MGD,878.22,,,,,,,per diem,878.22,878.22,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM ANKLE RT        ,74080139,CDM,322,RC,,,,,,Inpatient,,,878.22,878.22,HUMANA CHOICE PLUS,MGD,878.22,,,,,,,case rate,878.22,878.22,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,AETNA,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,BCBS,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,CIGNA,COM,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,TRICARE,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,UNITED HEALTHCARE,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,UNITED HEALTHCARE,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,VA,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,VA TRICARE,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,WELLMED,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,HUMANA,MGD,955.67,,,,,,,per diem,955.67,955.67,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP LT          ,74080140,CDM,322,RC,,,,,,Inpatient,,,955.67,955.67,HUMANA CHOICE PLUS,MGD,955.67,,,,,,,case rate,955.67,955.67,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,AETNA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,CIGNA,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,VA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,VA TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,WELLMED,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA,MGD,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM HIP RT          ,74080141,CDM,322,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA CHOICE PLUS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,AETNA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,CIGNA,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,WELLMED,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA,MGD,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER LT     ,74080142,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA CHOICE PLUS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,AETNA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,BCBS,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,CIGNA,COM,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,UNITED HEALTHCARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,VA TRICARE,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,WELLMED,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA,MGD,961.76,,,,,,,per diem,961.76,961.76,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM SHOULDER RT     ,74080143,CDM,322,RC,,,,,,Inpatient,,,961.76,961.76,HUMANA CHOICE PLUS,MGD,961.76,,,,,,,case rate,961.76,961.76,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST LT        ,74080144,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,AETNA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,BCBS,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,CIGNA,COM,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,UNITED HEALTHCARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,VA TRICARE,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,WELLMED,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA,MGD,939.27,,,,,,,per diem,939.27,939.27,"Per diem rate, code is bundled with other services"
XR ARTHROGRAM WRIST RT        ,74080145,CDM,322,RC,,,,,,Inpatient,,,939.27,939.27,HUMANA CHOICE PLUS,MGD,939.27,,,,,,,case rate,939.27,939.27,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,AETNA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,BCBS,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,CIGNA,COM,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,UNITED HEALTHCARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,VA,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,VA TRICARE,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,WELLMED,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA,MGD,375.92,,,,,,,per diem,375.92,375.92,"Per diem rate, code is bundled with other services"
XR BONE AGE STUDIES           ,74080146,CDM,320,RC,,,,,,Inpatient,,,375.92,375.92,HUMANA CHOICE PLUS,MGD,375.92,,,,,,,case rate,375.92,375.92,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,AETNA,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,BCBS,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,CIGNA,COM,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,TRICARE,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,UNITED HEALTHCARE,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,UNITED HEALTHCARE,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,VA,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,VA TRICARE,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,WELLMED,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,HUMANA,MGD,426.26,,,,,,,per diem,426.26,426.26,"Per diem rate, code is bundled with other services"
XR BONE LENGTH STUDIES        ,74080147,CDM,320,RC,,,,,,Inpatient,,,426.26,426.26,HUMANA CHOICE PLUS,MGD,426.26,,,,,,,case rate,426.26,426.26,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,AETNA,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,BCBS,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,CIGNA,COM,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,TRICARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,UNITED HEALTHCARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,UNITED HEALTHCARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,VA,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,VA TRICARE,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,WELLMED,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,HUMANA,MGD,481.95,,,,,,,per diem,481.95,481.95,"Per diem rate, code is bundled with other services"
XR BONE SURVEY LIMITED        ,74080148,CDM,320,RC,,,,,,Inpatient,,,481.95,481.95,HUMANA CHOICE PLUS,MGD,481.95,,,,,,,case rate,481.95,481.95,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,AETNA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,CIGNA,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,WELLMED,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA,MGD,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS BIL      ,74080149,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA CHOICE PLUS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,AETNA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,CIGNA,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,WELLMED,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA,MGD,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS LT       ,74080150,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA CHOICE PLUS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,AETNA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,CIGNA,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,VA TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,WELLMED,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA,MGD,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
XR CALCANEUS 2 VIEWS RT       ,74080151,CDM,320,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA CHOICE PLUS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,AETNA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,CIGNA,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,WELLMED,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA,MGD,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE BIL      ,74080152,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA CHOICE PLUS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,AETNA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,CIGNA,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,WELLMED,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA,MGD,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE LT       ,74080153,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA CHOICE PLUS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,AETNA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,BCBS,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,CIGNA,COM,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,UNITED HEALTHCARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,VA TRICARE,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,WELLMED,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA,MGD,831.1,,,,,,,per diem,831.1,831.1,"Per diem rate, code is bundled with other services"
XR CLAVICLE COMPLETE RT       ,74080154,CDM,320,RC,,,,,,Inpatient,,,831.1,831.1,HUMANA CHOICE PLUS,MGD,831.1,,,,,,,case rate,831.1,831.1,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,AETNA,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,BCBS,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,CIGNA,COM,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,TRICARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,UNITED HEALTHCARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,UNITED HEALTHCARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,VA,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,VA TRICARE,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,WELLMED,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,HUMANA,MGD,589.05,,,,,,,per diem,589.05,589.05,"Per diem rate, code is bundled with other services"
XR COLON ENMA THER OBSTRC     ,74080155,CDM,320,RC,,,,,,Inpatient,,,589.05,589.05,HUMANA CHOICE PLUS,MGD,589.05,,,,,,,case rate,589.05,589.05,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,AETNA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,CIGNA,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,WELLMED,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA,MGD,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS LT           ,74080156,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA CHOICE PLUS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,AETNA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,BCBS,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,CIGNA,COM,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,UNITED HEALTHCARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,VA TRICARE,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,WELLMED,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA,MGD,838.59,,,,,,,per diem,838.59,838.59,"Per diem rate, code is bundled with other services"
XR ELBOW 2 VIEWS RT           ,74080157,CDM,320,RC,,,,,,Inpatient,,,838.59,838.59,HUMANA CHOICE PLUS,MGD,838.59,,,,,,,case rate,838.59,838.59,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,AETNA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,CIGNA,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,WELLMED,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA,MGD,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS BIL          ,74080158,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA CHOICE PLUS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,AETNA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,CIGNA,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,WELLMED,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA,MGD,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS LT           ,74080159,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA CHOICE PLUS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,AETNA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,BCBS,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,CIGNA,COM,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,UNITED HEALTHCARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,VA TRICARE,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,WELLMED,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA,MGD,953.19,,,,,,,per diem,953.19,953.19,"Per diem rate, code is bundled with other services"
XR ELBOW 3 VIEWS RT           ,74080160,CDM,320,RC,,,,,,Inpatient,,,953.19,953.19,HUMANA CHOICE PLUS,MGD,953.19,,,,,,,case rate,953.19,953.19,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,AETNA,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,BCBS,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,CIGNA,COM,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,TRICARE,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,UNITED HEALTHCARE,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,UNITED HEALTHCARE,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,VA,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,VA TRICARE,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,WELLMED,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,HUMANA,MGD,1723.24,,,,,,,per diem,1723.24,1723.24,"Per diem rate, code is bundled with other services"
XR ENDO ERCP                  ,74080161,CDM,320,RC,,,,,,Inpatient,,,1723.24,1723.24,HUMANA CHOICE PLUS,MGD,1723.24,,,,,,,case rate,1723.24,1723.24,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,AETNA,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,BCBS,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,CIGNA,COM,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,TRICARE,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,UNITED HEALTHCARE,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,UNITED HEALTHCARE,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,VA,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,VA TRICARE,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,WELLMED,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,HUMANA,MGD,1409.44,,,,,,,per diem,1409.44,1409.44,"Per diem rate, code is bundled with other services"
XR ENDO PANCREAS DUCT CTH     ,74080162,CDM,320,RC,,,,,,Inpatient,,,1409.44,1409.44,HUMANA CHOICE PLUS,MGD,1409.44,,,,,,,case rate,1409.44,1409.44,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,AETNA,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,BCBS,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,CIGNA,COM,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,TRICARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,UNITED HEALTHCARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,UNITED HEALTHCARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,VA,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,VA TRICARE,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,WELLMED,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,HUMANA,MGD,578.34,,,,,,,per diem,578.34,578.34,"Per diem rate, code is bundled with other services"
XR ENVAS REP INFRAREN AAA     ,74080163,CDM,320,RC,,,,,,Inpatient,,,578.34,578.34,HUMANA CHOICE PLUS,MGD,578.34,,,,,,,case rate,578.34,578.34,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,AETNA,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,BCBS,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,CIGNA,COM,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,TRICARE,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,UNITED HEALTHCARE,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,UNITED HEALTHCARE,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,VA,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,VA TRICARE,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,WELLMED,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,HUMANA,MGD,519.44,,,,,,,per diem,519.44,519.44,"Per diem rate, code is bundled with other services"
XR FB LOCAL NOSE TO RECTM     ,74080164,CDM,320,RC,,,,,,Inpatient,,,519.44,519.44,HUMANA CHOICE PLUS,MGD,519.44,,,,,,,case rate,519.44,519.44,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,AETNA,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,BCBS,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,CIGNA,COM,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,TRICARE,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,UNITED HEALTHCARE,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,UNITED HEALTHCARE,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,VA,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,VA TRICARE,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,WELLMED,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,HUMANA,MGD,795.75,,,,,,,per diem,795.75,795.75,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS BIL        ,74080165,CDM,320,RC,,,,,,Inpatient,,,795.75,795.75,HUMANA CHOICE PLUS,MGD,795.75,,,,,,,case rate,795.75,795.75,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,AETNA,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,CIGNA,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,TRICARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,UNITED HEALTHCARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,UNITED HEALTHCARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,VA,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,VA TRICARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,WELLMED,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,HUMANA,MGD,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS LT         ,74080166,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,HUMANA CHOICE PLUS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,AETNA,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,BCBS,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,CIGNA,COM,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,TRICARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,UNITED HEALTHCARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,UNITED HEALTHCARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,VA,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,VA TRICARE,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,WELLMED,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,HUMANA,MGD,790.56,,,,,,,per diem,790.56,790.56,"Per diem rate, code is bundled with other services"
XR FINGERS 2 VIEWS RT         ,74080167,CDM,320,RC,,,,,,Inpatient,,,790.56,790.56,HUMANA CHOICE PLUS,MGD,790.56,,,,,,,case rate,790.56,790.56,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,AETNA,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,BCBS,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,CIGNA,COM,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,TRICARE,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,UNITED HEALTHCARE,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,UNITED HEALTHCARE,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,VA,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,VA TRICARE,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,WELLMED,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,HUMANA,MGD,1152.41,,,,,,,per diem,1152.41,1152.41,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS BIL           ,74080168,CDM,320,RC,,,,,,Inpatient,,,1152.41,1152.41,HUMANA CHOICE PLUS,MGD,1152.41,,,,,,,case rate,1152.41,1152.41,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,AETNA,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,BCBS,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,CIGNA,COM,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,TRICARE,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,UNITED HEALTHCARE,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,UNITED HEALTHCARE,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,VA,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,VA TRICARE,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,WELLMED,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,HUMANA,MGD,1209.16,,,,,,,per diem,1209.16,1209.16,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS LT            ,74080169,CDM,320,RC,,,,,,Inpatient,,,1209.16,1209.16,HUMANA CHOICE PLUS,MGD,1209.16,,,,,,,case rate,1209.16,1209.16,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,AETNA,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,BCBS,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,CIGNA,COM,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,TRICARE,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,UNITED HEALTHCARE,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,UNITED HEALTHCARE,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,VA,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,VA TRICARE,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,WELLMED,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,HUMANA,MGD,911.11,,,,,,,per diem,911.11,911.11,"Per diem rate, code is bundled with other services"
XR FOOT 2 VIEWS RT            ,74080170,CDM,320,RC,,,,,,Inpatient,,,911.11,911.11,HUMANA CHOICE PLUS,MGD,911.11,,,,,,,case rate,911.11,911.11,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,AETNA,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,BCBS,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,CIGNA,COM,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,TRICARE,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,UNITED HEALTHCARE,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,UNITED HEALTHCARE,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,VA,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,VA TRICARE,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,WELLMED,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,HUMANA,MGD,1676.12,,,,,,,per diem,1676.12,1676.12,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS BIL           ,74080171,CDM,320,RC,,,,,,Inpatient,,,1676.12,1676.12,HUMANA CHOICE PLUS,MGD,1676.12,,,,,,,case rate,1676.12,1676.12,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,AETNA,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,CIGNA,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,TRICARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,UNITED HEALTHCARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,UNITED HEALTHCARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,VA,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,VA TRICARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,WELLMED,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,HUMANA,MGD,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS LT            ,74080172,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,HUMANA CHOICE PLUS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,AETNA,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,BCBS,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,CIGNA,COM,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,TRICARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,UNITED HEALTHCARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,UNITED HEALTHCARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,VA,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,VA TRICARE,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,WELLMED,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,HUMANA,MGD,1374.09,,,,,,,per diem,1374.09,1374.09,"Per diem rate, code is bundled with other services"
XR FOOT 3 VIEWS RT            ,74080173,CDM,320,RC,,,,,,Inpatient,,,1374.09,1374.09,HUMANA CHOICE PLUS,MGD,1374.09,,,,,,,case rate,1374.09,1374.09,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,AETNA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,CIGNA,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,WELLMED,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA,MGD,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS BIL        ,74080174,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA CHOICE PLUS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,AETNA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,CIGNA,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,WELLMED,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA,MGD,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS LT         ,74080175,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA CHOICE PLUS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,AETNA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,BCBS,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,CIGNA,COM,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,UNITED HEALTHCARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,VA TRICARE,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,WELLMED,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA,MGD,947.84,,,,,,,per diem,947.84,947.84,"Per diem rate, code is bundled with other services"
XR FOREARM 2 VIEWS RT         ,74080176,CDM,320,RC,,,,,,Inpatient,,,947.84,947.84,HUMANA CHOICE PLUS,MGD,947.84,,,,,,,case rate,947.84,947.84,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,AETNA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,CIGNA,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,WELLMED,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA,MGD,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS BIL           ,74080177,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA CHOICE PLUS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,AETNA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,CIGNA,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,WELLMED,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA,MGD,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS LT            ,74080178,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA CHOICE PLUS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,AETNA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,BCBS,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,CIGNA,COM,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,UNITED HEALTHCARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,VA TRICARE,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,WELLMED,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA,MGD,1175.96,,,,,,,per diem,1175.96,1175.96,"Per diem rate, code is bundled with other services"
XR HAND 2 VIEWS RT            ,74080179,CDM,320,RC,,,,,,Inpatient,,,1175.96,1175.96,HUMANA CHOICE PLUS,MGD,1175.96,,,,,,,case rate,1175.96,1175.96,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,AETNA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,CIGNA,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,WELLMED,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA,MGD,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS BIL           ,74080180,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA CHOICE PLUS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,AETNA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,CIGNA,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,WELLMED,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA,MGD,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS LT            ,74080181,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA CHOICE PLUS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,AETNA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,BCBS,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,CIGNA,COM,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,UNITED HEALTHCARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,VA TRICARE,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,WELLMED,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA,MGD,1367.67,,,,,,,per diem,1367.67,1367.67,"Per diem rate, code is bundled with other services"
XR HAND 3 VIEWS RT            ,74080182,CDM,320,RC,,,,,,Inpatient,,,1367.67,1367.67,HUMANA CHOICE PLUS,MGD,1367.67,,,,,,,case rate,1367.67,1367.67,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,AETNA,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,BCBS,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,CIGNA,COM,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,TRICARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,UNITED HEALTHCARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,UNITED HEALTHCARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,VA,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,VA TRICARE,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,WELLMED,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,HUMANA,MGD,1460.84,,,,,,,per diem,1460.84,1460.84,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS BIL        ,74080183,CDM,320,RC,,,,,,Inpatient,,,1460.84,1460.84,HUMANA CHOICE PLUS,MGD,1460.84,,,,,,,case rate,1460.84,1460.84,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS LT         ,74080184,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,AETNA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,BCBS,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,CIGNA,COM,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,UNITED HEALTHCARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,VA,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,VA TRICARE,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,WELLMED,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA,MGD,973.54,,,,,,,per diem,973.54,973.54,"Per diem rate, code is bundled with other services"
XR HUMERUS 2 VIEWS RT         ,74080185,CDM,320,RC,,,,,,Inpatient,,,973.54,973.54,HUMANA CHOICE PLUS,MGD,973.54,,,,,,,case rate,973.54,973.54,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,AETNA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,CIGNA,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,WELLMED,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA,MGD,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS BIL      ,74080186,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA CHOICE PLUS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,AETNA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,CIGNA,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,WELLMED,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA,MGD,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS LT       ,74080187,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA CHOICE PLUS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,AETNA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,BCBS,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,CIGNA,COM,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,UNITED HEALTHCARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,VA TRICARE,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,WELLMED,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA,MGD,1157.75,,,,,,,per diem,1157.75,1157.75,"Per diem rate, code is bundled with other services"
XR KNEE 1 OR 2 VIEWS RT       ,74080188,CDM,320,RC,,,,,,Inpatient,,,1157.75,1157.75,HUMANA CHOICE PLUS,MGD,1157.75,,,,,,,case rate,1157.75,1157.75,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,AETNA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,CIGNA,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,WELLMED,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA,MGD,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS BIL           ,74080189,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA CHOICE PLUS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,AETNA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,CIGNA,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,WELLMED,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA,MGD,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS LT            ,74080190,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA CHOICE PLUS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,AETNA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,CIGNA,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,VA TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,WELLMED,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA,MGD,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
XR KNEE 3 VIEWS RT            ,74080191,CDM,320,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA CHOICE PLUS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,AETNA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,CIGNA,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,WELLMED,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA,MGD,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS BIL           ,74080192,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA CHOICE PLUS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,AETNA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,CIGNA,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,WELLMED,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA,MGD,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS LT            ,74080193,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA CHOICE PLUS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,AETNA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,BCBS,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,CIGNA,COM,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,UNITED HEALTHCARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,VA TRICARE,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,WELLMED,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA,MGD,1566.87,,,,,,,per diem,1566.87,1566.87,"Per diem rate, code is bundled with other services"
XR KNEE 4 VIEWS RT            ,74080194,CDM,320,RC,,,,,,Inpatient,,,1566.87,1566.87,HUMANA CHOICE PLUS,MGD,1566.87,,,,,,,case rate,1566.87,1566.87,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,AETNA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,CIGNA,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,VA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,VA TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,WELLMED,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA,MGD,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
XR MASTOIDS 3 VIEWS/SIDE      ,74080195,CDM,320,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA CHOICE PLUS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,AETNA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,CIGNA,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,VA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,VA TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,WELLMED,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,HUMANA,MGD,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
XR PHARYX &/OR CERV ESOPH     ,74080196,CDM,320,RC,,,,,,Inpatient,,,306.31,306.31,HUMANA CHOICE PLUS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,AETNA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,CIGNA,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,WELLMED,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA,MGD,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080197,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA CHOICE PLUS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,AETNA,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,CIGNA,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,TRICARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,UNITED HEALTHCARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,UNITED HEALTHCARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,VA,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,VA TRICARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,WELLMED,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,HUMANA,MGD,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS LT            ,74080198,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,HUMANA CHOICE PLUS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,AETNA,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,BCBS,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,CIGNA,COM,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,TRICARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,UNITED HEALTHCARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,UNITED HEALTHCARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,VA,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,VA TRICARE,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,WELLMED,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,HUMANA,MGD,1006.74,,,,,,,per diem,1006.74,1006.74,"Per diem rate, code is bundled with other services"
XR RIBS 2 VIEWS RT            ,74080199,CDM,320,RC,,,,,,Inpatient,,,1006.74,1006.74,HUMANA CHOICE PLUS,MGD,1006.74,,,,,,,case rate,1006.74,1006.74,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,AETNA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,CIGNA,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,VA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,VA TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,WELLMED,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA,MGD,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS LT      ,74080200,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA CHOICE PLUS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,AETNA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,CIGNA,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,VA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,VA TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,WELLMED,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA,MGD,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
XR RIBS W CHEST 3 VWS RT      ,74080201,CDM,320,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA CHOICE PLUS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,AETNA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,CIGNA,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,VA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,VA TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,WELLMED,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA,MGD,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE LT        ,74080202,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA CHOICE PLUS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,AETNA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,BCBS,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,CIGNA,COM,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,UNITED HEALTHCARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,VA,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,VA TRICARE,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,WELLMED,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA,MGD,969.26,,,,,,,per diem,969.26,969.26,"Per diem rate, code is bundled with other services"
XR SCAPULA COMPLETE RT        ,74080203,CDM,320,RC,,,,,,Inpatient,,,969.26,969.26,HUMANA CHOICE PLUS,MGD,969.26,,,,,,,case rate,969.26,969.26,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,AETNA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,BCBS,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,CIGNA,COM,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,UNITED HEALTHCARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,VA,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,VA TRICARE,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,WELLMED,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA,MGD,923.2,,,,,,,per diem,923.2,923.2,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW LT         ,74080204,CDM,320,RC,,,,,,Inpatient,,,923.2,923.2,HUMANA CHOICE PLUS,MGD,923.2,,,,,,,case rate,923.2,923.2,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,AETNA,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,BCBS,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,CIGNA,COM,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,TRICARE,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,UNITED HEALTHCARE,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,UNITED HEALTHCARE,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,VA,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,VA TRICARE,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,WELLMED,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,HUMANA,MGD,720.47,,,,,,,per diem,720.47,720.47,"Per diem rate, code is bundled with other services"
XR SHOULDER 1 VIEW RT         ,74080205,CDM,320,RC,,,,,,Inpatient,,,720.47,720.47,HUMANA CHOICE PLUS,MGD,720.47,,,,,,,case rate,720.47,720.47,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,AETNA,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,CIGNA,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,TRICARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,UNITED HEALTHCARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,UNITED HEALTHCARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,VA,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,VA TRICARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,WELLMED,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,HUMANA,MGD,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS BIL       ,74080206,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,HUMANA CHOICE PLUS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,AETNA,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,BCBS,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,CIGNA,COM,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,TRICARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,UNITED HEALTHCARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,UNITED HEALTHCARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,VA,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,VA TRICARE,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,WELLMED,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,HUMANA,MGD,1154.54,,,,,,,per diem,1154.54,1154.54,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS LT        ,74080207,CDM,320,RC,,,,,,Inpatient,,,1154.54,1154.54,HUMANA CHOICE PLUS,MGD,1154.54,,,,,,,case rate,1154.54,1154.54,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,AETNA,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,BCBS,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,CIGNA,COM,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,TRICARE,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,UNITED HEALTHCARE,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,UNITED HEALTHCARE,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,VA,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,VA TRICARE,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,WELLMED,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,HUMANA,MGD,800.69,,,,,,,per diem,800.69,800.69,"Per diem rate, code is bundled with other services"
XR SHOULDER 2 VIEWS RT        ,74080208,CDM,320,RC,,,,,,Inpatient,,,800.69,800.69,HUMANA CHOICE PLUS,MGD,800.69,,,,,,,case rate,800.69,800.69,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,AETNA,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,BCBS,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,CIGNA,COM,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,TRICARE,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,UNITED HEALTHCARE,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,UNITED HEALTHCARE,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,VA,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,VA TRICARE,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,WELLMED,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,HUMANA,MGD,689.72,,,,,,,per diem,689.72,689.72,"Per diem rate, code is bundled with other services"
XR SIALOGRAM UNI              ,74080209,CDM,320,RC,,,,,,Inpatient,,,689.72,689.72,HUMANA CHOICE PLUS,MGD,689.72,,,,,,,case rate,689.72,689.72,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,AETNA,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,CIGNA,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,TRICARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,UNITED HEALTHCARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,UNITED HEALTHCARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,VA,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,VA TRICARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,WELLMED,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,HUMANA,MGD,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW BIL     ,74080210,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,HUMANA CHOICE PLUS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,AETNA,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,BCBS,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,CIGNA,COM,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,TRICARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,UNITED HEALTHCARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,UNITED HEALTHCARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,VA,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,VA TRICARE,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,WELLMED,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,HUMANA,MGD,867.51,,,,,,,per diem,867.51,867.51,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW LT     ,74080211,CDM,320,RC,,,,,,Inpatient,,,867.51,867.51,HUMANA CHOICE PLUS,MGD,867.51,,,,,,,case rate,867.51,867.51,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,AETNA,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,BCBS,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,CIGNA,COM,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,TRICARE,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,UNITED HEALTHCARE,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,UNITED HEALTHCARE,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,VA,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,VA TRICARE,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,WELLMED,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,HUMANA,MGD,692.24,,,,,,,per diem,692.24,692.24,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 2 VW RT     ,74080212,CDM,320,RC,,,,,,Inpatient,,,692.24,692.24,HUMANA CHOICE PLUS,MGD,692.24,,,,,,,case rate,692.24,692.24,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,AETNA,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,BCBS,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,CIGNA,COM,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,TRICARE,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,UNITED HEALTHCARE,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,UNITED HEALTHCARE,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,VA,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,VA TRICARE,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,WELLMED,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,HUMANA,MGD,462.22,,,,,,,per diem,462.22,462.22,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS LT            ,74080213,CDM,320,RC,,,,,,Inpatient,,,462.22,462.22,HUMANA CHOICE PLUS,MGD,462.22,,,,,,,case rate,462.22,462.22,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,AETNA,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,BCBS,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,CIGNA,COM,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,TRICARE,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,UNITED HEALTHCARE,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,UNITED HEALTHCARE,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,VA,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,VA TRICARE,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,WELLMED,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,HUMANA,MGD,619.25,,,,,,,per diem,619.25,619.25,"Per diem rate, code is bundled with other services"
XR TOES 2 VIEWS RT            ,74080214,CDM,320,RC,,,,,,Inpatient,,,619.25,619.25,HUMANA CHOICE PLUS,MGD,619.25,,,,,,,case rate,619.25,619.25,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,AETNA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,CIGNA,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,WELLMED,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA,MGD,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY LT      ,74080215,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA CHOICE PLUS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,AETNA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,BCBS,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,CIGNA,COM,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,UNITED HEALTHCARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,VA TRICARE,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,WELLMED,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA,MGD,5072.26,,,,,,,per diem,5072.26,5072.26,"Per diem rate, code is bundled with other services"
XR VENOGRAM EXTREMITY RT      ,74080216,CDM,320,RC,,,,,,Inpatient,,,5072.26,5072.26,HUMANA CHOICE PLUS,MGD,5072.26,,,,,,,case rate,5072.26,5072.26,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,AETNA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,CIGNA,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,VA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,VA TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,WELLMED,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA,MGD,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS LT           ,74080217,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA CHOICE PLUS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,AETNA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,CIGNA,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,VA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,VA TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,WELLMED,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA,MGD,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
XR WRIST 2 VIEWS RT           ,74080218,CDM,320,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA CHOICE PLUS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,AETNA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,CIGNA,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,WELLMED,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA,MGD,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS BIL          ,74080219,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA CHOICE PLUS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,AETNA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,CIGNA,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,WELLMED,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA,MGD,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS LT           ,74080220,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA CHOICE PLUS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,AETNA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,CIGNA,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,VA TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,WELLMED,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA,MGD,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
XR WRIST 3 VIEWS RT           ,74080221,CDM,320,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA CHOICE PLUS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,AETNA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,BCBS,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,CIGNA,COM,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,UNITED HEALTHCARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,VA TRICARE,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,WELLMED,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA,MGD,5645.24,,,,,,,per diem,5645.24,5645.24,"Per diem rate, code is bundled with other services"
XR PTA VENOUS                 ,74080222,CDM,320,RC,,,,,,Inpatient,,,5645.24,5645.24,HUMANA CHOICE PLUS,MGD,5645.24,,,,,,,case rate,5645.24,5645.24,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,AETNA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,CIGNA,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,WELLMED,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA,MGD,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 30GM/100ML INJ      ,74080223,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA CHOICE PLUS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,AETNA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,BCBS,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,CIGNA,COM,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,UNITED HEALTHCARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,VA,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,VA TRICARE,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,WELLMED,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,HUMANA,MGD,145.66,,,,,,,per diem,145.66,145.66,"Per diem rate, code is bundled with other services"
IOPAMIDOL 18.5GM/50ML INJ     ,74080224,CDM,636,RC,,,,,,Inpatient,1,EA,145.66,145.66,HUMANA CHOICE PLUS,MGD,145.66,,,,,,,case rate,145.66,145.66,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,AETNA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,BCBS,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,CIGNA,COM,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,UNITED HEALTHCARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,VA TRICARE,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,WELLMED,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA,MGD,291.31,,,,,,,per diem,291.31,291.31,"Per diem rate, code is bundled with other services"
IOPAMIDOL 37GM/100ML INJ      ,74080225,CDM,636,RC,,,,,,Inpatient,1,EA,291.31,291.31,HUMANA CHOICE PLUS,MGD,291.31,,,,,,,case rate,291.31,291.31,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,AETNA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,CIGNA,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,WELLMED,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA,MGD,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY LT         ,74080226,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA CHOICE PLUS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,AETNA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,BCBS,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,CIGNA,COM,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,UNITED HEALTHCARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,VA TRICARE,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,WELLMED,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA,MGD,5115.1,,,,,,,per diem,5115.1,5115.1,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY RT         ,74080227,CDM,323,RC,,,,,,Inpatient,,,5115.1,5115.1,HUMANA CHOICE PLUS,MGD,5115.1,,,,,,,case rate,5115.1,5115.1,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,AETNA,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,BCBS,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,CIGNA,COM,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,TRICARE,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,UNITED HEALTHCARE,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,UNITED HEALTHCARE,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,VA,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,VA TRICARE,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,WELLMED,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,HUMANA,MGD,267.05,,,,,,,per diem,267.05,267.05,"Per diem rate, code is bundled with other services"
XR DXA VERTEBRA FX ASSESS     ,74080228,CDM,320,RC,,,,,,Inpatient,,,267.05,267.05,HUMANA CHOICE PLUS,MGD,267.05,,,,,,,case rate,267.05,267.05,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,AETNA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,CIGNA,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,VA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,VA TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,WELLMED,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,HUMANA,MGD,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
XR BONE DENSITY DXA STUDY     ,74080229,CDM,320,RC,,,,,,Inpatient,,,688.65,688.65,HUMANA CHOICE PLUS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,AETNA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,CIGNA,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,WELLMED,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA,MGD,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG RT        ,74080230,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA CHOICE PLUS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,AETNA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,BCBS,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,CIGNA,COM,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,UNITED HEALTHCARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,VA TRICARE,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,WELLMED,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA,MGD,210.99,,,,,,,per diem,210.99,210.99,"Per diem rate, code is bundled with other services"
MA MAMMO SCREEN DIG LT        ,74080231,CDM,403,RC,,,,,,Inpatient,,,210.99,210.99,HUMANA CHOICE PLUS,MGD,210.99,,,,,,,case rate,210.99,210.99,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,AETNA,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,BCBS,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,CIGNA,COM,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,TRICARE,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,UNITED HEALTHCARE,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,UNITED HEALTHCARE,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,VA,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,VA TRICARE,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,WELLMED,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,HUMANA,MGD,274.9,,,,,,,per diem,274.9,274.9,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW LT          ,74080232,CDM,320,RC,,,,,,Inpatient,,,274.9,274.9,HUMANA CHOICE PLUS,MGD,274.9,,,,,,,case rate,274.9,274.9,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,AETNA,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,CIGNA,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,TRICARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,UNITED HEALTHCARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,UNITED HEALTHCARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,VA,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,VA TRICARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,WELLMED,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,HUMANA,MGD,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW LT            ,74080233,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,HUMANA CHOICE PLUS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,AETNA,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,BCBS,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,CIGNA,COM,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,TRICARE,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,UNITED HEALTHCARE,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,UNITED HEALTHCARE,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,VA,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,VA TRICARE,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,WELLMED,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,HUMANA,MGD,344.9,,,,,,,per diem,344.9,344.9,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW LT          ,74080234,CDM,320,RC,,,,,,Inpatient,,,344.9,344.9,HUMANA CHOICE PLUS,MGD,344.9,,,,,,,case rate,344.9,344.9,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,AETNA,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,CIGNA,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,TRICARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,UNITED HEALTHCARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,UNITED HEALTHCARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,VA,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,VA TRICARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,WELLMED,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,HUMANA,MGD,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW LT            ,74080235,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,HUMANA CHOICE PLUS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW LT            ,74080236,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,AETNA,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,CIGNA,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,TRICARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,UNITED HEALTHCARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,UNITED HEALTHCARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,VA,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,VA TRICARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,WELLMED,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,HUMANA,MGD,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW LT      ,74080237,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,HUMANA CHOICE PLUS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,AETNA,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,CIGNA,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,TRICARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,UNITED HEALTHCARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,UNITED HEALTHCARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,VA,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,VA TRICARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,WELLMED,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,HUMANA,MGD,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR HUMERUS 1 VIEW RT          ,74080238,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,HUMANA CHOICE PLUS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,AETNA,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,BCBS,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,CIGNA,COM,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,TRICARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,UNITED HEALTHCARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,UNITED HEALTHCARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,VA,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,VA TRICARE,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,WELLMED,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,HUMANA,MGD,362.08,,,,,,,per diem,362.08,362.08,"Per diem rate, code is bundled with other services"
XR ELBOW 1 VIEW RT            ,74080239,CDM,320,RC,,,,,,Inpatient,,,362.08,362.08,HUMANA CHOICE PLUS,MGD,362.08,,,,,,,case rate,362.08,362.08,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,AETNA,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,BCBS,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,CIGNA,COM,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,TRICARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,UNITED HEALTHCARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,UNITED HEALTHCARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,VA,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,VA TRICARE,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,WELLMED,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,HUMANA,MGD,359.86,,,,,,,per diem,359.86,359.86,"Per diem rate, code is bundled with other services"
XR FOREARM 1 VIEW RT          ,74080240,CDM,320,RC,,,,,,Inpatient,,,359.86,359.86,HUMANA CHOICE PLUS,MGD,359.86,,,,,,,case rate,359.86,359.86,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,AETNA,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,BCBS,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,CIGNA,COM,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,TRICARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,UNITED HEALTHCARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,UNITED HEALTHCARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,VA,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,VA TRICARE,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,WELLMED,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,HUMANA,MGD,582.62,,,,,,,per diem,582.62,582.62,"Per diem rate, code is bundled with other services"
XR ANKLE 1 VIEW RT            ,74080241,CDM,320,RC,,,,,,Inpatient,,,582.62,582.62,HUMANA CHOICE PLUS,MGD,582.62,,,,,,,case rate,582.62,582.62,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,AETNA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,BCBS,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,CIGNA,COM,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,UNITED HEALTHCARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,VA,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,VA TRICARE,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,WELLMED,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA,MGD,360.93,,,,,,,per diem,360.93,360.93,"Per diem rate, code is bundled with other services"
XR WRIST 1 VIEW RT            ,74080242,CDM,320,RC,,,,,,Inpatient,,,360.93,360.93,HUMANA CHOICE PLUS,MGD,360.93,,,,,,,case rate,360.93,360.93,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,AETNA,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,BCBS,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,CIGNA,COM,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,TRICARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,UNITED HEALTHCARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,UNITED HEALTHCARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,VA,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,VA TRICARE,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,WELLMED,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,HUMANA,MGD,364.14,,,,,,,per diem,364.14,364.14,"Per diem rate, code is bundled with other services"
XR TIBIA & FIBULA 1VW RT      ,74080243,CDM,320,RC,,,,,,Inpatient,,,364.14,364.14,HUMANA CHOICE PLUS,MGD,364.14,,,,,,,case rate,364.14,364.14,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,AETNA,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,BCBS,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,CIGNA,COM,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,TRICARE,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,UNITED HEALTHCARE,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,UNITED HEALTHCARE,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,VA,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,VA TRICARE,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,WELLMED,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,HUMANA,MGD,480.88,,,,,,,per diem,480.88,480.88,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW LT             ,74080244,CDM,320,RC,,,,,,Inpatient,,,480.88,480.88,HUMANA CHOICE PLUS,MGD,480.88,,,,,,,case rate,480.88,480.88,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,AETNA,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,CIGNA,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,TRICARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,UNITED HEALTHCARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,UNITED HEALTHCARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,VA,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,VA TRICARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,WELLMED,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,HUMANA,MGD,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
XR FOOT 1 VIEW RT             ,74080245,CDM,320,RC,,,,,,Inpatient,,,355.58,355.58,HUMANA CHOICE PLUS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,AETNA,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,BCBS,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,CIGNA,COM,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,TRICARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,UNITED HEALTHCARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,UNITED HEALTHCARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,VA,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,VA TRICARE,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,WELLMED,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,HUMANA,MGD,5647.38,,,,,,,per diem,5647.38,5647.38,"Per diem rate, code is bundled with other services"
XR PTA PERIPHERAL ARTERY      ,74080246,CDM,320,RC,,,,,,Inpatient,,,5647.38,5647.38,HUMANA CHOICE PLUS,MGD,5647.38,,,,,,,case rate,5647.38,5647.38,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,AETNA,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,BCBS,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,CIGNA,COM,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,TRICARE,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,UNITED HEALTHCARE,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,UNITED HEALTHCARE,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,VA,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,VA TRICARE,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,WELLMED,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,HUMANA,MGD,728.67,,,,,,,per diem,728.67,728.67,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 1 VIEW        ,74080247,CDM,320,RC,,,,,,Inpatient,,,728.67,728.67,HUMANA CHOICE PLUS,MGD,728.67,,,,,,,case rate,728.67,728.67,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,AETNA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,CIGNA,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,WELLMED,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA,MGD,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 2-3 VIEWS     ,74080248,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA CHOICE PLUS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,AETNA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,CIGNA,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,WELLMED,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA,MGD,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 4-5 VIEWS     ,74080249,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA CHOICE PLUS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,AETNA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,BCBS,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,CIGNA,COM,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,UNITED HEALTHCARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,VA TRICARE,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,WELLMED,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA,MGD,978.89,,,,,,,per diem,978.89,978.89,"Per diem rate, code is bundled with other services"
XR SPINE ENTIRE 6 VIEWS       ,74080250,CDM,320,RC,,,,,,Inpatient,,,978.89,978.89,HUMANA CHOICE PLUS,MGD,978.89,,,,,,,case rate,978.89,978.89,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW LT     ,74080251,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELVIS 1 VIEW RT     ,74080252,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS LT     ,74080253,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PEL 2-3 VIEWS RT     ,74080254,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS LT      ,74080255,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,AETNA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,BCBS,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,CIGNA,COM,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,UNITED HEALTHCARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,VA TRICARE,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,WELLMED,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA,MGD,790.4,,,,,,,per diem,790.4,790.4,"Per diem rate, code is bundled with other services"
XR HIP W PELV 4 VIEWS RT      ,74080256,CDM,320,RC,,,,,,Inpatient,,,790.4,790.4,HUMANA CHOICE PLUS,MGD,790.4,,,,,,,case rate,790.4,790.4,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,AETNA,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,CIGNA,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,TRICARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,UNITED HEALTHCARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,UNITED HEALTHCARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,VA,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,VA TRICARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,WELLMED,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,HUMANA,MGD,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PELV 2 VIEWS BIL     ,74080257,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,HUMANA CHOICE PLUS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,AETNA,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,BCBS,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,CIGNA,COM,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,TRICARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,UNITED HEALTHCARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,UNITED HEALTHCARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,VA,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,VA TRICARE,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,WELLMED,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,HUMANA,MGD,559.06,,,,,,,per diem,559.06,559.06,"Per diem rate, code is bundled with other services"
XR HIP W PEL 3-4 VIEWS BI     ,74080258,CDM,320,RC,,,,,,Inpatient,,,559.06,559.06,HUMANA CHOICE PLUS,MGD,559.06,,,,,,,case rate,559.06,559.06,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,AETNA,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,BCBS,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,CIGNA,COM,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,TRICARE,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,UNITED HEALTHCARE,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,UNITED HEALTHCARE,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,VA,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,VA TRICARE,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,WELLMED,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,HUMANA,MGD,645.47,,,,,,,per diem,645.47,645.47,"Per diem rate, code is bundled with other services"
XR HIP W PEL 5 VIEWS BIL      ,74080259,CDM,320,RC,,,,,,Inpatient,,,645.47,645.47,HUMANA CHOICE PLUS,MGD,645.47,,,,,,,case rate,645.47,645.47,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,AETNA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,CIGNA,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,WELLMED,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA,MGD,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW LT            ,74080260,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA CHOICE PLUS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,AETNA,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,BCBS,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,CIGNA,COM,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,TRICARE,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,UNITED HEALTHCARE,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,UNITED HEALTHCARE,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,VA,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,VA TRICARE,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,WELLMED,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,HUMANA,MGD,434.15,,,,,,,per diem,434.15,434.15,"Per diem rate, code is bundled with other services"
XR FEMUR 1 VIEW RT            ,74080261,CDM,320,RC,,,,,,Inpatient,,,434.15,434.15,HUMANA CHOICE PLUS,MGD,434.15,,,,,,,case rate,434.15,434.15,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,AETNA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,CIGNA,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,WELLMED,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA,MGD,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS LT           ,74080262,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA CHOICE PLUS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,AETNA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,CIGNA,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,WELLMED,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA,MGD,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS RT           ,74080263,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA CHOICE PLUS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,AETNA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,CIGNA,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,VA TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,WELLMED,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA,MGD,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
XR FEMUR 2 VIEWS BIL          ,74080264,CDM,320,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA CHOICE PLUS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,AETNA,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,BCBS,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,CIGNA,COM,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,TRICARE,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,UNITED HEALTHCARE,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,UNITED HEALTHCARE,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,VA,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,VA TRICARE,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,WELLMED,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,HUMANA,MGD,2592.89,,,,,,,per diem,2592.89,2592.89,"Per diem rate, code is bundled with other services"
XR ANGIO EA ADD VESSEL        ,74080265,CDM,323,RC,,,,,,Inpatient,,,2592.89,2592.89,HUMANA CHOICE PLUS,MGD,2592.89,,,,,,,case rate,2592.89,2592.89,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,AETNA,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,BCBS,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,CIGNA,COM,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,TRICARE,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,UNITED HEALTHCARE,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,UNITED HEALTHCARE,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,VA,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,VA TRICARE,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,WELLMED,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,HUMANA,MGD,2930.26,,,,,,,per diem,2930.26,2930.26,"Per diem rate, code is bundled with other services"
XR PTA RENAL/VISCERAL         ,74080266,CDM,320,RC,,,,,,Inpatient,,,2930.26,2930.26,HUMANA CHOICE PLUS,MGD,2930.26,,,,,,,case rate,2930.26,2930.26,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,AETNA,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,BCBS,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,CIGNA,COM,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,TRICARE,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,UNITED HEALTHCARE,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,UNITED HEALTHCARE,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,VA,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,VA TRICARE,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,WELLMED,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,HUMANA,MGD,883.58,,,,,,,per diem,883.58,883.58,"Per diem rate, code is bundled with other services"
XR UPP EXTRM INFANT 2 BI      ,74080267,CDM,320,RC,,,,,,Inpatient,,,883.58,883.58,HUMANA CHOICE PLUS,MGD,883.58,,,,,,,case rate,883.58,883.58,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,AETNA,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,BCBS,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,CIGNA,COM,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,TRICARE,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,UNITED HEALTHCARE,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,UNITED HEALTHCARE,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,VA,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,VA TRICARE,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,WELLMED,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,HUMANA,MGD,48288.18,,,,,,,per diem,48288.18,48288.18,"Per diem rate, code is bundled with other services"
INSERT TIPS                   ,74080268,CDM,360,RC,,,,,,Inpatient,,,48288.18,48288.18,HUMANA CHOICE PLUS,MGD,48288.18,,,,,,,case rate,48288.18,48288.18,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,AETNA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,CIGNA,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,VA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,VA TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,WELLMED,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA,MGD,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUSON/EMBOLIZ CNS PERM     ,74080269,CDM,360,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA CHOICE PLUS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,AETNA,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,BCBS,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,CIGNA,COM,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,TRICARE,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,UNITED HEALTHCARE,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,UNITED HEALTHCARE,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,VA,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,VA TRICARE,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,WELLMED,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,HUMANA,MGD,3628.55,,,,,,,per diem,3628.55,3628.55,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,74080270,CDM,360,RC,,,,,,Inpatient,,,3628.55,3628.55,HUMANA CHOICE PLUS,MGD,3628.55,,,,,,,case rate,3628.55,3628.55,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,AETNA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,CIGNA,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,WELLMED,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA,MGD,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 1     ,74080271,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA CHOICE PLUS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,AETNA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,CIGNA,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,WELLMED,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA,MGD,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 2     ,74080272,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA CHOICE PLUS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,AETNA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,CIGNA,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,WELLMED,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA,MGD,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 3     ,74080273,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA CHOICE PLUS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,AETNA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,BCBS,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,CIGNA,COM,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,UNITED HEALTHCARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,VA TRICARE,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,WELLMED,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA,MGD,16361.67,,,,,,,per diem,16361.67,16361.67,"Per diem rate, code is bundled with other services"
ENDOVAS REPR VISC AORTA 4     ,74080274,CDM,360,RC,,,,,,Inpatient,,,16361.67,16361.67,HUMANA CHOICE PLUS,MGD,16361.67,,,,,,,case rate,16361.67,16361.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,AETNA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,CIGNA,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,WELLMED,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA,MGD,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 1     ,74080275,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA CHOICE PLUS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,AETNA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,CIGNA,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,WELLMED,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA,MGD,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 2     ,74080276,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA CHOICE PLUS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,AETNA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,CIGNA,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,WELLMED,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA,MGD,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 3     ,74080277,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA CHOICE PLUS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,AETNA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,BCBS,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,CIGNA,COM,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,UNITED HEALTHCARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,VA TRICARE,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,WELLMED,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA,MGD,2785.67,,,,,,,per diem,2785.67,2785.67,"Per diem rate, code is bundled with other services"
ENDOVAS RPR VISC&INFRAR 4     ,74080278,CDM,360,RC,,,,,,Inpatient,,,2785.67,2785.67,HUMANA CHOICE PLUS,MGD,2785.67,,,,,,,case rate,2785.67,2785.67,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,74080279,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,AETNA,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,CIGNA,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,TRICARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,UNITED HEALTHCARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,UNITED HEALTHCARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,VA,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,VA TRICARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,WELLMED,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,HUMANA,MGD,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,74080280,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,HUMANA CHOICE PLUS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,AETNA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,CIGNA,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,WELLMED,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA,MGD,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,74080281,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA CHOICE PLUS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ANEURYM/VAS FIST IA EMBOL     ,74080282,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,AETNA,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,CIGNA,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,TRICARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,UNITED HEALTHCARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,UNITED HEALTHCARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,VA,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,VA TRICARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,WELLMED,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,HUMANA,MGD,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROM 2NDARY ADD     ,74080283,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,HUMANA CHOICE PLUS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,AETNA,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,BCBS,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,CIGNA,COM,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,TRICARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,UNITED HEALTHCARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,UNITED HEALTHCARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,VA,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,VA TRICARE,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,WELLMED,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,HUMANA,MGD,5544.57,,,,,,,per diem,5544.57,5544.57,"Per diem rate, code is bundled with other services"
ART MECH THROMB PRIM ADD      ,74080284,CDM,361,RC,,,,,,Inpatient,,,5544.57,5544.57,HUMANA CHOICE PLUS,MGD,5544.57,,,,,,,case rate,5544.57,5544.57,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,AETNA,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,CIGNA,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,TRICARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,UNITED HEALTHCARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,UNITED HEALTHCARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,VA,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,VA TRICARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,WELLMED,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,HUMANA,MGD,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
ART MECH THROMBECTMY PRIM     ,74080285,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,HUMANA CHOICE PLUS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,AETNA,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,BCBS,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,CIGNA,COM,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,TRICARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,UNITED HEALTHCARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,UNITED HEALTHCARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,VA,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,VA TRICARE,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,WELLMED,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,HUMANA,MGD,355.58,,,,,,,per diem,355.58,355.58,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080286,CDM,361,RC,,,,,,Inpatient,,,355.58,355.58,HUMANA CHOICE PLUS,MGD,355.58,,,,,,,case rate,355.58,355.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,AETNA,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,BCBS,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,CIGNA,COM,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,TRICARE,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,UNITED HEALTHCARE,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,UNITED HEALTHCARE,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,VA,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,VA TRICARE,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,WELLMED,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,HUMANA,MGD,1324.83,,,,,,,per diem,1324.83,1324.83,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080287,CDM,361,RC,,,,,,Inpatient,,,1324.83,1324.83,HUMANA CHOICE PLUS,MGD,1324.83,,,,,,,case rate,1324.83,1324.83,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,AETNA,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,BCBS,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,CIGNA,COM,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,TRICARE,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,UNITED HEALTHCARE,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,UNITED HEALTHCARE,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,VA,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,VA TRICARE,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,WELLMED,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,HUMANA,MGD,1577.58,,,,,,,per diem,1577.58,1577.58,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080288,CDM,361,RC,,,,,,Inpatient,,,1577.58,1577.58,HUMANA CHOICE PLUS,MGD,1577.58,,,,,,,case rate,1577.58,1577.58,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,AETNA,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,BCBS,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,CIGNA,COM,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,TRICARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,UNITED HEALTHCARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,UNITED HEALTHCARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,VA,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,VA TRICARE,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,WELLMED,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,HUMANA,MGD,283.82,,,,,,,per diem,283.82,283.82,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080289,CDM,361,RC,,,,,,Inpatient,,,283.82,283.82,HUMANA CHOICE PLUS,MGD,283.82,,,,,,,case rate,283.82,283.82,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080290,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,AETNA,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,BCBS,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,CIGNA,COM,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,TRICARE,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,UNITED HEALTHCARE,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,UNITED HEALTHCARE,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,VA,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,VA TRICARE,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,WELLMED,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,HUMANA,MGD,367.35,,,,,,,per diem,367.35,367.35,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080291,CDM,361,RC,,,,,,Inpatient,,,367.35,367.35,HUMANA CHOICE PLUS,MGD,367.35,,,,,,,case rate,367.35,367.35,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,AETNA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,BCBS,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,CIGNA,COM,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,UNITED HEALTHCARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,VA,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,VA TRICARE,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,WELLMED,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA,MGD,220.63,,,,,,,per diem,220.63,220.63,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080292,CDM,361,RC,,,,,,Inpatient,,,220.63,220.63,HUMANA CHOICE PLUS,MGD,220.63,,,,,,,case rate,220.63,220.63,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,AETNA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,CIGNA,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,WELLMED,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA,MGD,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080293,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA CHOICE PLUS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,AETNA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,BCBS,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,CIGNA,COM,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,UNITED HEALTHCARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,VA,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,VA TRICARE,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,WELLMED,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA,MGD,245.26,,,,,,,per diem,245.26,245.26,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080294,CDM,361,RC,,,,,,Inpatient,,,245.26,245.26,HUMANA CHOICE PLUS,MGD,245.26,,,,,,,case rate,245.26,245.26,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,AETNA,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,BCBS,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,CIGNA,COM,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,TRICARE,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,UNITED HEALTHCARE,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,UNITED HEALTHCARE,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,VA,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,VA TRICARE,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,WELLMED,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,HUMANA,MGD,536.57,,,,,,,per diem,536.57,536.57,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,74080295,CDM,361,RC,,,,,,Inpatient,,,536.57,536.57,HUMANA CHOICE PLUS,MGD,536.57,,,,,,,case rate,536.57,536.57,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,AETNA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,CIGNA,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,WELLMED,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA,MGD,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,74080296,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA CHOICE PLUS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,AETNA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,BCBS,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,CIGNA,COM,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,UNITED HEALTHCARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,VA,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,VA TRICARE,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,WELLMED,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA,MGD,635.1,,,,,,,per diem,635.1,635.1,"Per diem rate, code is bundled with other services"
ASP FINE NDL WO IMAGING       ,74080297,CDM,361,RC,,,,,,Inpatient,,,635.1,635.1,HUMANA CHOICE PLUS,MGD,635.1,,,,,,,case rate,635.1,635.1,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,AETNA,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,BCBS,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,CIGNA,COM,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,TRICARE,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,UNITED HEALTHCARE,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,UNITED HEALTHCARE,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,VA,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,VA TRICARE,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,WELLMED,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,HUMANA,MGD,9408.74,,,,,,,per diem,9408.74,9408.74,"Per diem rate, code is bundled with other services"
AV FISTUL LIG/BAND ACCESS     ,74080298,CDM,361,RC,,,,,,Inpatient,,,9408.74,9408.74,HUMANA CHOICE PLUS,MGD,9408.74,,,,,,,case rate,9408.74,9408.74,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,AETNA,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,CIGNA,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,TRICARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,UNITED HEALTHCARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,UNITED HEALTHCARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,VA,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,VA TRICARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,WELLMED,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,HUMANA,MGD,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO BX PERC          ,74080299,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,HUMANA CHOICE PLUS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,AETNA,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,BCBS,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,CIGNA,COM,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,TRICARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,UNITED HEALTHCARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,UNITED HEALTHCARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,VA,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,VA TRICARE,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,WELLMED,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,HUMANA,MGD,7664.08,,,,,,,per diem,7664.08,7664.08,"Per diem rate, code is bundled with other services"
BILIARY ENDO DX PERC          ,74080300,CDM,361,RC,,,,,,Inpatient,,,7664.08,7664.08,HUMANA CHOICE PLUS,MGD,7664.08,,,,,,,case rate,7664.08,7664.08,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,AETNA,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,BCBS,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,CIGNA,COM,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,TRICARE,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,UNITED HEALTHCARE,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,UNITED HEALTHCARE,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,VA,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,VA TRICARE,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,WELLMED,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,HUMANA,MGD,3668.18,,,,,,,per diem,3668.18,3668.18,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,74080301,CDM,361,RC,,,,,,Inpatient,,,3668.18,3668.18,HUMANA CHOICE PLUS,MGD,3668.18,,,,,,,case rate,3668.18,3668.18,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,AETNA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,CIGNA,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,WELLMED,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA,MGD,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,74080302,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA CHOICE PLUS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,AETNA,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,BCBS,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,CIGNA,COM,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,TRICARE,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,UNITED HEALTHCARE,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,UNITED HEALTHCARE,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,VA,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,VA TRICARE,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,WELLMED,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,HUMANA,MGD,7028.97,,,,,,,per diem,7028.97,7028.97,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,74080303,CDM,361,RC,,,,,,Inpatient,,,7028.97,7028.97,HUMANA CHOICE PLUS,MGD,7028.97,,,,,,,case rate,7028.97,7028.97,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,AETNA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,CIGNA,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,WELLMED,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA,MGD,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BONE MARROW ASP ONLY          ,74080304,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA CHOICE PLUS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,AETNA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,CIGNA,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,VA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,VA TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,WELLMED,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA,MGD,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,74080305,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA CHOICE PLUS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,AETNA,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,BCBS,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,CIGNA,COM,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,TRICARE,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,UNITED HEALTHCARE,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,UNITED HEALTHCARE,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,VA,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,VA TRICARE,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,WELLMED,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,HUMANA,MGD,2616.38,,,,,,,per diem,2616.38,2616.38,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,74080306,CDM,361,RC,,,,,,Inpatient,,,2616.38,2616.38,HUMANA CHOICE PLUS,MGD,2616.38,,,,,,,case rate,2616.38,2616.38,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,AETNA,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,CIGNA,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,TRICARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,UNITED HEALTHCARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,UNITED HEALTHCARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,VA,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,VA TRICARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,WELLMED,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,HUMANA,MGD,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080307,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,HUMANA CHOICE PLUS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,AETNA,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,CIGNA,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,TRICARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,UNITED HEALTHCARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,UNITED HEALTHCARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,VA,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,VA TRICARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,WELLMED,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,HUMANA,MGD,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080308,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,HUMANA CHOICE PLUS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,AETNA,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,BCBS,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,CIGNA,COM,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,TRICARE,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,UNITED HEALTHCARE,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,UNITED HEALTHCARE,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,VA,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,VA TRICARE,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,WELLMED,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,HUMANA,MGD,4521.76,,,,,,,per diem,4521.76,4521.76,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080309,CDM,361,RC,,,,,,Inpatient,,,4521.76,4521.76,HUMANA CHOICE PLUS,MGD,4521.76,,,,,,,case rate,4521.76,4521.76,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,AETNA,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,CIGNA,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,TRICARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,UNITED HEALTHCARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,UNITED HEALTHCARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,VA,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,VA TRICARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,WELLMED,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,HUMANA,MGD,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080310,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,HUMANA CHOICE PLUS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,AETNA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,CIGNA,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,WELLMED,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA,MGD,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,74080311,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA CHOICE PLUS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,AETNA,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,BCBS,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,CIGNA,COM,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,TRICARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,UNITED HEALTHCARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,UNITED HEALTHCARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,VA,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,VA TRICARE,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,WELLMED,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,HUMANA,MGD,1300.19,,,,,,,per diem,1300.19,1300.19,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,74080312,CDM,361,RC,,,,,,Inpatient,,,1300.19,1300.19,HUMANA CHOICE PLUS,MGD,1300.19,,,,,,,case rate,1300.19,1300.19,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,AETNA,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,BCBS,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,CIGNA,COM,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,TRICARE,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,UNITED HEALTHCARE,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,UNITED HEALTHCARE,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,VA,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,VA TRICARE,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,WELLMED,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,HUMANA,MGD,8385.93,,,,,,,per diem,8385.93,8385.93,"Per diem rate, code is bundled with other services"
BX UP ARM SOFT TISS SUPER     ,74080313,CDM,361,RC,,,,,,Inpatient,,,8385.93,8385.93,HUMANA CHOICE PLUS,MGD,8385.93,,,,,,,case rate,8385.93,8385.93,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,AETNA,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,BCBS,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,CIGNA,COM,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,TRICARE,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,UNITED HEALTHCARE,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,UNITED HEALTHCARE,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,VA,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,VA TRICARE,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,WELLMED,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,HUMANA,MGD,1564.73,,,,,,,per diem,1564.73,1564.73,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080314,CDM,361,RC,,,,,,Inpatient,,,1564.73,1564.73,HUMANA CHOICE PLUS,MGD,1564.73,,,,,,,case rate,1564.73,1564.73,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,AETNA,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,CIGNA,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,TRICARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,UNITED HEALTHCARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,UNITED HEALTHCARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,VA,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,VA TRICARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,WELLMED,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,HUMANA,MGD,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080315,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,HUMANA CHOICE PLUS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,AETNA,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,BCBS,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,CIGNA,COM,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,TRICARE,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,UNITED HEALTHCARE,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,UNITED HEALTHCARE,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,VA,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,VA TRICARE,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,WELLMED,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,HUMANA,MGD,3440.05,,,,,,,per diem,3440.05,3440.05,"Per diem rate, code is bundled with other services"
CATH PLACE PUL ART SEGMNT     ,74080316,CDM,361,RC,,,,,,Inpatient,,,3440.05,3440.05,HUMANA CHOICE PLUS,MGD,3440.05,,,,,,,case rate,3440.05,3440.05,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH PLACE RT HRT/PUL ART     ,74080317,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,AETNA,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,CIGNA,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,TRICARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,UNITED HEALTHCARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,UNITED HEALTHCARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,VA,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,VA TRICARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,WELLMED,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,HUMANA,MGD,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 1ST SELECT     ,74080318,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,HUMANA CHOICE PLUS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,AETNA,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,BCBS,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,CIGNA,COM,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,TRICARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,UNITED HEALTHCARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,UNITED HEALTHCARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,VA,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,VA TRICARE,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,WELLMED,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,HUMANA,MGD,2910.98,,,,,,,per diem,2910.98,2910.98,"Per diem rate, code is bundled with other services"
CATH PLACE VEN 2ND ORD        ,74080319,CDM,361,RC,,,,,,Inpatient,,,2910.98,2910.98,HUMANA CHOICE PLUS,MGD,2910.98,,,,,,,case rate,2910.98,2910.98,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,AETNA,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,BCBS,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,CIGNA,COM,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,TRICARE,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,UNITED HEALTHCARE,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,UNITED HEALTHCARE,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,VA,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,VA TRICARE,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,WELLMED,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,HUMANA,MGD,4113.71,,,,,,,per diem,4113.71,4113.71,"Per diem rate, code is bundled with other services"
CATH PLC PULM L/R ART SEL     ,74080320,CDM,361,RC,,,,,,Inpatient,,,4113.71,4113.71,HUMANA CHOICE PLUS,MGD,4113.71,,,,,,,case rate,4113.71,4113.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,AETNA,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,BCBS,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,CIGNA,COM,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,TRICARE,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,UNITED HEALTHCARE,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,UNITED HEALTHCARE,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,VA,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,VA TRICARE,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,WELLMED,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,HUMANA,MGD,2424.74,,,,,,,per diem,2424.74,2424.74,"Per diem rate, code is bundled with other services"
CATH/NDL PLACE EXTREM ART     ,74080321,CDM,361,RC,,,,,,Inpatient,,,2424.74,2424.74,HUMANA CHOICE PLUS,MGD,2424.74,,,,,,,case rate,2424.74,2424.74,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AORTA TRANSL     ,74080322,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,AETNA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,CIGNA,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,VA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,VA TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,WELLMED,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA,MGD,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI ADD     ,74080323,CDM,361,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA CHOICE PLUS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,AETNA,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,BCBS,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,CIGNA,COM,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,TRICARE,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,UNITED HEALTHCARE,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,UNITED HEALTHCARE,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,VA,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,VA TRICARE,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,WELLMED,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,HUMANA,MGD,3404.71,,,,,,,per diem,3404.71,3404.71,"Per diem rate, code is bundled with other services"
CATH/NDL PLC AV SH DI INI     ,74080324,CDM,361,RC,,,,,,Inpatient,,,3404.71,3404.71,HUMANA CHOICE PLUS,MGD,3404.71,,,,,,,case rate,3404.71,3404.71,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
CATH/NDL PLC CARO/VER ART     ,74080325,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,AETNA,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,BCBS,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,CIGNA,COM,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,TRICARE,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,UNITED HEALTHCARE,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,UNITED HEALTHCARE,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,VA,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,VA TRICARE,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,WELLMED,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,HUMANA,MGD,2426.89,,,,,,,per diem,2426.89,2426.89,"Per diem rate, code is bundled with other services"
CATH/NDL PLC RETROG BRACH     ,74080326,CDM,361,RC,,,,,,Inpatient,,,2426.89,2426.89,HUMANA CHOICE PLUS,MGD,2426.89,,,,,,,case rate,2426.89,2426.89,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,AETNA,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,BCBS,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,CIGNA,COM,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,TRICARE,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,UNITED HEALTHCARE,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,UNITED HEALTHCARE,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,VA,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,VA TRICARE,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,WELLMED,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,HUMANA,MGD,411.26,,,,,,,per diem,411.26,411.26,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,74080327,CDM,361,RC,,,,,,Inpatient,,,411.26,411.26,HUMANA CHOICE PLUS,MGD,411.26,,,,,,,case rate,411.26,411.26,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,AETNA,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,BCBS,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,CIGNA,COM,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,TRICARE,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,UNITED HEALTHCARE,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,UNITED HEALTHCARE,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,VA,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,VA TRICARE,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,WELLMED,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,HUMANA,MGD,3066.27,,,,,,,per diem,3066.27,3066.27,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,74080328,CDM,361,RC,,,,,,Inpatient,,,3066.27,3066.27,HUMANA CHOICE PLUS,MGD,3066.27,,,,,,,case rate,3066.27,3066.27,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,AETNA,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,CIGNA,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,TRICARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,UNITED HEALTHCARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,UNITED HEALTHCARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,VA,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,VA TRICARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,WELLMED,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,HUMANA,MGD,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
CHOLEDOCHAL STENT PLACE       ,74080329,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,HUMANA CHOICE PLUS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM ART SEL BI     ,74080330,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL CAR/INM SEL ICA BI     ,74080331,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PL SUB/INM ART SEL BI     ,74080332,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,AETNA,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,BCBS,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,CIGNA,COM,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,TRICARE,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,UNITED HEALTHCARE,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,UNITED HEALTHCARE,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,VA,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,VA TRICARE,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,WELLMED,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,HUMANA,MGD,5198.63,,,,,,,per diem,5198.63,5198.63,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 2ND INIT     ,74080333,CDM,361,RC,,,,,,Inpatient,,,5198.63,5198.63,HUMANA CHOICE PLUS,MGD,5198.63,,,,,,,case rate,5198.63,5198.63,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,AETNA,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,BCBS,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,CIGNA,COM,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,TRICARE,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,UNITED HEALTHCARE,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,UNITED HEALTHCARE,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,VA,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,VA TRICARE,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,WELLMED,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,HUMANA,MGD,6188.24,,,,,,,per diem,6188.24,6188.24,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/ 3RD INIT     ,74080334,CDM,361,RC,,,,,,Inpatient,,,6188.24,6188.24,HUMANA CHOICE PLUS,MGD,6188.24,,,,,,,case rate,6188.24,6188.24,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,AETNA,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,BCBS,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,CIGNA,COM,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,TRICARE,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,UNITED HEALTHCARE,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,UNITED HEALTHCARE,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,VA,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,VA TRICARE,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,WELLMED,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,HUMANA,MGD,3352.23,,,,,,,per diem,3352.23,3352.23,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX 1ST EA     ,74080335,CDM,361,RC,,,,,,Inpatient,,,3352.23,3352.23,HUMANA CHOICE PLUS,MGD,3352.23,,,,,,,case rate,3352.23,3352.23,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,AETNA,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,BCBS,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,CIGNA,COM,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,TRICARE,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,UNITED HEALTHCARE,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,UNITED HEALTHCARE,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,VA,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,VA TRICARE,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,WELLMED,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,HUMANA,MGD,4702.76,,,,,,,per diem,4702.76,4702.76,"Per diem rate, code is bundled with other services"
CTH PLC ABD/PEL/EX EA ADD     ,74080336,CDM,361,RC,,,,,,Inpatient,,,4702.76,4702.76,HUMANA CHOICE PLUS,MGD,4702.76,,,,,,,case rate,4702.76,4702.76,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM ART SEL      ,74080337,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC CAR/INOM SEL ICA      ,74080338,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,AETNA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,CIGNA,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,WELLMED,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA,MGD,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080339,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA CHOICE PLUS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,AETNA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,CIGNA,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,WELLMED,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA,MGD,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL               ,74080340,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA CHOICE PLUS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,AETNA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,CIGNA,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,WELLMED,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA,MGD,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC ICA SEL BILAT         ,74080341,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA CHOICE PLUS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,AETNA,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,CIGNA,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,TRICARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,UNITED HEALTHCARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,UNITED HEALTHCARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,VA,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,VA TRICARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,WELLMED,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,HUMANA,MGD,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL BIL     ,74080342,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,HUMANA CHOICE PLUS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,AETNA,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,BCBS,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,CIGNA,COM,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,TRICARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,UNITED HEALTHCARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,UNITED HEALTHCARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,VA,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,VA TRICARE,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,WELLMED,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,HUMANA,MGD,9603.66,,,,,,,per diem,9603.66,9603.66,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL BIL     ,74080343,CDM,361,RC,,,,,,Inpatient,,,9603.66,9603.66,HUMANA CHOICE PLUS,MGD,9603.66,,,,,,,case rate,9603.66,9603.66,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC SUBC/INOM ART SEL     ,74080344,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
CTH PLC THOR AOR NSEL         ,74080345,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,AETNA,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,BCBS,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,CIGNA,COM,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,TRICARE,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,UNITED HEALTHCARE,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,UNITED HEALTHCARE,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,VA,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,VA TRICARE,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,WELLMED,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,HUMANA,MGD,3988.4,,,,,,,per diem,3988.4,3988.4,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 1ST SEL     ,74080346,CDM,361,RC,,,,,,Inpatient,,,3988.4,3988.4,HUMANA CHOICE PLUS,MGD,3988.4,,,,,,,case rate,3988.4,3988.4,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,AETNA,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,BCBS,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,CIGNA,COM,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,TRICARE,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,UNITED HEALTHCARE,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,UNITED HEALTHCARE,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,VA,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,VA TRICARE,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,WELLMED,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,HUMANA,MGD,4231.52,,,,,,,per diem,4231.52,4231.52,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 2ND SEL     ,74080347,CDM,361,RC,,,,,,Inpatient,,,4231.52,4231.52,HUMANA CHOICE PLUS,MGD,4231.52,,,,,,,case rate,4231.52,4231.52,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,AETNA,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,BCBS,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,CIGNA,COM,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,TRICARE,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,UNITED HEALTHCARE,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,UNITED HEALTHCARE,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,VA,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,VA TRICARE,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,WELLMED,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,HUMANA,MGD,5424.62,,,,,,,per diem,5424.62,5424.62,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC 3RD SEL     ,74080348,CDM,361,RC,,,,,,Inpatient,,,5424.62,5424.62,HUMANA CHOICE PLUS,MGD,5424.62,,,,,,,case rate,5424.62,5424.62,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,AETNA,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,BCBS,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,CIGNA,COM,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,TRICARE,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,UNITED HEALTHCARE,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,UNITED HEALTHCARE,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,VA,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,VA TRICARE,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,WELLMED,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,HUMANA,MGD,3417.56,,,,,,,per diem,3417.56,3417.56,"Per diem rate, code is bundled with other services"
CTH PLC THOR/BRAC ADD 2-3     ,74080349,CDM,361,RC,,,,,,Inpatient,,,3417.56,3417.56,HUMANA CHOICE PLUS,MGD,3417.56,,,,,,,case rate,3417.56,3417.56,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,AETNA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,CIGNA,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,WELLMED,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA,MGD,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL              ,74080350,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA CHOICE PLUS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,AETNA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,BCBS,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,CIGNA,COM,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,UNITED HEALTHCARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,VA TRICARE,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,WELLMED,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA,MGD,9658.28,,,,,,,per diem,9658.28,9658.28,"Per diem rate, code is bundled with other services"
CTH PLC VERT SEL BILAT        ,74080351,CDM,361,RC,,,,,,Inpatient,,,9658.28,9658.28,HUMANA CHOICE PLUS,MGD,9658.28,,,,,,,case rate,9658.28,9658.28,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,AETNA,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,BCBS,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,CIGNA,COM,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,TRICARE,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,UNITED HEALTHCARE,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,UNITED HEALTHCARE,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,VA,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,VA TRICARE,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,WELLMED,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,HUMANA,MGD,3630.69,,,,,,,per diem,3630.69,3630.69,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE COMPLEX     ,74080352,CDM,361,RC,,,,,,Inpatient,,,3630.69,3630.69,HUMANA CHOICE PLUS,MGD,3630.69,,,,,,,case rate,3630.69,3630.69,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,AETNA,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,CIGNA,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,TRICARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,UNITED HEALTHCARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,UNITED HEALTHCARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,VA,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,VA TRICARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,WELLMED,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,HUMANA,MGD,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
CYSTO TUBE CHANGE SIMPLE      ,74080353,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,HUMANA CHOICE PLUS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,AETNA,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,BCBS,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,CIGNA,COM,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,TRICARE,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,UNITED HEALTHCARE,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,UNITED HEALTHCARE,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,VA,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,VA TRICARE,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,WELLMED,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,HUMANA,MGD,1004.6,,,,,,,per diem,1004.6,1004.6,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080354,CDM,361,RC,,,,,,Inpatient,,,1004.6,1004.6,HUMANA CHOICE PLUS,MGD,1004.6,,,,,,,case rate,1004.6,1004.6,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,AETNA,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,CIGNA,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,TRICARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,UNITED HEALTHCARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,UNITED HEALTHCARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,VA,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,VA TRICARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,WELLMED,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,HUMANA,MGD,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN W BLN CTH      ,74080355,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,HUMANA CHOICE PLUS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,AETNA,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,BCBS,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,CIGNA,COM,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,TRICARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,UNITED HEALTHCARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,UNITED HEALTHCARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,VA,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,VA TRICARE,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,WELLMED,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,HUMANA,MGD,1036.73,,,,,,,per diem,1036.73,1036.73,"Per diem rate, code is bundled with other services"
DECLOT EXT CAN WO BLN CTH     ,74080356,CDM,361,RC,,,,,,Inpatient,,,1036.73,1036.73,HUMANA CHOICE PLUS,MGD,1036.73,,,,,,,case rate,1036.73,1036.73,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,AETNA,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,CIGNA,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,TRICARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,UNITED HEALTHCARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,UNITED HEALTHCARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,VA,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,VA TRICARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,WELLMED,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,HUMANA,MGD,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT W STENT      ,74080357,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,HUMANA CHOICE PLUS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,AETNA,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,BCBS,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,CIGNA,COM,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,TRICARE,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,UNITED HEALTHCARE,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,UNITED HEALTHCARE,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,VA,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,VA TRICARE,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,WELLMED,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,HUMANA,MGD,2333.71,,,,,,,per diem,2333.71,2333.71,"Per diem rate, code is bundled with other services"
DILATE BILE DUCT WO STENT     ,74080358,CDM,361,RC,,,,,,Inpatient,,,2333.71,2333.71,HUMANA CHOICE PLUS,MGD,2333.71,,,,,,,case rate,2333.71,2333.71,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,AETNA,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,BCBS,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,CIGNA,COM,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,TRICARE,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,UNITED HEALTHCARE,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,UNITED HEALTHCARE,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,VA,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,VA TRICARE,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,WELLMED,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,HUMANA,MGD,2843.51,,,,,,,per diem,2843.51,2843.51,"Per diem rate, code is bundled with other services"
DILATE ESOPHAGUS W WIRE       ,74080359,CDM,361,RC,,,,,,Inpatient,,,2843.51,2843.51,HUMANA CHOICE PLUS,MGD,2843.51,,,,,,,case rate,2843.51,2843.51,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,AETNA,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,BCBS,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,CIGNA,COM,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,TRICARE,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,UNITED HEALTHCARE,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,UNITED HEALTHCARE,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,VA,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,VA TRICARE,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,WELLMED,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,HUMANA,MGD,575.13,,,,,,,per diem,575.13,575.13,"Per diem rate, code is bundled with other services"
DISKOGRM CER/T EA LVL INJ     ,74080360,CDM,361,RC,,,,,,Inpatient,,,575.13,575.13,HUMANA CHOICE PLUS,MGD,575.13,,,,,,,case rate,575.13,575.13,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,AETNA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,BCBS,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,CIGNA,COM,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,UNITED HEALTHCARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,VA,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,VA TRICARE,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,WELLMED,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,HUMANA,MGD,688.65,,,,,,,per diem,688.65,688.65,"Per diem rate, code is bundled with other services"
DISKOGRM LUMB EA LVL INJ      ,74080361,CDM,361,RC,,,,,,Inpatient,,,688.65,688.65,HUMANA CHOICE PLUS,MGD,688.65,,,,,,,case rate,688.65,688.65,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,AETNA,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,BCBS,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,CIGNA,COM,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,TRICARE,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,UNITED HEALTHCARE,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,UNITED HEALTHCARE,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,VA,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,VA TRICARE,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,WELLMED,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,HUMANA,MGD,4280.79,,,,,,,per diem,4280.79,4280.79,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE PERC PLACE      ,74080362,CDM,361,RC,,,,,,Inpatient,,,4280.79,4280.79,HUMANA CHOICE PLUS,MGD,4280.79,,,,,,,case rate,4280.79,4280.79,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,AETNA,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,BCBS,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,CIGNA,COM,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,TRICARE,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,UNITED HEALTHCARE,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,UNITED HEALTHCARE,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,VA,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,VA TRICARE,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,WELLMED,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,HUMANA,MGD,1537.96,,,,,,,per diem,1537.96,1537.96,"Per diem rate, code is bundled with other services"
DUOD/JEJ TUBE REPLC PERC      ,74080363,CDM,361,RC,,,,,,Inpatient,,,1537.96,1537.96,HUMANA CHOICE PLUS,MGD,1537.96,,,,,,,case rate,1537.96,1537.96,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,AETNA,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,CIGNA,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,TRICARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,UNITED HEALTHCARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,UNITED HEALTHCARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,VA,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,VA TRICARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,WELLMED,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,HUMANA,MGD,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
EGD G TUBE PLACE PERC         ,74080364,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,HUMANA CHOICE PLUS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,AETNA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,CIGNA,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,WELLMED,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA,MGD,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR EA ADD VES       ,74080365,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA CHOICE PLUS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,AETNA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,CIGNA,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,WELLMED,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA,MGD,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS REPR PROS INT VES     ,74080366,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA CHOICE PLUS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,AETNA,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,BCBS,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,CIGNA,COM,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,TRICARE,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,UNITED HEALTHCARE,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,UNITED HEALTHCARE,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,VA,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,VA TRICARE,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,WELLMED,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,HUMANA,MGD,7777.6,,,,,,,per diem,7777.6,7777.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA MOD BI 1      ,74080367,CDM,361,RC,,,,,,Inpatient,,,7777.6,7777.6,HUMANA CHOICE PLUS,MGD,7777.6,,,,,,,case rate,7777.6,7777.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,AETNA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,BCBS,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,CIGNA,COM,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,UNITED HEALTHCARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,VA TRICARE,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,WELLMED,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA,MGD,989.6,,,,,,,per diem,989.6,989.6,"Per diem rate, code is bundled with other services"
ENDOVAS RPR AAA UNI BIF       ,74080368,CDM,361,RC,,,,,,Inpatient,,,989.6,989.6,HUMANA CHOICE PLUS,MGD,989.6,,,,,,,case rate,989.6,989.6,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,AETNA,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,BCBS,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,CIGNA,COM,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,TRICARE,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,UNITED HEALTHCARE,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,UNITED HEALTHCARE,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,VA,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,VA TRICARE,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,WELLMED,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,HUMANA,MGD,10421.9,,,,,,,per diem,10421.9,10421.9,"Per diem rate, code is bundled with other services"
ENTEROSTOMY/CECOSTMY TUBE     ,74080369,CDM,361,RC,,,,,,Inpatient,,,10421.9,10421.9,HUMANA CHOICE PLUS,MGD,10421.9,,,,,,,case rate,10421.9,10421.9,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,74080370,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,AETNA,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,BCBS,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,CIGNA,COM,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,TRICARE,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,UNITED HEALTHCARE,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,UNITED HEALTHCARE,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,VA,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,VA TRICARE,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,WELLMED,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,HUMANA,MGD,2279.09,,,,,,,per diem,2279.09,2279.09,"Per diem rate, code is bundled with other services"
EPI/SUBARACH L/S DRUG INJ     ,74080371,CDM,361,RC,,,,,,Inpatient,,,2279.09,2279.09,HUMANA CHOICE PLUS,MGD,2279.09,,,,,,,case rate,2279.09,2279.09,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,AETNA,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,BCBS,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,CIGNA,COM,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,TRICARE,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,UNITED HEALTHCARE,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,UNITED HEALTHCARE,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,VA,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,VA TRICARE,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,WELLMED,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,HUMANA,MGD,1576.13,,,,,,,per diem,1576.13,1576.13,"Per diem rate, code is bundled with other services"
EPIDURAL BLOOD PATCH          ,74080372,CDM,361,RC,,,,,,Inpatient,,,1576.13,1576.13,HUMANA CHOICE PLUS,MGD,1576.13,,,,,,,case rate,1576.13,1576.13,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,AETNA,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,BCBS,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,CIGNA,COM,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,TRICARE,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,UNITED HEALTHCARE,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,UNITED HEALTHCARE,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,VA,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,VA TRICARE,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,WELLMED,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,HUMANA,MGD,3536.44,,,,,,,per diem,3536.44,3536.44,"Per diem rate, code is bundled with other services"
ESOPH W BALLOON DILATION      ,74080373,CDM,361,RC,,,,,,Inpatient,,,3536.44,3536.44,HUMANA CHOICE PLUS,MGD,3536.44,,,,,,,case rate,3536.44,3536.44,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,AETNA,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,CIGNA,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,TRICARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,UNITED HEALTHCARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,UNITED HEALTHCARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,VA,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,VA TRICARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,WELLMED,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,HUMANA,MGD,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080374,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,HUMANA CHOICE PLUS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,AETNA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,CIGNA,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,WELLMED,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA,MGD,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080375,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA CHOICE PLUS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,AETNA,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,BCBS,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,CIGNA,COM,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,TRICARE,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,UNITED HEALTHCARE,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,UNITED HEALTHCARE,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,VA,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,VA TRICARE,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,WELLMED,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,HUMANA,MGD,21462.84,,,,,,,per diem,21462.84,21462.84,"Per diem rate, code is bundled with other services"
EXTRM VEIN ABLAT RF 1ST       ,74080376,CDM,361,RC,,,,,,Inpatient,,,21462.84,21462.84,HUMANA CHOICE PLUS,MGD,21462.84,,,,,,,case rate,21462.84,21462.84,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,AETNA,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,BCBS,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,CIGNA,COM,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,TRICARE,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,UNITED HEALTHCARE,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,UNITED HEALTHCARE,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,VA,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,VA TRICARE,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,WELLMED,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,HUMANA,MGD,12668.86,,,,,,,per diem,12668.86,12668.86,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT RF EA ADD     ,74080377,CDM,361,RC,,,,,,Inpatient,,,12668.86,12668.86,HUMANA CHOICE PLUS,MGD,12668.86,,,,,,,case rate,12668.86,12668.86,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,AETNA,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,BCBS,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,CIGNA,COM,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,TRICARE,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,UNITED HEALTHCARE,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,UNITED HEALTHCARE,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,VA,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,VA TRICARE,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,WELLMED,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,HUMANA,MGD,882.5,,,,,,,per diem,882.5,882.5,"Per diem rate, code is bundled with other services"
FACET JT/NRV L/S SNG INJ      ,74080378,CDM,361,RC,,,,,,Inpatient,,,882.5,882.5,HUMANA CHOICE PLUS,MGD,882.5,,,,,,,case rate,882.5,882.5,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,AETNA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,BCBS,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,CIGNA,COM,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,UNITED HEALTHCARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,VA,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,VA TRICARE,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,WELLMED,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,HUMANA,MGD,1995.27,,,,,,,per diem,1995.27,1995.27,"Per diem rate, code is bundled with other services"
FALLOP TUBE CTH PATNCY/DX     ,74080379,CDM,361,RC,,,,,,Inpatient,,,1995.27,1995.27,HUMANA CHOICE PLUS,MGD,1995.27,,,,,,,case rate,1995.27,1995.27,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,AETNA,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,BCBS,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,CIGNA,COM,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,TRICARE,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,UNITED HEALTHCARE,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,UNITED HEALTHCARE,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,VA,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,VA TRICARE,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,WELLMED,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,HUMANA,MGD,2465.44,,,,,,,per diem,2465.44,2465.44,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANG WO IMAG     ,74080380,CDM,361,RC,,,,,,Inpatient,,,2465.44,2465.44,HUMANA CHOICE PLUS,MGD,2465.44,,,,,,,case rate,2465.44,2465.44,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,AETNA,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,BCBS,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,CIGNA,COM,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,TRICARE,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,UNITED HEALTHCARE,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,UNITED HEALTHCARE,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,VA,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,VA TRICARE,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,WELLMED,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,HUMANA,MGD,2411.89,,,,,,,per diem,2411.89,2411.89,"Per diem rate, code is bundled with other services"
GASTRO TUBE CHANGE W IMAG     ,74080381,CDM,361,RC,,,,,,Inpatient,,,2411.89,2411.89,HUMANA CHOICE PLUS,MGD,2411.89,,,,,,,case rate,2411.89,2411.89,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,AETNA,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,BCBS,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,CIGNA,COM,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,TRICARE,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,UNITED HEALTHCARE,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,UNITED HEALTHCARE,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,VA,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,VA TRICARE,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,WELLMED,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,HUMANA,MGD,3014.87,,,,,,,per diem,3014.87,3014.87,"Per diem rate, code is bundled with other services"
GASTRO TUBE PERC PLACE        ,74080382,CDM,361,RC,,,,,,Inpatient,,,3014.87,3014.87,HUMANA CHOICE PLUS,MGD,3014.87,,,,,,,case rate,3014.87,3014.87,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,AETNA,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,BCBS,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,CIGNA,COM,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,TRICARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,UNITED HEALTHCARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,UNITED HEALTHCARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,VA,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,VA TRICARE,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,WELLMED,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,HUMANA,MGD,900.71,,,,,,,per diem,900.71,900.71,"Per diem rate, code is bundled with other services"
GASTROSTOMY TUBE REPOSIT      ,74080383,CDM,361,RC,,,,,,Inpatient,,,900.71,900.71,HUMANA CHOICE PLUS,MGD,900.71,,,,,,,case rate,900.71,900.71,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,AETNA,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,BCBS,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,CIGNA,COM,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,TRICARE,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,UNITED HEALTHCARE,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,UNITED HEALTHCARE,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,VA,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,VA TRICARE,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,WELLMED,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,HUMANA,MGD,1314.12,,,,,,,per diem,1314.12,1314.12,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080384,CDM,361,RC,,,,,,Inpatient,,,1314.12,1314.12,HUMANA CHOICE PLUS,MGD,1314.12,,,,,,,case rate,1314.12,1314.12,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,AETNA,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,CIGNA,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,TRICARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,UNITED HEALTHCARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,UNITED HEALTHCARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,VA,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,VA TRICARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,WELLMED,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,HUMANA,MGD,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,74080385,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,HUMANA CHOICE PLUS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,AETNA,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,BCBS,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,CIGNA,COM,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,TRICARE,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,UNITED HEALTHCARE,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,UNITED HEALTHCARE,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,VA,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,VA TRICARE,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,WELLMED,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,HUMANA,MGD,19450.43,,,,,,,per diem,19450.43,19450.43,"Per diem rate, code is bundled with other services"
HEMODIALYS UPP EXTR DRIL      ,74080386,CDM,361,RC,,,,,,Inpatient,,,19450.43,19450.43,HUMANA CHOICE PLUS,MGD,19450.43,,,,,,,case rate,19450.43,19450.43,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,AETNA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,CIGNA,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,WELLMED,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA,MGD,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080387,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA CHOICE PLUS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
ILEAL CONDUIT/URETPYL INJ     ,74080388,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,AETNA,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,BCBS,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,CIGNA,COM,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,TRICARE,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,UNITED HEALTHCARE,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,UNITED HEALTHCARE,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,VA,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,VA TRICARE,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,WELLMED,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,HUMANA,MGD,1299.12,,,,,,,per diem,1299.12,1299.12,"Per diem rate, code is bundled with other services"
INJ TRIGGER PT 1-2 MUSCL      ,74080389,CDM,361,RC,,,,,,Inpatient,,,1299.12,1299.12,HUMANA CHOICE PLUS,MGD,1299.12,,,,,,,case rate,1299.12,1299.12,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,AETNA,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,BCBS,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,CIGNA,COM,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,TRICARE,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,UNITED HEALTHCARE,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,UNITED HEALTHCARE,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,VA,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,VA TRICARE,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,WELLMED,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,HUMANA,MGD,3885.59,,,,,,,per diem,3885.59,3885.59,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPOR=>5YR     ,74080390,CDM,361,RC,,,,,,Inpatient,,,3885.59,3885.59,HUMANA CHOICE PLUS,MGD,3885.59,,,,,,,case rate,3885.59,3885.59,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,AETNA,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,CIGNA,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,TRICARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,UNITED HEALTHCARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,UNITED HEALTHCARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,VA,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,VA TRICARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,WELLMED,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,HUMANA,MGD,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
INS CVAD PERIPH WPORT<5YR     ,74080391,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,HUMANA CHOICE PLUS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,AETNA,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,BCBS,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,CIGNA,COM,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,TRICARE,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,UNITED HEALTHCARE,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,UNITED HEALTHCARE,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,VA,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,VA TRICARE,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,WELLMED,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,HUMANA,MGD,14379.25,,,,,,,per diem,14379.25,14379.25,"Per diem rate, code is bundled with other services"
INS INTRAPERIT CATH PERM      ,74080392,CDM,361,RC,,,,,,Inpatient,,,14379.25,14379.25,HUMANA CHOICE PLUS,MGD,14379.25,,,,,,,case rate,14379.25,14379.25,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,AETNA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,CIGNA,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,WELLMED,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA,MGD,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080393,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA CHOICE PLUS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,AETNA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,CIGNA,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,WELLMED,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA,MGD,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP<5YR     ,74080394,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA CHOICE PLUS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,AETNA,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,BCBS,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,CIGNA,COM,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,TRICARE,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,UNITED HEALTHCARE,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,UNITED HEALTHCARE,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,VA,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,VA TRICARE,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,WELLMED,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,HUMANA,MGD,1404.76,,,,,,,per diem,1404.76,1404.76,"Per diem rate, code is bundled with other services"
INS PICC WO PORT/PUMP>5YR     ,74080395,CDM,361,RC,,,,,,Inpatient,,,1404.76,1404.76,HUMANA CHOICE PLUS,MGD,1404.76,,,,,,,case rate,1404.76,1404.76,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,AETNA,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,BCBS,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,CIGNA,COM,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,TRICARE,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,UNITED HEALTHCARE,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,UNITED HEALTHCARE,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,VA,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,VA TRICARE,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,WELLMED,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,HUMANA,MGD,2862.78,,,,,,,per diem,2862.78,2862.78,"Per diem rate, code is bundled with other services"
INS TUN CTH PLEURAL W CUF     ,74080396,CDM,361,RC,,,,,,Inpatient,,,2862.78,2862.78,HUMANA CHOICE PLUS,MGD,2862.78,,,,,,,case rate,2862.78,2862.78,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,AETNA,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,BCBS,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,CIGNA,COM,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,TRICARE,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,UNITED HEALTHCARE,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,UNITED HEALTHCARE,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,VA,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,VA TRICARE,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,WELLMED,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,HUMANA,MGD,2199.83,,,,,,,per diem,2199.83,2199.83,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT<5     ,74080397,CDM,361,RC,,,,,,Inpatient,,,2199.83,2199.83,HUMANA CHOICE PLUS,MGD,2199.83,,,,,,,case rate,2199.83,2199.83,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,AETNA,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,BCBS,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,CIGNA,COM,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,TRICARE,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,UNITED HEALTHCARE,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,UNITED HEALTHCARE,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,VA,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,VA TRICARE,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,WELLMED,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,HUMANA,MGD,2716.06,,,,,,,per diem,2716.06,2716.06,"Per diem rate, code is bundled with other services"
INS TUN CV CATH WO PORT>5     ,74080398,CDM,361,RC,,,,,,Inpatient,,,2716.06,2716.06,HUMANA CHOICE PLUS,MGD,2716.06,,,,,,,case rate,2716.06,2716.06,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,AETNA,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,BCBS,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,CIGNA,COM,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,TRICARE,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,UNITED HEALTHCARE,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,UNITED HEALTHCARE,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,VA,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,VA TRICARE,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,WELLMED,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,HUMANA,MGD,2810.3,,,,,,,per diem,2810.3,2810.3,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH W PORT     ,74080399,CDM,361,RC,,,,,,Inpatient,,,2810.3,2810.3,HUMANA CHOICE PLUS,MGD,2810.3,,,,,,,case rate,2810.3,2810.3,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,AETNA,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,BCBS,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,CIGNA,COM,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,TRICARE,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,UNITED HEALTHCARE,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,UNITED HEALTHCARE,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,VA,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,VA TRICARE,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,WELLMED,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,HUMANA,MGD,4111.57,,,,,,,per diem,4111.57,4111.57,"Per diem rate, code is bundled with other services"
INS TUN CVAD 2CATH WO PRT     ,74080400,CDM,361,RC,,,,,,Inpatient,,,4111.57,4111.57,HUMANA CHOICE PLUS,MGD,4111.57,,,,,,,case rate,4111.57,4111.57,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,AETNA,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,BCBS,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,CIGNA,COM,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,TRICARE,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,UNITED HEALTHCARE,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,UNITED HEALTHCARE,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,VA,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,VA TRICARE,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,WELLMED,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,HUMANA,MGD,2726.67,,,,,,,per diem,2726.67,2726.67,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT<5      ,74080401,CDM,361,RC,,,,,,Inpatient,,,2726.67,2726.67,HUMANA CHOICE PLUS,MGD,2726.67,,,,,,,case rate,2726.67,2726.67,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,AETNA,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,BCBS,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,CIGNA,COM,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,TRICARE,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,UNITED HEALTHCARE,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,UNITED HEALTHCARE,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,VA,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,VA TRICARE,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,WELLMED,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,HUMANA,MGD,5281.22,,,,,,,per diem,5281.22,5281.22,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PORT>5      ,74080402,CDM,361,RC,,,,,,Inpatient,,,5281.22,5281.22,HUMANA CHOICE PLUS,MGD,5281.22,,,,,,,case rate,5281.22,5281.22,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,AETNA,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,BCBS,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,CIGNA,COM,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,TRICARE,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,UNITED HEALTHCARE,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,UNITED HEALTHCARE,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,VA,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,VA TRICARE,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,WELLMED,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,HUMANA,MGD,4044.1,,,,,,,per diem,4044.1,4044.1,"Per diem rate, code is bundled with other services"
INS TUNNEL CVAD W PUMP        ,74080403,CDM,361,RC,,,,,,Inpatient,,,4044.1,4044.1,HUMANA CHOICE PLUS,MGD,4044.1,,,,,,,case rate,4044.1,4044.1,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,AETNA,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,BCBS,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,CIGNA,COM,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,TRICARE,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,UNITED HEALTHCARE,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,UNITED HEALTHCARE,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,VA,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,VA TRICARE,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,WELLMED,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,HUMANA,MGD,1679.33,,,,,,,per diem,1679.33,1679.33,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH <5      ,74080404,CDM,361,RC,,,,,,Inpatient,,,1679.33,1679.33,HUMANA CHOICE PLUS,MGD,1679.33,,,,,,,case rate,1679.33,1679.33,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,AETNA,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,BCBS,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,CIGNA,COM,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,TRICARE,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,UNITED HEALTHCARE,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,UNITED HEALTHCARE,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,VA,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,VA TRICARE,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,WELLMED,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,HUMANA,MGD,2047.75,,,,,,,per diem,2047.75,2047.75,"Per diem rate, code is bundled with other services"
INSERT NONTUN CV CATH >5      ,74080405,CDM,361,RC,,,,,,Inpatient,,,2047.75,2047.75,HUMANA CHOICE PLUS,MGD,2047.75,,,,,,,case rate,2047.75,2047.75,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,AETNA,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,BCBS,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,CIGNA,COM,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,TRICARE,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,UNITED HEALTHCARE,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,UNITED HEALTHCARE,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,VA,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,VA TRICARE,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,WELLMED,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,HUMANA,MGD,2802.81,,,,,,,per diem,2802.81,2802.81,"Per diem rate, code is bundled with other services"
INTRO NDL/INTRACATH VEIN      ,74080406,CDM,361,RC,,,,,,Inpatient,,,2802.81,2802.81,HUMANA CHOICE PLUS,MGD,2802.81,,,,,,,case rate,2802.81,2802.81,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,AETNA,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,BCBS,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,CIGNA,COM,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,TRICARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,UNITED HEALTHCARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,UNITED HEALTHCARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,VA,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,VA TRICARE,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,WELLMED,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,HUMANA,MGD,650.1,,,,,,,per diem,650.1,650.1,"Per diem rate, code is bundled with other services"
JEJUN TUBE/NDL INTRAOP        ,74080407,CDM,361,RC,,,,,,Inpatient,,,650.1,650.1,HUMANA CHOICE PLUS,MGD,650.1,,,,,,,case rate,650.1,650.1,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,AETNA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,CIGNA,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,WELLMED,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA,MGD,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
JEJUNOSTMY TUBE REPL PERC     ,74080408,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA CHOICE PLUS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,AETNA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,CIGNA,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,WELLMED,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA,MGD,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMAL DES 2-14 EA     ,74080409,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA CHOICE PLUS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,AETNA,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,BCBS,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,CIGNA,COM,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,TRICARE,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,UNITED HEALTHCARE,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,UNITED HEALTHCARE,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,VA,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,VA TRICARE,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,WELLMED,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,HUMANA,MGD,1019.59,,,,,,,per diem,1019.59,1019.59,"Per diem rate, code is bundled with other services"
LESION PREMALG DESTR >=15     ,74080410,CDM,361,RC,,,,,,Inpatient,,,1019.59,1019.59,HUMANA CHOICE PLUS,MGD,1019.59,,,,,,,case rate,1019.59,1019.59,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,AETNA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,BCBS,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,CIGNA,COM,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,UNITED HEALTHCARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,VA TRICARE,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,WELLMED,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA,MGD,319.16,,,,,,,per diem,319.16,319.16,"Per diem rate, code is bundled with other services"
LESION PREMALIG DESTR 1ST     ,74080411,CDM,361,RC,,,,,,Inpatient,,,319.16,319.16,HUMANA CHOICE PLUS,MGD,319.16,,,,,,,case rate,319.16,319.16,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,AETNA,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,BCBS,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,CIGNA,COM,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,TRICARE,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,UNITED HEALTHCARE,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,UNITED HEALTHCARE,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,VA,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,VA TRICARE,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,WELLMED,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,HUMANA,MGD,11761.72,,,,,,,per diem,11761.72,11761.72,"Per diem rate, code is bundled with other services"
LIG/STRIP SAPH W EXC ULCR     ,74080412,CDM,361,RC,,,,,,Inpatient,,,11761.72,11761.72,HUMANA CHOICE PLUS,MGD,11761.72,,,,,,,case rate,11761.72,11761.72,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,AETNA,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,CIGNA,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,TRICARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,UNITED HEALTHCARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,UNITED HEALTHCARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,VA,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,VA TRICARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,WELLMED,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,HUMANA,MGD,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/DIV/EXC VAR VEIN 1LEG     ,74080413,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,HUMANA CHOICE PLUS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,AETNA,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,BCBS,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,CIGNA,COM,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,TRICARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,UNITED HEALTHCARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,UNITED HEALTHCARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,VA,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,VA TRICARE,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,WELLMED,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,HUMANA,MGD,13345.73,,,,,,,per diem,13345.73,13345.73,"Per diem rate, code is bundled with other services"
LIG/STRP SHORT SAPH VEIN      ,74080414,CDM,361,RC,,,,,,Inpatient,,,13345.73,13345.73,HUMANA CHOICE PLUS,MGD,13345.73,,,,,,,case rate,13345.73,13345.73,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,AETNA,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,BCBS,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,CIGNA,COM,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,TRICARE,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,UNITED HEALTHCARE,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,UNITED HEALTHCARE,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,VA,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,VA TRICARE,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,WELLMED,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,HUMANA,MGD,8339.88,,,,,,,per diem,8339.88,8339.88,"Per diem rate, code is bundled with other services"
LIGATION VENA CAVA INFER      ,74080415,CDM,361,RC,,,,,,Inpatient,,,8339.88,8339.88,HUMANA CHOICE PLUS,MGD,8339.88,,,,,,,case rate,8339.88,8339.88,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,AETNA,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,BCBS,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,CIGNA,COM,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,TRICARE,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,UNITED HEALTHCARE,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,UNITED HEALTHCARE,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,VA,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,VA TRICARE,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,WELLMED,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,HUMANA,MGD,2007.05,,,,,,,per diem,2007.05,2007.05,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080416,CDM,361,RC,,,,,,Inpatient,,,2007.05,2007.05,HUMANA CHOICE PLUS,MGD,2007.05,,,,,,,case rate,2007.05,2007.05,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,AETNA,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,BCBS,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,CIGNA,COM,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,TRICARE,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,UNITED HEALTHCARE,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,UNITED HEALTHCARE,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,VA,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,VA TRICARE,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,WELLMED,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,HUMANA,MGD,777.55,,,,,,,per diem,777.55,777.55,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080417,CDM,361,RC,,,,,,Inpatient,,,777.55,777.55,HUMANA CHOICE PLUS,MGD,777.55,,,,,,,case rate,777.55,777.55,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,AETNA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,BCBS,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,CIGNA,COM,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,UNITED HEALTHCARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,VA,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,VA TRICARE,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,WELLMED,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA,MGD,227.05,,,,,,,per diem,227.05,227.05,"Per diem rate, code is bundled with other services"
MAMMARY DUCTOGRAM INJ         ,74080418,CDM,361,RC,,,,,,Inpatient,,,227.05,227.05,HUMANA CHOICE PLUS,MGD,227.05,,,,,,,case rate,227.05,227.05,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,AETNA,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,BCBS,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,CIGNA,COM,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,TRICARE,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,UNITED HEALTHCARE,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,UNITED HEALTHCARE,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,VA,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,VA TRICARE,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,WELLMED,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,HUMANA,MGD,2770.68,,,,,,,per diem,2770.68,2770.68,"Per diem rate, code is bundled with other services"
NEPHRO TB REMOVE W FLUORO     ,74080419,CDM,361,RC,,,,,,Inpatient,,,2770.68,2770.68,HUMANA CHOICE PLUS,MGD,2770.68,,,,,,,case rate,2770.68,2770.68,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,AETNA,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,BCBS,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,CIGNA,COM,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,TRICARE,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,UNITED HEALTHCARE,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,UNITED HEALTHCARE,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,VA,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,VA TRICARE,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,WELLMED,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,HUMANA,MGD,2935.61,,,,,,,per diem,2935.61,2935.61,"Per diem rate, code is bundled with other services"
NEPHRO TRACT DILAT W GUID     ,74080420,CDM,361,RC,,,,,,Inpatient,,,2935.61,2935.61,HUMANA CHOICE PLUS,MGD,2935.61,,,,,,,case rate,2935.61,2935.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,AETNA,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,BCBS,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,CIGNA,COM,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,TRICARE,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,UNITED HEALTHCARE,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,UNITED HEALTHCARE,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,VA,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,VA TRICARE,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,WELLMED,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,HUMANA,MGD,23284.61,,,,,,,per diem,23284.61,23284.61,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL<2CM     ,74080421,CDM,361,RC,,,,,,Inpatient,,,23284.61,23284.61,HUMANA CHOICE PLUS,MGD,23284.61,,,,,,,case rate,23284.61,23284.61,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,AETNA,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,BCBS,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,CIGNA,COM,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,TRICARE,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,UNITED HEALTHCARE,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,UNITED HEALTHCARE,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,VA,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,VA TRICARE,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,WELLMED,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,HUMANA,MGD,15806.89,,,,,,,per diem,15806.89,15806.89,"Per diem rate, code is bundled with other services"
NEPHROSTOLITHOTM/PYEL>2CM     ,74080422,CDM,361,RC,,,,,,Inpatient,,,15806.89,15806.89,HUMANA CHOICE PLUS,MGD,15806.89,,,,,,,case rate,15806.89,15806.89,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,AETNA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,CIGNA,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,VA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,VA TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,WELLMED,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA,MGD,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
OCCLUS/EMBOL NON CNS PERM     ,74080423,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA CHOICE PLUS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,AETNA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,BCBS,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,CIGNA,COM,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,UNITED HEALTHCARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,VA,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,VA TRICARE,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,WELLMED,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA,MGD,924.27,,,,,,,per diem,924.27,924.27,"Per diem rate, code is bundled with other services"
PANCREATOGRAM INTRAOP INJ     ,74080424,CDM,361,RC,,,,,,Inpatient,,,924.27,924.27,HUMANA CHOICE PLUS,MGD,924.27,,,,,,,case rate,924.27,924.27,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,AETNA,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,BCBS,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,CIGNA,COM,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,TRICARE,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,UNITED HEALTHCARE,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,UNITED HEALTHCARE,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,VA,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,VA TRICARE,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,WELLMED,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,HUMANA,MGD,1283.06,,,,,,,per diem,1283.06,1283.06,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,74080425,CDM,361,RC,,,,,,Inpatient,,,1283.06,1283.06,HUMANA CHOICE PLUS,MGD,1283.06,,,,,,,case rate,1283.06,1283.06,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,AETNA,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,BCBS,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,CIGNA,COM,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,TRICARE,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,UNITED HEALTHCARE,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,UNITED HEALTHCARE,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,VA,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,VA TRICARE,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,WELLMED,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,HUMANA,MGD,2803.5,,,,,,,per diem,2803.5,2803.5,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,74080426,CDM,361,RC,,,,,,Inpatient,,,2803.5,2803.5,HUMANA CHOICE PLUS,MGD,2803.5,,,,,,,case rate,2803.5,2803.5,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,AETNA,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,CIGNA,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,TRICARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,UNITED HEALTHCARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,UNITED HEALTHCARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,VA,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,VA TRICARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,WELLMED,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,HUMANA,MGD,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
PELV ABSCS DRAIN TRANSREC     ,74080427,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,HUMANA CHOICE PLUS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,AETNA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,BCBS,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,CIGNA,COM,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,UNITED HEALTHCARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,VA TRICARE,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,WELLMED,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA,MGD,837.52,,,,,,,per diem,837.52,837.52,"Per diem rate, code is bundled with other services"
PERICARDIOCENT SUBSEQ         ,74080428,CDM,361,RC,,,,,,Inpatient,,,837.52,837.52,HUMANA CHOICE PLUS,MGD,837.52,,,,,,,case rate,837.52,837.52,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,AETNA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,BCBS,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,CIGNA,COM,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,UNITED HEALTHCARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,VA,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,VA TRICARE,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,WELLMED,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA,MGD,1020.66,,,,,,,per diem,1020.66,1020.66,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,74080429,CDM,361,RC,,,,,,Inpatient,,,1020.66,1020.66,HUMANA CHOICE PLUS,MGD,1020.66,,,,,,,case rate,1020.66,1020.66,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,AETNA,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,BCBS,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,CIGNA,COM,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,TRICARE,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,UNITED HEALTHCARE,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,UNITED HEALTHCARE,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,VA,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,VA TRICARE,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,WELLMED,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,HUMANA,MGD,14519.55,,,,,,,per diem,14519.55,14519.55,"Per diem rate, code is bundled with other services"
PERITL CTH DRN/DIALY PERM     ,74080430,CDM,361,RC,,,,,,Inpatient,,,14519.55,14519.55,HUMANA CHOICE PLUS,MGD,14519.55,,,,,,,case rate,14519.55,14519.55,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,AETNA,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,BCBS,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,CIGNA,COM,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,TRICARE,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,UNITED HEALTHCARE,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,UNITED HEALTHCARE,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,VA,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,VA TRICARE,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,WELLMED,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,HUMANA,MGD,11244.43,,,,,,,per diem,11244.43,11244.43,"Per diem rate, code is bundled with other services"
PERITL CTH W SQ RESR PERM     ,74080431,CDM,361,RC,,,,,,Inpatient,,,11244.43,11244.43,HUMANA CHOICE PLUS,MGD,11244.43,,,,,,,case rate,11244.43,11244.43,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,AETNA,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,BCBS,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,CIGNA,COM,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,TRICARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,UNITED HEALTHCARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,UNITED HEALTHCARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,VA,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,VA TRICARE,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,WELLMED,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,HUMANA,MGD,2603.6,,,,,,,per diem,2603.6,2603.6,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,74080432,CDM,361,RC,,,,,,Inpatient,,,2603.6,2603.6,HUMANA CHOICE PLUS,MGD,2603.6,,,,,,,case rate,2603.6,2603.6,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,AETNA,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,BCBS,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,CIGNA,COM,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,TRICARE,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,UNITED HEALTHCARE,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,UNITED HEALTHCARE,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,VA,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,VA TRICARE,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,WELLMED,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,HUMANA,MGD,1076.01,,,,,,,per diem,1076.01,1076.01,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,74080433,CDM,361,RC,,,,,,Inpatient,,,1076.01,1076.01,HUMANA CHOICE PLUS,MGD,1076.01,,,,,,,case rate,1076.01,1076.01,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,AETNA,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,BCBS,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,CIGNA,COM,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,TRICARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,UNITED HEALTHCARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,UNITED HEALTHCARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,VA,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,VA TRICARE,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,WELLMED,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,HUMANA,MGD,477.67,,,,,,,per diem,477.67,477.67,"Per diem rate, code is bundled with other services"
PERITONEL CAV AIR/CON INJ     ,74080434,CDM,361,RC,,,,,,Inpatient,,,477.67,477.67,HUMANA CHOICE PLUS,MGD,477.67,,,,,,,case rate,477.67,477.67,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,AETNA,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,BCBS,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,CIGNA,COM,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,TRICARE,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,UNITED HEALTHCARE,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,UNITED HEALTHCARE,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,VA,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,VA TRICARE,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,WELLMED,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,HUMANA,MGD,10943.48,,,,,,,per diem,10943.48,10943.48,"Per diem rate, code is bundled with other services"
PLACE AORTA AORTIC TUBE       ,74080435,CDM,361,RC,,,,,,Inpatient,,,10943.48,10943.48,HUMANA CHOICE PLUS,MGD,10943.48,,,,,,,case rate,10943.48,10943.48,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,AETNA,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,BCBS,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,CIGNA,COM,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,TRICARE,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,UNITED HEALTHCARE,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,UNITED HEALTHCARE,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,VA,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,VA TRICARE,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,WELLMED,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,HUMANA,MGD,3104.83,,,,,,,per diem,3104.83,3104.83,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080436,CDM,361,RC,,,,,,Inpatient,,,3104.83,3104.83,HUMANA CHOICE PLUS,MGD,3104.83,,,,,,,case rate,3104.83,3104.83,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,AETNA,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,BCBS,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,CIGNA,COM,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,TRICARE,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,UNITED HEALTHCARE,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,UNITED HEALTHCARE,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,VA,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,VA TRICARE,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,WELLMED,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,HUMANA,MGD,5898,,,,,,,per diem,5898,5898,"Per diem rate, code is bundled with other services"
PLC INTERSTIT PERC THORAX     ,74080437,CDM,361,RC,,,,,,Inpatient,,,5898,5898,HUMANA CHOICE PLUS,MGD,5898,,,,,,,case rate,5898,5898,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,AETNA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,CIGNA,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,WELLMED,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA,MGD,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,74080438,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA CHOICE PLUS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,AETNA,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,BCBS,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,CIGNA,COM,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,TRICARE,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,UNITED HEALTHCARE,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,UNITED HEALTHCARE,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,VA,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,VA TRICARE,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,WELLMED,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,HUMANA,MGD,806.46,,,,,,,per diem,806.46,806.46,"Per diem rate, code is bundled with other services"
PORTAL VEIN CATH PERC         ,74080439,CDM,361,RC,,,,,,Inpatient,,,806.46,806.46,HUMANA CHOICE PLUS,MGD,806.46,,,,,,,case rate,806.46,806.46,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,AETNA,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,BCBS,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,CIGNA,COM,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,TRICARE,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,UNITED HEALTHCARE,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,UNITED HEALTHCARE,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,VA,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,VA TRICARE,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,WELLMED,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,HUMANA,MGD,1066.72,,,,,,,per diem,1066.72,1066.72,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,74080440,CDM,361,RC,,,,,,Inpatient,,,1066.72,1066.72,HUMANA CHOICE PLUS,MGD,1066.72,,,,,,,case rate,1066.72,1066.72,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,AETNA,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,CIGNA,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,TRICARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,UNITED HEALTHCARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,UNITED HEALTHCARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,VA,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,VA TRICARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,WELLMED,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,HUMANA,MGD,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
PTA AORTIC                    ,74080441,CDM,361,RC,,,,,,Inpatient,,,861.08,861.08,HUMANA CHOICE PLUS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,AETNA,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,BCBS,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,CIGNA,COM,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,TRICARE,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,UNITED HEALTHCARE,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,UNITED HEALTHCARE,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,VA,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,VA TRICARE,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,WELLMED,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,HUMANA,MGD,14352.47,,,,,,,per diem,14352.47,14352.47,"Per diem rate, code is bundled with other services"
PTA BRACHIOCEP EA VES         ,74080442,CDM,361,RC,,,,,,Inpatient,,,14352.47,14352.47,HUMANA CHOICE PLUS,MGD,14352.47,,,,,,,case rate,14352.47,14352.47,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,AETNA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,BCBS,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,CIGNA,COM,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,UNITED HEALTHCARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,VA,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,VA TRICARE,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,WELLMED,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA,MGD,717.57,,,,,,,per diem,717.57,717.57,"Per diem rate, code is bundled with other services"
PTA RENAL/VISCERAL            ,74080443,CDM,361,RC,,,,,,Inpatient,,,717.57,717.57,HUMANA CHOICE PLUS,MGD,717.57,,,,,,,case rate,717.57,717.57,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,AETNA,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,BCBS,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,CIGNA,COM,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,TRICARE,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,UNITED HEALTHCARE,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,UNITED HEALTHCARE,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,VA,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,VA TRICARE,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,WELLMED,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,HUMANA,MGD,7400.61,,,,,,,per diem,7400.61,7400.61,"Per diem rate, code is bundled with other services"
PTA VENOUS                    ,74080444,CDM,361,RC,,,,,,Inpatient,,,7400.61,7400.61,HUMANA CHOICE PLUS,MGD,7400.61,,,,,,,case rate,7400.61,7400.61,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,AETNA,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,BCBS,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,CIGNA,COM,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,TRICARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,UNITED HEALTHCARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,UNITED HEALTHCARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,VA,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,VA TRICARE,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,WELLMED,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,HUMANA,MGD,1781.07,,,,,,,per diem,1781.07,1781.07,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,74080445,CDM,361,RC,,,,,,Inpatient,,,1781.07,1781.07,HUMANA CHOICE PLUS,MGD,1781.07,,,,,,,case rate,1781.07,1781.07,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,AETNA,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,BCBS,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,CIGNA,COM,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,TRICARE,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,UNITED HEALTHCARE,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,UNITED HEALTHCARE,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,VA,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,VA TRICARE,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,WELLMED,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,HUMANA,MGD,10339.43,,,,,,,per diem,10339.43,10339.43,"Per diem rate, code is bundled with other services"
REM FB SHOULDER DEEP          ,74080446,CDM,361,RC,,,,,,Inpatient,,,10339.43,10339.43,HUMANA CHOICE PLUS,MGD,10339.43,,,,,,,case rate,10339.43,10339.43,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,AETNA,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,CIGNA,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,TRICARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,UNITED HEALTHCARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,UNITED HEALTHCARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,VA,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,VA TRICARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,WELLMED,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,HUMANA,MGD,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM INTRALUM MATERL CVDEV     ,74080447,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,HUMANA CHOICE PLUS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,AETNA,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,BCBS,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,CIGNA,COM,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,TRICARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,UNITED HEALTHCARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,UNITED HEALTHCARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,VA,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,VA TRICARE,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,WELLMED,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,HUMANA,MGD,11989.85,,,,,,,per diem,11989.85,11989.85,"Per diem rate, code is bundled with other services"
REM PERICATH MATER CV DEV     ,74080448,CDM,361,RC,,,,,,Inpatient,,,11989.85,11989.85,HUMANA CHOICE PLUS,MGD,11989.85,,,,,,,case rate,11989.85,11989.85,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,AETNA,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,BCBS,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,CIGNA,COM,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,TRICARE,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,UNITED HEALTHCARE,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,UNITED HEALTHCARE,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,VA,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,VA TRICARE,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,WELLMED,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,HUMANA,MGD,9852.13,,,,,,,per diem,9852.13,9852.13,"Per diem rate, code is bundled with other services"
REM PERM PERITONEAL CATH      ,74080449,CDM,361,RC,,,,,,Inpatient,,,9852.13,9852.13,HUMANA CHOICE PLUS,MGD,9852.13,,,,,,,case rate,9852.13,9852.13,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,AETNA,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,BCBS,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,CIGNA,COM,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,TRICARE,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,UNITED HEALTHCARE,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,UNITED HEALTHCARE,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,VA,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,VA TRICARE,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,WELLMED,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,HUMANA,MGD,1824.28,,,,,,,per diem,1824.28,1824.28,"Per diem rate, code is bundled with other services"
REM TUN CV CATH WO PORT/P     ,74080450,CDM,361,RC,,,,,,Inpatient,,,1824.28,1824.28,HUMANA CHOICE PLUS,MGD,1824.28,,,,,,,case rate,1824.28,1824.28,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,AETNA,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,BCBS,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,CIGNA,COM,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,TRICARE,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,UNITED HEALTHCARE,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,UNITED HEALTHCARE,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,VA,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,VA TRICARE,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,WELLMED,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,HUMANA,MGD,1586.15,,,,,,,per diem,1586.15,1586.15,"Per diem rate, code is bundled with other services"
REM TUN CVA DEV W PORT/P      ,74080451,CDM,361,RC,,,,,,Inpatient,,,1586.15,1586.15,HUMANA CHOICE PLUS,MGD,1586.15,,,,,,,case rate,1586.15,1586.15,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,AETNA,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,CIGNA,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,TRICARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,UNITED HEALTHCARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,UNITED HEALTHCARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,VA,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,VA TRICARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,WELLMED,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,HUMANA,MGD,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
REM TUNNEL PLEURAL CATH       ,74080452,CDM,361,RC,,,,,,Inpatient,,,620.11,620.11,HUMANA CHOICE PLUS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,AETNA,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,BCBS,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,CIGNA,COM,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,TRICARE,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,UNITED HEALTHCARE,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,UNITED HEALTHCARE,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,VA,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,VA TRICARE,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,WELLMED,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,HUMANA,MGD,1596.24,,,,,,,per diem,1596.24,1596.24,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,74080453,CDM,361,RC,,,,,,Inpatient,,,1596.24,1596.24,HUMANA CHOICE PLUS,MGD,1596.24,,,,,,,case rate,1596.24,1596.24,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,AETNA,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,BCBS,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,CIGNA,COM,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,TRICARE,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,UNITED HEALTHCARE,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,UNITED HEALTHCARE,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,VA,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,VA TRICARE,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,WELLMED,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,HUMANA,MGD,2674.96,,,,,,,per diem,2674.96,2674.96,"Per diem rate, code is bundled with other services"
RENAL ENDO W URET CTH EST     ,74080454,CDM,361,RC,,,,,,Inpatient,,,2674.96,2674.96,HUMANA CHOICE PLUS,MGD,2674.96,,,,,,,case rate,2674.96,2674.96,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,AETNA,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,BCBS,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,CIGNA,COM,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,TRICARE,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,UNITED HEALTHCARE,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,UNITED HEALTHCARE,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,VA,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,VA TRICARE,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,WELLMED,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,HUMANA,MGD,625.92,,,,,,,per diem,625.92,625.92,"Per diem rate, code is bundled with other services"
RENAL PEL/URET THER INSTL     ,74080455,CDM,361,RC,,,,,,Inpatient,,,625.92,625.92,HUMANA CHOICE PLUS,MGD,625.92,,,,,,,case rate,625.92,625.92,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
REPAIR CV CATH WO PUM/POR     ,74080456,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,AETNA,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,BCBS,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,CIGNA,COM,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,TRICARE,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,UNITED HEALTHCARE,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,UNITED HEALTHCARE,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,VA,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,VA TRICARE,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,WELLMED,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,HUMANA,MGD,1075.28,,,,,,,per diem,1075.28,1075.28,"Per diem rate, code is bundled with other services"
REPAIR CVAD W PORT OR PMP     ,74080457,CDM,361,RC,,,,,,Inpatient,,,1075.28,1075.28,HUMANA CHOICE PLUS,MGD,1075.28,,,,,,,case rate,1075.28,1075.28,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,AETNA,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,BCBS,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,CIGNA,COM,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,TRICARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,UNITED HEALTHCARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,UNITED HEALTHCARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,VA,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,VA TRICARE,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,WELLMED,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,HUMANA,MGD,2521.13,,,,,,,per diem,2521.13,2521.13,"Per diem rate, code is bundled with other services"
REPL CVAD W PORT PERIPH       ,74080458,CDM,361,RC,,,,,,Inpatient,,,2521.13,2521.13,HUMANA CHOICE PLUS,MGD,2521.13,,,,,,,case rate,2521.13,2521.13,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
REPL NOTUN CV CATH WO PRT     ,74080459,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,AETNA,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,BCBS,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,CIGNA,COM,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,TRICARE,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,UNITED HEALTHCARE,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,UNITED HEALTHCARE,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,VA,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,VA TRICARE,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,WELLMED,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,HUMANA,MGD,925.34,,,,,,,per diem,925.34,925.34,"Per diem rate, code is bundled with other services"
REPL PICC WO PORT             ,74080460,CDM,361,RC,,,,,,Inpatient,,,925.34,925.34,HUMANA CHOICE PLUS,MGD,925.34,,,,,,,case rate,925.34,925.34,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,AETNA,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,BCBS,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,CIGNA,COM,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,TRICARE,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,UNITED HEALTHCARE,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,UNITED HEALTHCARE,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,VA,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,VA TRICARE,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,WELLMED,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,HUMANA,MGD,5010.77,,,,,,,per diem,5010.77,5010.77,"Per diem rate, code is bundled with other services"
REPL TUN CV CATH WO PORT      ,74080461,CDM,361,RC,,,,,,Inpatient,,,5010.77,5010.77,HUMANA CHOICE PLUS,MGD,5010.77,,,,,,,case rate,5010.77,5010.77,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,AETNA,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,BCBS,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,CIGNA,COM,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,TRICARE,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,UNITED HEALTHCARE,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,UNITED HEALTHCARE,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,VA,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,VA TRICARE,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,WELLMED,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,HUMANA,MGD,3026.65,,,,,,,per diem,3026.65,3026.65,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PORT CV       ,74080462,CDM,361,RC,,,,,,Inpatient,,,3026.65,3026.65,HUMANA CHOICE PLUS,MGD,3026.65,,,,,,,case rate,3026.65,3026.65,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,AETNA,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,BCBS,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,CIGNA,COM,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,TRICARE,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,UNITED HEALTHCARE,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,UNITED HEALTHCARE,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,VA,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,VA TRICARE,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,WELLMED,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,HUMANA,MGD,2524.35,,,,,,,per diem,2524.35,2524.35,"Per diem rate, code is bundled with other services"
REPL TUN CVAD W PUMP CV       ,74080463,CDM,361,RC,,,,,,Inpatient,,,2524.35,2524.35,HUMANA CHOICE PLUS,MGD,2524.35,,,,,,,case rate,2524.35,2524.35,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,AETNA,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,BCBS,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,CIGNA,COM,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,TRICARE,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,UNITED HEALTHCARE,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,UNITED HEALTHCARE,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,VA,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,VA TRICARE,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,WELLMED,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,HUMANA,MGD,1368.74,,,,,,,per diem,1368.74,1368.74,"Per diem rate, code is bundled with other services"
REPLACE CATH ONLY CVAD W      ,74080464,CDM,361,RC,,,,,,Inpatient,,,1368.74,1368.74,HUMANA CHOICE PLUS,MGD,1368.74,,,,,,,case rate,1368.74,1368.74,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,AETNA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,CIGNA,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,WELLMED,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA,MGD,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
REPOS IVC FILTER ENDOVAS      ,74080465,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA CHOICE PLUS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,AETNA,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,BCBS,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,CIGNA,COM,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,TRICARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,UNITED HEALTHCARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,UNITED HEALTHCARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,VA,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,VA TRICARE,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,WELLMED,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,HUMANA,MGD,1027.09,,,,,,,per diem,1027.09,1027.09,"Per diem rate, code is bundled with other services"
REPOSITION CV CATH W FLUR     ,74080466,CDM,361,RC,,,,,,Inpatient,,,1027.09,1027.09,HUMANA CHOICE PLUS,MGD,1027.09,,,,,,,case rate,1027.09,1027.09,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,AETNA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,CIGNA,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,WELLMED,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA,MGD,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
RETR IVC FILTER ENDOVAS       ,74080467,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA CHOICE PLUS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,AETNA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,CIGNA,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,WELLMED,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA,MGD,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP ATHERECTOMY     ,74080468,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA CHOICE PLUS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,AETNA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,CIGNA,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,WELLMED,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA,MGD,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEM POP STENT ATHER     ,74080469,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA CHOICE PLUS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,AETNA,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,BCBS,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,CIGNA,COM,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,TRICARE,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,UNITED HEALTHCARE,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,UNITED HEALTHCARE,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,VA,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,VA TRICARE,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,WELLMED,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,HUMANA,MGD,10774.26,,,,,,,per diem,10774.26,10774.26,"Per diem rate, code is bundled with other services"
REVAS FEM POP TRANS ANGIO     ,74080470,CDM,361,RC,,,,,,Inpatient,,,10774.26,10774.26,HUMANA CHOICE PLUS,MGD,10774.26,,,,,,,case rate,10774.26,10774.26,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,AETNA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,BCBS,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,CIGNA,COM,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,UNITED HEALTHCARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,VA TRICARE,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,WELLMED,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA,MGD,25905.35,,,,,,,per diem,25905.35,25905.35,"Per diem rate, code is bundled with other services"
REVAS FEMORAL POPLT STENT     ,74080471,CDM,361,RC,,,,,,Inpatient,,,25905.35,25905.35,HUMANA CHOICE PLUS,MGD,25905.35,,,,,,,case rate,25905.35,25905.35,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC STENT INI VES     ,74080472,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS ILIAC TRNS ANG INI      ,74080473,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI ANGIO ADD     ,74080474,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS IPSIL ILI STENT ADD     ,74080475,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ANGIO ADD     ,74080476,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,AETNA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,CIGNA,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,WELLMED,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA,MGD,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER ADD     ,74080477,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA CHOICE PLUS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,AETNA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,CIGNA,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,WELLMED,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA,MGD,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON ATHER INI     ,74080478,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA CHOICE PLUS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,AETNA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,CIGNA,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,WELLMED,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA,MGD,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PERON STENT INI     ,74080479,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA CHOICE PLUS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH ADD     ,74080480,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,AETNA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,BCBS,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,CIGNA,COM,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,UNITED HEALTHCARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,VA TRICARE,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,WELLMED,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA,MGD,26002.81,,,,,,,per diem,26002.81,26002.81,"Per diem rate, code is bundled with other services"
REVAS TIB PR STNT ATH INI     ,74080481,CDM,361,RC,,,,,,Inpatient,,,26002.81,26002.81,HUMANA CHOICE PLUS,MGD,26002.81,,,,,,,case rate,26002.81,26002.81,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,AETNA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,BCBS,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,CIGNA,COM,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,UNITED HEALTHCARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,VA TRICARE,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,WELLMED,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA,MGD,10802.11,,,,,,,per diem,10802.11,10802.11,"Per diem rate, code is bundled with other services"
REVAS TIBIAL PERN ANG INI     ,74080482,CDM,361,RC,,,,,,Inpatient,,,10802.11,10802.11,HUMANA CHOICE PLUS,MGD,10802.11,,,,,,,case rate,10802.11,10802.11,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,AETNA,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,BCBS,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,CIGNA,COM,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,TRICARE,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,UNITED HEALTHCARE,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,UNITED HEALTHCARE,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,VA,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,VA TRICARE,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,WELLMED,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,HUMANA,MGD,47034.04,,,,,,,per diem,47034.04,47034.04,"Per diem rate, code is bundled with other services"
REVISE TIPS                   ,74080483,CDM,361,RC,,,,,,Inpatient,,,47034.04,47034.04,HUMANA CHOICE PLUS,MGD,47034.04,,,,,,,case rate,47034.04,47034.04,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,AETNA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,CIGNA,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,WELLMED,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA,MGD,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ MULT VEIN      ,74080484,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA CHOICE PLUS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,AETNA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,CIGNA,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,WELLMED,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA,MGD,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SCLEROSING INJ SNGL VEIN      ,74080485,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA CHOICE PLUS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080486,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,AETNA,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,BCBS,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,CIGNA,COM,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,TRICARE,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,UNITED HEALTHCARE,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,UNITED HEALTHCARE,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,VA,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,VA TRICARE,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,WELLMED,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,HUMANA,MGD,1217.73,,,,,,,per diem,1217.73,1217.73,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080487,CDM,361,RC,,,,,,Inpatient,,,1217.73,1217.73,HUMANA CHOICE PLUS,MGD,1217.73,,,,,,,case rate,1217.73,1217.73,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,AETNA,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,BCBS,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,CIGNA,COM,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,TRICARE,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,UNITED HEALTHCARE,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,UNITED HEALTHCARE,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,VA,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,VA TRICARE,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,WELLMED,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,HUMANA,MGD,4722.04,,,,,,,per diem,4722.04,4722.04,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080488,CDM,361,RC,,,,,,Inpatient,,,4722.04,4722.04,HUMANA CHOICE PLUS,MGD,4722.04,,,,,,,case rate,4722.04,4722.04,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,AETNA,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,BCBS,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,CIGNA,COM,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,TRICARE,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,UNITED HEALTHCARE,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,UNITED HEALTHCARE,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,VA,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,VA TRICARE,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,WELLMED,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,HUMANA,MGD,740.06,,,,,,,per diem,740.06,740.06,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ THERAP        ,74080489,CDM,361,RC,,,,,,Inpatient,,,740.06,740.06,HUMANA CHOICE PLUS,MGD,740.06,,,,,,,case rate,740.06,740.06,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,AETNA,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,BCBS,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,CIGNA,COM,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,TRICARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,UNITED HEALTHCARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,UNITED HEALTHCARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,VA,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,VA TRICARE,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,WELLMED,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,HUMANA,MGD,1166.32,,,,,,,per diem,1166.32,1166.32,"Per diem rate, code is bundled with other services"
SML BWL ENDO G TO J TUBE      ,74080490,CDM,361,RC,,,,,,Inpatient,,,1166.32,1166.32,HUMANA CHOICE PLUS,MGD,1166.32,,,,,,,case rate,1166.32,1166.32,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,AETNA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,BCBS,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,CIGNA,COM,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,UNITED HEALTHCARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,VA TRICARE,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,WELLMED,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA,MGD,544.07,,,,,,,per diem,544.07,544.07,"Per diem rate, code is bundled with other services"
SPIDER VEN INJ SNG/MULT       ,74080491,CDM,361,RC,,,,,,Inpatient,,,544.07,544.07,HUMANA CHOICE PLUS,MGD,544.07,,,,,,,case rate,544.07,544.07,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,AETNA,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,BCBS,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,CIGNA,COM,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,TRICARE,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,UNITED HEALTHCARE,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,UNITED HEALTHCARE,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,VA,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,VA TRICARE,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,WELLMED,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,HUMANA,MGD,1016.38,,,,,,,per diem,1016.38,1016.38,"Per diem rate, code is bundled with other services"
SPINAL ART AV MALFORM INJ     ,74080492,CDM,361,RC,,,,,,Inpatient,,,1016.38,1016.38,HUMANA CHOICE PLUS,MGD,1016.38,,,,,,,case rate,1016.38,1016.38,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,AETNA,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,BCBS,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,CIGNA,COM,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,TRICARE,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,UNITED HEALTHCARE,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,UNITED HEALTHCARE,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,VA,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,VA TRICARE,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,WELLMED,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,HUMANA,MGD,1901.03,,,,,,,per diem,1901.03,1901.03,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,74080493,CDM,361,RC,,,,,,Inpatient,,,1901.03,1901.03,HUMANA CHOICE PLUS,MGD,1901.03,,,,,,,case rate,1901.03,1901.03,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,AETNA,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,BCBS,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,CIGNA,COM,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,TRICARE,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,UNITED HEALTHCARE,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,UNITED HEALTHCARE,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,VA,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,VA TRICARE,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,WELLMED,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,HUMANA,MGD,896.43,,,,,,,per diem,896.43,896.43,"Per diem rate, code is bundled with other services"
SPLENOPORTOGRAM INJ           ,74080494,CDM,361,RC,,,,,,Inpatient,,,896.43,896.43,HUMANA CHOICE PLUS,MGD,896.43,,,,,,,case rate,896.43,896.43,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,AETNA,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,CIGNA,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,TRICARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,UNITED HEALTHCARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,UNITED HEALTHCARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,VA,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,VA TRICARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,WELLMED,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,HUMANA,MGD,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,74080495,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,HUMANA CHOICE PLUS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,AETNA,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,BCBS,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,CIGNA,COM,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,TRICARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,UNITED HEALTHCARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,UNITED HEALTHCARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,VA,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,VA TRICARE,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,WELLMED,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,HUMANA,MGD,2750.33,,,,,,,per diem,2750.33,2750.33,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,74080496,CDM,361,RC,,,,,,Inpatient,,,2750.33,2750.33,HUMANA CHOICE PLUS,MGD,2750.33,,,,,,,case rate,2750.33,2750.33,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,AETNA,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,BCBS,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,CIGNA,COM,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,TRICARE,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,UNITED HEALTHCARE,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,UNITED HEALTHCARE,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,VA,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,VA TRICARE,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,WELLMED,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,HUMANA,MGD,1512.25,,,,,,,per diem,1512.25,1512.25,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,74080497,CDM,361,RC,,,,,,Inpatient,,,1512.25,1512.25,HUMANA CHOICE PLUS,MGD,1512.25,,,,,,,case rate,1512.25,1512.25,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,AETNA,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,BCBS,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,CIGNA,COM,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,TRICARE,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,UNITED HEALTHCARE,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,UNITED HEALTHCARE,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,VA,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,VA TRICARE,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,WELLMED,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,HUMANA,MGD,12045.54,,,,,,,per diem,12045.54,12045.54,"Per diem rate, code is bundled with other services"
THROMBECT AV FISTL W/GRFT     ,74080498,CDM,361,RC,,,,,,Inpatient,,,12045.54,12045.54,HUMANA CHOICE PLUS,MGD,12045.54,,,,,,,case rate,12045.54,12045.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,AETNA,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,BCBS,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,CIGNA,COM,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,TRICARE,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,UNITED HEALTHCARE,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,UNITED HEALTHCARE,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,VA,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,VA TRICARE,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,WELLMED,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,HUMANA,MGD,15786.54,,,,,,,per diem,15786.54,15786.54,"Per diem rate, code is bundled with other services"
THROMBECT AV GRFT NONDIAL     ,74080499,CDM,361,RC,,,,,,Inpatient,,,15786.54,15786.54,HUMANA CHOICE PLUS,MGD,15786.54,,,,,,,case rate,15786.54,15786.54,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,AETNA,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,BCBS,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,CIGNA,COM,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,TRICARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,UNITED HEALTHCARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,UNITED HEALTHCARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,VA,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,VA TRICARE,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,WELLMED,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,HUMANA,MGD,6689.47,,,,,,,per diem,6689.47,6689.47,"Per diem rate, code is bundled with other services"
THROMBOLY CEREBR IV INFUS     ,74080500,CDM,361,RC,,,,,,Inpatient,,,6689.47,6689.47,HUMANA CHOICE PLUS,MGD,6689.47,,,,,,,case rate,6689.47,6689.47,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,AETNA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,CIGNA,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,WELLMED,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA,MGD,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS ART INIT DAY       ,74080501,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA CHOICE PLUS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,AETNA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,CIGNA,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,WELLMED,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA,MGD,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS FINAL DAY          ,74080502,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA CHOICE PLUS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,AETNA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,CIGNA,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,WELLMED,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA,MGD,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS SUBSEQUENT DAY     ,74080503,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA CHOICE PLUS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,AETNA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,BCBS,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,CIGNA,COM,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,UNITED HEALTHCARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,VA TRICARE,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,WELLMED,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA,MGD,4666.35,,,,,,,per diem,4666.35,4666.35,"Per diem rate, code is bundled with other services"
THROMBOLYS VEN INIT DAY       ,74080504,CDM,361,RC,,,,,,Inpatient,,,4666.35,4666.35,HUMANA CHOICE PLUS,MGD,4666.35,,,,,,,case rate,4666.35,4666.35,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,AETNA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,CIGNA,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,WELLMED,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA,MGD,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
TRANSCATHETER BIOPSY          ,74080505,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA CHOICE PLUS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,AETNA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,BCBS,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,CIGNA,COM,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,UNITED HEALTHCARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,VA TRICARE,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,WELLMED,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA,MGD,5926.91,,,,,,,per diem,5926.91,5926.91,"Per diem rate, code is bundled with other services"
TRANSCTH RET IVAS FB PERC     ,74080506,CDM,361,RC,,,,,,Inpatient,,,5926.91,5926.91,HUMANA CHOICE PLUS,MGD,5926.91,,,,,,,case rate,5926.91,5926.91,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,AETNA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,CIGNA,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,WELLMED,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA,MGD,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER ABD AORTA      ,74080507,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA CHOICE PLUS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,AETNA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,CIGNA,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,WELLMED,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA,MGD,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHER RENAL ART      ,74080508,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA CHOICE PLUS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,AETNA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,CIGNA,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,WELLMED,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA,MGD,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC BRACH EA     ,74080509,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA CHOICE PLUS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,AETNA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,CIGNA,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,WELLMED,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA,MGD,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHEREC ILIAC EA     ,74080510,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA CHOICE PLUS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,AETNA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,BCBS,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,CIGNA,COM,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,UNITED HEALTHCARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,VA TRICARE,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,WELLMED,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA,MGD,21362.17,,,,,,,per diem,21362.17,21362.17,"Per diem rate, code is bundled with other services"
TRANSLUM ATHR VISCERAL EA     ,74080511,CDM,361,RC,,,,,,Inpatient,,,21362.17,21362.17,HUMANA CHOICE PLUS,MGD,21362.17,,,,,,,case rate,21362.17,21362.17,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,AETNA,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,BCBS,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,CIGNA,COM,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,TRICARE,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,UNITED HEALTHCARE,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,UNITED HEALTHCARE,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,VA,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,VA TRICARE,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,WELLMED,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,HUMANA,MGD,2977.38,,,,,,,per diem,2977.38,2977.38,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,74080512,CDM,361,RC,,,,,,Inpatient,,,2977.38,2977.38,HUMANA CHOICE PLUS,MGD,2977.38,,,,,,,case rate,2977.38,2977.38,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,AETNA,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,BCBS,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,CIGNA,COM,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,TRICARE,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,UNITED HEALTHCARE,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,UNITED HEALTHCARE,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,VA,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,VA TRICARE,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,WELLMED,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,HUMANA,MGD,7296.72,,,,,,,per diem,7296.72,7296.72,"Per diem rate, code is bundled with other services"
REM&REP NEPHROURE CTH EXT     ,74080513,CDM,361,RC,,,,,,Inpatient,,,7296.72,7296.72,HUMANA CHOICE PLUS,MGD,7296.72,,,,,,,case rate,7296.72,7296.72,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,AETNA,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,BCBS,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,CIGNA,COM,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,TRICARE,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,UNITED HEALTHCARE,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,UNITED HEALTHCARE,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,VA,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,VA TRICARE,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,WELLMED,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,HUMANA,MGD,1003.53,,,,,,,per diem,1003.53,1003.53,"Per diem rate, code is bundled with other services"
URETEROGM INJ THRU OSTOM      ,74080514,CDM,361,RC,,,,,,Inpatient,,,1003.53,1003.53,HUMANA CHOICE PLUS,MGD,1003.53,,,,,,,case rate,1003.53,1003.53,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,AETNA,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,BCBS,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,CIGNA,COM,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,TRICARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,UNITED HEALTHCARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,UNITED HEALTHCARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,VA,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,VA TRICARE,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,WELLMED,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,HUMANA,MGD,955.33,,,,,,,per diem,955.33,955.33,"Per diem rate, code is bundled with other services"
URETEROSTOMY TUBE CHANGE      ,74080515,CDM,361,RC,,,,,,Inpatient,,,955.33,955.33,HUMANA CHOICE PLUS,MGD,955.33,,,,,,,case rate,955.33,955.33,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,AETNA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,BCBS,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,CIGNA,COM,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,UNITED HEALTHCARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,VA,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,VA TRICARE,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,WELLMED,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA,MGD,430.54,,,,,,,per diem,430.54,430.54,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM RETRO INJ     ,74080516,CDM,361,RC,,,,,,Inpatient,,,430.54,430.54,HUMANA CHOICE PLUS,MGD,430.54,,,,,,,case rate,430.54,430.54,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,AETNA,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,BCBS,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,CIGNA,COM,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,TRICARE,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,UNITED HEALTHCARE,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,UNITED HEALTHCARE,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,VA,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,VA TRICARE,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,WELLMED,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,HUMANA,MGD,13795.55,,,,,,,per diem,13795.55,13795.55,"Per diem rate, code is bundled with other services"
VEN MECH THROMBECT EA ADD     ,74080517,CDM,361,RC,,,,,,Inpatient,,,13795.55,13795.55,HUMANA CHOICE PLUS,MGD,13795.55,,,,,,,case rate,13795.55,13795.55,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,AETNA,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,BCBS,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,CIGNA,COM,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,TRICARE,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,UNITED HEALTHCARE,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,UNITED HEALTHCARE,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,VA,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,VA TRICARE,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,WELLMED,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,HUMANA,MGD,4065.95,,,,,,,per diem,4065.95,4065.95,"Per diem rate, code is bundled with other services"
VENA CAVA INTRO CATH          ,74080518,CDM,361,RC,,,,,,Inpatient,,,4065.95,4065.95,HUMANA CHOICE PLUS,MGD,4065.95,,,,,,,case rate,4065.95,4065.95,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,AETNA,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,BCBS,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,CIGNA,COM,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,TRICARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,UNITED HEALTHCARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,UNITED HEALTHCARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,VA,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,VA TRICARE,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,WELLMED,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,HUMANA,MGD,40.7,,,,,,,per diem,40.7,40.7,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080519,CDM,361,RC,,,,,,Inpatient,,,40.7,40.7,HUMANA CHOICE PLUS,MGD,40.7,,,,,,,case rate,40.7,40.7,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
VENIPUNCTURE <3YR FEM/JUG     ,74080520,CDM,361,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,AETNA,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,BCBS,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,CIGNA,COM,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,TRICARE,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,UNITED HEALTHCARE,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,UNITED HEALTHCARE,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,VA,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,VA TRICARE,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,WELLMED,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,HUMANA,MGD,3751.71,,,,,,,per diem,3751.71,3751.71,"Per diem rate, code is bundled with other services"
VENOGRAM ANATOMIC VARIANT     ,74080521,CDM,361,RC,,,,,,Inpatient,,,3751.71,3751.71,HUMANA CHOICE PLUS,MGD,3751.71,,,,,,,case rate,3751.71,3751.71,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,AETNA,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,BCBS,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,CIGNA,COM,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,TRICARE,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,UNITED HEALTHCARE,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,UNITED HEALTHCARE,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,VA,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,VA TRICARE,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,WELLMED,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,HUMANA,MGD,919.99,,,,,,,per diem,919.99,919.99,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080522,CDM,361,RC,,,,,,Inpatient,,,919.99,919.99,HUMANA CHOICE PLUS,MGD,919.99,,,,,,,case rate,919.99,919.99,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,AETNA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,BCBS,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,CIGNA,COM,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,UNITED HEALTHCARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,VA,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,VA TRICARE,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,WELLMED,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA,MGD,341.65,,,,,,,per diem,341.65,341.65,"Per diem rate, code is bundled with other services"
VENOUS BLOOD SAMPL SPECIF     ,74080523,CDM,361,RC,,,,,,Inpatient,,,341.65,341.65,HUMANA CHOICE PLUS,MGD,341.65,,,,,,,case rate,341.65,341.65,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,AETNA,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,BCBS,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,CIGNA,COM,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,TRICARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,UNITED HEALTHCARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,UNITED HEALTHCARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,VA,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,VA TRICARE,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,WELLMED,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,HUMANA,MGD,13524.59,,,,,,,per diem,13524.59,13524.59,"Per diem rate, code is bundled with other services"
VENOUS MECH THROMBECTOMY      ,74080524,CDM,361,RC,,,,,,Inpatient,,,13524.59,13524.59,HUMANA CHOICE PLUS,MGD,13524.59,,,,,,,case rate,13524.59,13524.59,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,AETNA,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,BCBS,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,CIGNA,COM,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,TRICARE,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,UNITED HEALTHCARE,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,UNITED HEALTHCARE,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,VA,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,VA TRICARE,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,WELLMED,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,HUMANA,MGD,38869.8,,,,,,,per diem,38869.8,38869.8,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART INI     ,74080525,CDM,361,RC,,,,,,Inpatient,,,38869.8,38869.8,HUMANA CHOICE PLUS,MGD,38869.8,,,,,,,case rate,38869.8,38869.8,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,AETNA,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,BCBS,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,CIGNA,COM,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,TRICARE,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,UNITED HEALTHCARE,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,UNITED HEALTHCARE,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,VA,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,VA TRICARE,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,WELLMED,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,HUMANA,MGD,18411.56,,,,,,,per diem,18411.56,18411.56,"Per diem rate, code is bundled with other services"
STNT PLC TRANSCTH ART ADD     ,74080526,CDM,361,RC,,,,,,Inpatient,,,18411.56,18411.56,HUMANA CHOICE PLUS,MGD,18411.56,,,,,,,case rate,18411.56,18411.56,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,AETNA,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,BCBS,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,CIGNA,COM,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,TRICARE,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,UNITED HEALTHCARE,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,UNITED HEALTHCARE,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,VA,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,VA TRICARE,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,WELLMED,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,HUMANA,MGD,39032.6,,,,,,,per diem,39032.6,39032.6,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN INI      ,74080527,CDM,361,RC,,,,,,Inpatient,,,39032.6,39032.6,HUMANA CHOICE PLUS,MGD,39032.6,,,,,,,case rate,39032.6,39032.6,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,AETNA,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,BCBS,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,CIGNA,COM,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,TRICARE,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,UNITED HEALTHCARE,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,UNITED HEALTHCARE,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,VA,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,VA TRICARE,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,WELLMED,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,HUMANA,MGD,18736.07,,,,,,,per diem,18736.07,18736.07,"Per diem rate, code is bundled with other services"
STNT PLC TRANSC VEIN ADD      ,74080528,CDM,361,RC,,,,,,Inpatient,,,18736.07,18736.07,HUMANA CHOICE PLUS,MGD,18736.07,,,,,,,case rate,18736.07,18736.07,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,AETNA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,CIGNA,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,WELLMED,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA,MGD,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR VENOUS     ,74080529,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA CHOICE PLUS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,AETNA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,CIGNA,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,WELLMED,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA,MGD,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB NON HEMORR ART        ,74080530,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA CHOICE PLUS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,AETNA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,CIGNA,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,WELLMED,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA,MGD,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB TUMOR/ORGAN INFAR     ,74080531,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA CHOICE PLUS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,AETNA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,BCBS,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,CIGNA,COM,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,UNITED HEALTHCARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,VA TRICARE,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,WELLMED,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA,MGD,56399.93,,,,,,,per diem,56399.93,56399.93,"Per diem rate, code is bundled with other services"
OCC/EMB HEMORRHAG/LYMPH       ,74080532,CDM,361,RC,,,,,,Inpatient,,,56399.93,56399.93,HUMANA CHOICE PLUS,MGD,56399.93,,,,,,,case rate,56399.93,56399.93,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,74080533,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,74080534,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,AETNA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,CIGNA,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,WELLMED,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA,MGD,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL RT      ,74080535,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA CHOICE PLUS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,AETNA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,CIGNA,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,WELLMED,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA,MGD,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL SUPRSEL LT      ,74080536,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA CHOICE PLUS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,AETNA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,CIGNA,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,WELLMED,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA,MGD,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL RT      ,74080537,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA CHOICE PLUS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,AETNA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,BCBS,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,CIGNA,COM,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,UNITED HEALTHCARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,VA TRICARE,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,WELLMED,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA,MGD,16486.97,,,,,,,per diem,16486.97,16486.97,"Per diem rate, code is bundled with other services"
CTH PLC RENAL ART SEL LT      ,74080538,CDM,361,RC,,,,,,Inpatient,,,16486.97,16486.97,HUMANA CHOICE PLUS,MGD,16486.97,,,,,,,case rate,16486.97,16486.97,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,AETNA,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,BCBS,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,CIGNA,COM,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,TRICARE,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,UNITED HEALTHCARE,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,UNITED HEALTHCARE,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,VA,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,VA TRICARE,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,WELLMED,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,HUMANA,MGD,3103.76,,,,,,,per diem,3103.76,3103.76,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAG BIL      ,74080539,CDM,361,RC,,,,,,Inpatient,,,3103.76,3103.76,HUMANA CHOICE PLUS,MGD,3103.76,,,,,,,case rate,3103.76,3103.76,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,AETNA,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,BCBS,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,CIGNA,COM,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,TRICARE,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,UNITED HEALTHCARE,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,UNITED HEALTHCARE,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,VA,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,VA TRICARE,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,WELLMED,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,HUMANA,MGD,9322.24,,,,,,,per diem,9322.24,9322.24,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER 1ST     ,74080540,CDM,361,RC,,,,,,Inpatient,,,9322.24,9322.24,HUMANA CHOICE PLUS,MGD,9322.24,,,,,,,case rate,9322.24,9322.24,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,AETNA,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,BCBS,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,CIGNA,COM,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,TRICARE,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,UNITED HEALTHCARE,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,UNITED HEALTHCARE,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,VA,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,VA TRICARE,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,WELLMED,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,HUMANA,MGD,4295.78,,,,,,,per diem,4295.78,4295.78,"Per diem rate, code is bundled with other services"
ANES/STE EPI L/S SNGL INJ     ,74080541,CDM,361,RC,,,,,,Inpatient,,,4295.78,4295.78,HUMANA CHOICE PLUS,MGD,4295.78,,,,,,,case rate,4295.78,4295.78,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,AETNA,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,BCBS,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,CIGNA,COM,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,TRICARE,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,UNITED HEALTHCARE,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,UNITED HEALTHCARE,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,VA,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,VA TRICARE,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,WELLMED,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,HUMANA,MGD,13707.73,,,,,,,per diem,13707.73,13707.73,"Per diem rate, code is bundled with other services"
EXTRM VEN ABLAT LASER ADD     ,74080542,CDM,361,RC,,,,,,Inpatient,,,13707.73,13707.73,HUMANA CHOICE PLUS,MGD,13707.73,,,,,,,case rate,13707.73,13707.73,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,AETNA,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,BCBS,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,CIGNA,COM,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,TRICARE,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,UNITED HEALTHCARE,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,UNITED HEALTHCARE,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,VA,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,VA TRICARE,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,WELLMED,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,HUMANA,MGD,11264.78,,,,,,,per diem,11264.78,11264.78,"Per diem rate, code is bundled with other services"
RPR INTEST FISTULA W PLUG     ,74080543,CDM,361,RC,,,,,,Inpatient,,,11264.78,11264.78,HUMANA CHOICE PLUS,MGD,11264.78,,,,,,,case rate,11264.78,11264.78,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,AETNA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,CIGNA,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,WELLMED,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA,MGD,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ C/T W IMAG     ,74080544,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA CHOICE PLUS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,AETNA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,CIGNA,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,WELLMED,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA,MGD,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ L/S W IMAG     ,74080545,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA CHOICE PLUS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,AETNA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,BCBS,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,CIGNA,COM,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,UNITED HEALTHCARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,VA TRICARE,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,WELLMED,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA,MGD,15953.62,,,,,,,per diem,15953.62,15953.62,"Per diem rate, code is bundled with other services"
VERTEBROPL INJ ADD W IMAG     ,74080546,CDM,361,RC,,,,,,Inpatient,,,15953.62,15953.62,HUMANA CHOICE PLUS,MGD,15953.62,,,,,,,case rate,15953.62,15953.62,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,AETNA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,CIGNA,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,WELLMED,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA,MGD,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM THORAC W IMAG     ,74080547,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA CHOICE PLUS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,AETNA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,CIGNA,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,WELLMED,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA,MGD,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM LUMBAR W IMAG     ,74080548,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA CHOICE PLUS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,AETNA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,BCBS,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,CIGNA,COM,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,UNITED HEALTHCARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,VA TRICARE,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,WELLMED,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA,MGD,38769.13,,,,,,,per diem,38769.13,38769.13,"Per diem rate, code is bundled with other services"
VERTEB AUGM EA ADD W IMAG     ,74080549,CDM,361,RC,,,,,,Inpatient,,,38769.13,38769.13,HUMANA CHOICE PLUS,MGD,38769.13,,,,,,,case rate,38769.13,38769.13,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080550,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080551,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080552,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,AETNA,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,BCBS,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,CIGNA,COM,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,TRICARE,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,UNITED HEALTHCARE,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,UNITED HEALTHCARE,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,VA,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,VA TRICARE,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,WELLMED,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,HUMANA,MGD,2658,,,,,,,per diem,2658,2658,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080553,CDM,361,RC,,,,,,Inpatient,,,2658,2658,HUMANA CHOICE PLUS,MGD,2658,,,,,,,case rate,2658,2658,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080554,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080555,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080556,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,AETNA,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,BCBS,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,CIGNA,COM,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,TRICARE,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,UNITED HEALTHCARE,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,UNITED HEALTHCARE,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,VA,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,VA TRICARE,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,WELLMED,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,HUMANA,MGD,7991.05,,,,,,,per diem,7991.05,7991.05,"Per diem rate, code is bundled with other services"
CAROTID STNT TRANSC ANTEG     ,74080557,CDM,361,RC,,,,,,Inpatient,,,7991.05,7991.05,HUMANA CHOICE PLUS,MGD,7991.05,,,,,,,case rate,7991.05,7991.05,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,AETNA,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,BCBS,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,CIGNA,COM,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,TRICARE,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,UNITED HEALTHCARE,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,UNITED HEALTHCARE,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,VA,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,VA TRICARE,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,WELLMED,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,HUMANA,MGD,4754.17,,,,,,,per diem,4754.17,4754.17,"Per diem rate, code is bundled with other services"
REM CALCULI BILI DUCT/GB      ,74080558,CDM,361,RC,,,,,,Inpatient,,,4754.17,4754.17,HUMANA CHOICE PLUS,MGD,4754.17,,,,,,,case rate,4754.17,4754.17,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,AETNA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,CIGNA,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,VA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,VA TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,WELLMED,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA,MGD,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX INI     ,74080559,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA CHOICE PLUS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,AETNA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,BCBS,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,CIGNA,COM,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,UNITED HEALTHCARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,VA,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,VA TRICARE,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,WELLMED,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA,MGD,752.91,,,,,,,per diem,752.91,752.91,"Per diem rate, code is bundled with other services"
ENDO INTR PRLNG AD RX ADD     ,74080560,CDM,361,RC,,,,,,Inpatient,,,752.91,752.91,HUMANA CHOICE PLUS,MGD,752.91,,,,,,,case rate,752.91,752.91,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,AETNA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,CIGNA,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,WELLMED,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA,MGD,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEGR NEPH&/URETE NW     ,74080561,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA CHOICE PLUS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,AETNA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,CIGNA,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,WELLMED,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA,MGD,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTEG NEPH&/URETER EX     ,74080562,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA CHOICE PLUS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,74080563,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,AETNA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,CIGNA,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,WELLMED,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA,MGD,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
ENDOLUM BX UETER/RNL PELV     ,74080564,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA CHOICE PLUS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,AETNA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,CIGNA,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,VA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,VA TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,WELLMED,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA,MGD,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORON W IMAG INI     ,74080565,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA CHOICE PLUS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,AETNA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,BCBS,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,CIGNA,COM,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,UNITED HEALTHCARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,VA,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,VA TRICARE,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,WELLMED,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA,MGD,556.92,,,,,,,per diem,556.92,556.92,"Per diem rate, code is bundled with other services"
IVUS NON CORO W IM EA ADD     ,74080566,CDM,361,RC,,,,,,Inpatient,,,556.92,556.92,HUMANA CHOICE PLUS,MGD,556.92,,,,,,,case rate,556.92,556.92,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,74080567,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,74080568,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,74080569,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,74080570,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,74080571,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,74080572,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,AETNA,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,BCBS,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,CIGNA,COM,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,TRICARE,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,UNITED HEALTHCARE,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,UNITED HEALTHCARE,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,VA,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,VA TRICARE,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,WELLMED,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,HUMANA,MGD,2054.18,,,,,,,per diem,2054.18,2054.18,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080573,CDM,361,RC,,,,,,Inpatient,,,2054.18,2054.18,HUMANA CHOICE PLUS,MGD,2054.18,,,,,,,case rate,2054.18,2054.18,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080574,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080575,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080576,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080577,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080578,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,AETNA,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,BCBS,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,CIGNA,COM,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,TRICARE,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,UNITED HEALTHCARE,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,UNITED HEALTHCARE,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,VA,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,VA TRICARE,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,WELLMED,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,HUMANA,MGD,2585.39,,,,,,,per diem,2585.39,2585.39,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080579,CDM,361,RC,,,,,,Inpatient,,,2585.39,2585.39,HUMANA CHOICE PLUS,MGD,2585.39,,,,,,,case rate,2585.39,2585.39,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080580,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080581,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080582,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080583,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,74080584,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,74080585,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,74080586,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,74080587,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,74080588,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,74080589,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,AETNA,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,BCBS,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,CIGNA,COM,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,TRICARE,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,UNITED HEALTHCARE,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,UNITED HEALTHCARE,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,VA,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,VA TRICARE,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,WELLMED,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,HUMANA,MGD,9267.36,,,,,,,per diem,9267.36,9267.36,"Per diem rate, code is bundled with other services"
OCCLUSION/EMBOL URETERAL      ,74080590,CDM,361,RC,,,,,,Inpatient,,,9267.36,9267.36,HUMANA CHOICE PLUS,MGD,9267.36,,,,,,,case rate,9267.36,9267.36,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,AETNA,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,BCBS,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,CIGNA,COM,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,TRICARE,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,UNITED HEALTHCARE,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,UNITED HEALTHCARE,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,VA,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,VA TRICARE,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,WELLMED,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,HUMANA,MGD,4153.34,,,,,,,per diem,4153.34,4153.34,"Per diem rate, code is bundled with other services"
BALLOON DIL URETER STRICT     ,74080591,CDM,361,RC,,,,,,Inpatient,,,4153.34,4153.34,HUMANA CHOICE PLUS,MGD,4153.34,,,,,,,case rate,4153.34,4153.34,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,AETNA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,CIGNA,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,WELLMED,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA,MGD,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET NW BI     ,74080592,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA CHOICE PLUS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,AETNA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,BCBS,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,CIGNA,COM,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,UNITED HEALTHCARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,VA TRICARE,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,WELLMED,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA,MGD,3511.81,,,,,,,per diem,3511.81,3511.81,"Per diem rate, code is bundled with other services"
INJ ANTE NEPH&/URET EX BI     ,74080593,CDM,361,RC,,,,,,Inpatient,,,3511.81,3511.81,HUMANA CHOICE PLUS,MGD,3511.81,,,,,,,case rate,3511.81,3511.81,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,AETNA,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,CIGNA,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,TRICARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,UNITED HEALTHCARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,UNITED HEALTHCARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,VA,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,VA TRICARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,WELLMED,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,HUMANA,MGD,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080594,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,HUMANA CHOICE PLUS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,AETNA,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,BCBS,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,CIGNA,COM,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,TRICARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,UNITED HEALTHCARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,UNITED HEALTHCARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,VA,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,VA TRICARE,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,WELLMED,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,HUMANA,MGD,524.79,,,,,,,per diem,524.79,524.79,"Per diem rate, code is bundled with other services"
INSERT CATH BLADDER SMPL      ,74080595,CDM,361,RC,,,,,,Inpatient,,,524.79,524.79,HUMANA CHOICE PLUS,MGD,524.79,,,,,,,case rate,524.79,524.79,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM 1ST     ,74080596,CDM,360,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,AETNA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,CIGNA,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,VA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,VA TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,WELLMED,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA,MGD,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MAMM ADD     ,74080597,CDM,360,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA CHOICE PLUS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,AETNA,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,CIGNA,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,TRICARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,UNITED HEALTHCARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,UNITED HEALTHCARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,VA,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,VA TRICARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,WELLMED,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,HUMANA,MGD,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER 1ST     ,74080598,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,HUMANA CHOICE PLUS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,AETNA,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,BCBS,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,CIGNA,COM,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,TRICARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,UNITED HEALTHCARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,UNITED HEALTHCARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,VA,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,VA TRICARE,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,WELLMED,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,HUMANA,MGD,751.84,,,,,,,per diem,751.84,751.84,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV STER ADD     ,74080599,CDM,360,RC,,,,,,Inpatient,,,751.84,751.84,HUMANA CHOICE PLUS,MGD,751.84,,,,,,,case rate,751.84,751.84,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,AETNA,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,BCBS,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,CIGNA,COM,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,TRICARE,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,UNITED HEALTHCARE,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,UNITED HEALTHCARE,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,VA,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,VA TRICARE,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,WELLMED,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,HUMANA,MGD,706.86,,,,,,,per diem,706.86,706.86,"Per diem rate, code is bundled with other services"
ARTERIAL CATH/CANN PERC       ,74080600,CDM,361,RC,,,,,,Inpatient,,,706.86,706.86,HUMANA CHOICE PLUS,MGD,706.86,,,,,,,case rate,706.86,706.86,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,AETNA,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,BCBS,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,CIGNA,COM,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,TRICARE,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,UNITED HEALTHCARE,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,UNITED HEALTHCARE,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,VA,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,VA TRICARE,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,WELLMED,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,HUMANA,MGD,1167.39,,,,,,,per diem,1167.39,1167.39,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,74080601,CDM,361,RC,,,,,,Inpatient,,,1167.39,1167.39,HUMANA CHOICE PLUS,MGD,1167.39,,,,,,,case rate,1167.39,1167.39,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,AETNA,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,CIGNA,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,TRICARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,UNITED HEALTHCARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,UNITED HEALTHCARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,VA,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,VA TRICARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,WELLMED,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,HUMANA,MGD,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,74080602,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,HUMANA CHOICE PLUS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,AETNA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,CIGNA,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,VA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,VA TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,WELLMED,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA,MGD,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,74080603,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA CHOICE PLUS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,AETNA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,CIGNA,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,VA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,VA TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,WELLMED,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA,MGD,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM ANKLE INJ          ,74080604,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA CHOICE PLUS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM ELBOW INJ          ,74080605,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74080606,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,AETNA,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,BCBS,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,CIGNA,COM,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,TRICARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,UNITED HEALTHCARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,UNITED HEALTHCARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,VA,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,VA TRICARE,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,WELLMED,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,HUMANA,MGD,197.06,,,,,,,per diem,197.06,197.06,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74080607,CDM,361,RC,,,,,,Inpatient,,,197.06,197.06,HUMANA CHOICE PLUS,MGD,197.06,,,,,,,case rate,197.06,197.06,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRAM TMJ INJ PROC       ,74080608,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,AETNA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,BCBS,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,CIGNA,COM,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,UNITED HEALTHCARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,VA,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,VA TRICARE,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,WELLMED,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA,MGD,327.73,,,,,,,per diem,327.73,327.73,"Per diem rate, code is bundled with other services"
ARTHROGRAM WRIST INJ          ,74080609,CDM,361,RC,,,,,,Inpatient,,,327.73,327.73,HUMANA CHOICE PLUS,MGD,327.73,,,,,,,case rate,327.73,327.73,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
ARTHROGRM HIP WO ANES INJ     ,74080610,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,AETNA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,CIGNA,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,WELLMED,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA,MGD,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,74080611,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA CHOICE PLUS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,AETNA,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,BCBS,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,CIGNA,COM,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,TRICARE,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,UNITED HEALTHCARE,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,UNITED HEALTHCARE,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,VA,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,VA TRICARE,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,WELLMED,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,HUMANA,MGD,2296.22,,,,,,,per diem,2296.22,2296.22,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,74080612,CDM,361,RC,,,,,,Inpatient,,,2296.22,2296.22,HUMANA CHOICE PLUS,MGD,2296.22,,,,,,,case rate,2296.22,2296.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,AETNA,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,BCBS,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,CIGNA,COM,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,TRICARE,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,UNITED HEALTHCARE,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,UNITED HEALTHCARE,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,VA,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,VA TRICARE,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,WELLMED,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,HUMANA,MGD,2130.22,,,,,,,per diem,2130.22,2130.22,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,74080613,CDM,361,RC,,,,,,Inpatient,,,2130.22,2130.22,HUMANA CHOICE PLUS,MGD,2130.22,,,,,,,case rate,2130.22,2130.22,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,AETNA,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,BCBS,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,CIGNA,COM,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,TRICARE,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,UNITED HEALTHCARE,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,UNITED HEALTHCARE,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,VA,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,VA TRICARE,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,WELLMED,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,HUMANA,MGD,2435.45,,,,,,,per diem,2435.45,2435.45,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,74080614,CDM,361,RC,,,,,,Inpatient,,,2435.45,2435.45,HUMANA CHOICE PLUS,MGD,2435.45,,,,,,,case rate,2435.45,2435.45,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,AETNA,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,BCBS,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,CIGNA,COM,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,TRICARE,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,UNITED HEALTHCARE,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,UNITED HEALTHCARE,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,VA,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,VA TRICARE,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,WELLMED,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,HUMANA,MGD,2012.41,,,,,,,per diem,2012.41,2012.41,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,74080615,CDM,361,RC,,,,,,Inpatient,,,2012.41,2012.41,HUMANA CHOICE PLUS,MGD,2012.41,,,,,,,case rate,2012.41,2012.41,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,AETNA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,CIGNA,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,VA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,VA TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,WELLMED,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA,MGD,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,74080616,CDM,361,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA CHOICE PLUS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,AETNA,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,BCBS,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,CIGNA,COM,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,TRICARE,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,UNITED HEALTHCARE,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,UNITED HEALTHCARE,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,VA,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,VA TRICARE,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,WELLMED,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,HUMANA,MGD,2321.93,,,,,,,per diem,2321.93,2321.93,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,74080617,CDM,361,RC,,,,,,Inpatient,,,2321.93,2321.93,HUMANA CHOICE PLUS,MGD,2321.93,,,,,,,case rate,2321.93,2321.93,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,AETNA,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,BCBS,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,CIGNA,COM,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,TRICARE,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,UNITED HEALTHCARE,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,UNITED HEALTHCARE,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,VA,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,VA TRICARE,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,WELLMED,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,HUMANA,MGD,1994.2,,,,,,,per diem,1994.2,1994.2,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,74080618,CDM,361,RC,,,,,,Inpatient,,,1994.2,1994.2,HUMANA CHOICE PLUS,MGD,1994.2,,,,,,,case rate,1994.2,1994.2,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,AETNA,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,BCBS,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,CIGNA,COM,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,TRICARE,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,UNITED HEALTHCARE,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,UNITED HEALTHCARE,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,VA,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,VA TRICARE,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,WELLMED,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,HUMANA,MGD,1968.5,,,,,,,per diem,1968.5,1968.5,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,74080619,CDM,361,RC,,,,,,Inpatient,,,1968.5,1968.5,HUMANA CHOICE PLUS,MGD,1968.5,,,,,,,case rate,1968.5,1968.5,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,AETNA,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,BCBS,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,CIGNA,COM,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,TRICARE,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,UNITED HEALTHCARE,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,UNITED HEALTHCARE,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,VA,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,VA TRICARE,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,WELLMED,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,HUMANA,MGD,1134.19,,,,,,,per diem,1134.19,1134.19,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,74080620,CDM,361,RC,,,,,,Inpatient,,,1134.19,1134.19,HUMANA CHOICE PLUS,MGD,1134.19,,,,,,,case rate,1134.19,1134.19,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,AETNA,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,BCBS,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,CIGNA,COM,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,TRICARE,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,UNITED HEALTHCARE,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,UNITED HEALTHCARE,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,VA,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,VA TRICARE,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,WELLMED,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,HUMANA,MGD,2175.2,,,,,,,per diem,2175.2,2175.2,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,74080621,CDM,361,RC,,,,,,Inpatient,,,2175.2,2175.2,HUMANA CHOICE PLUS,MGD,2175.2,,,,,,,case rate,2175.2,2175.2,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
C1-C2 PUNC CIS/LAT W INJ      ,74080622,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,AETNA,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,BCBS,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,CIGNA,COM,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,TRICARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,UNITED HEALTHCARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,UNITED HEALTHCARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,VA,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,VA TRICARE,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,WELLMED,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,HUMANA,MGD,1084.92,,,,,,,per diem,1084.92,1084.92,"Per diem rate, code is bundled with other services"
CATH PLACE AORTA              ,74080623,CDM,361,RC,,,,,,Inpatient,,,1084.92,1084.92,HUMANA CHOICE PLUS,MGD,1084.92,,,,,,,case rate,1084.92,1084.92,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,AETNA,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,BCBS,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,CIGNA,COM,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,TRICARE,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,UNITED HEALTHCARE,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,UNITED HEALTHCARE,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,VA,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,VA TRICARE,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,WELLMED,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,HUMANA,MGD,9712.9,,,,,,,per diem,9712.9,9712.9,"Per diem rate, code is bundled with other services"
CTH PLC ECA SEL ADDON         ,74080624,CDM,361,RC,,,,,,Inpatient,,,9712.9,9712.9,HUMANA CHOICE PLUS,MGD,9712.9,,,,,,,case rate,9712.9,9712.9,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,AETNA,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,BCBS,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,CIGNA,COM,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,TRICARE,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,UNITED HEALTHCARE,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,UNITED HEALTHCARE,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,VA,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,VA TRICARE,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,WELLMED,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,HUMANA,MGD,881.43,,,,,,,per diem,881.43,881.43,"Per diem rate, code is bundled with other services"
CYSTO/VOID URETHR INJ         ,74080625,CDM,361,RC,,,,,,Inpatient,,,881.43,881.43,HUMANA CHOICE PLUS,MGD,881.43,,,,,,,case rate,881.43,881.43,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,AETNA,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,BCBS,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,CIGNA,COM,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,TRICARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,UNITED HEALTHCARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,UNITED HEALTHCARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,VA,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,VA TRICARE,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,WELLMED,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,HUMANA,MGD,6650.91,,,,,,,per diem,6650.91,6650.91,"Per diem rate, code is bundled with other services"
EVAL CV DVCE W FLUORO INJ     ,74080626,CDM,361,RC,,,,,,Inpatient,,,6650.91,6650.91,HUMANA CHOICE PLUS,MGD,6650.91,,,,,,,case rate,6650.91,6650.91,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,AETNA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,BCBS,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,CIGNA,COM,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,UNITED HEALTHCARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,VA TRICARE,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,WELLMED,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA,MGD,692.94,,,,,,,per diem,692.94,692.94,"Per diem rate, code is bundled with other services"
EVAL GI TBE PRC W FLU INJ     ,74080627,CDM,361,RC,,,,,,Inpatient,,,692.94,692.94,HUMANA CHOICE PLUS,MGD,692.94,,,,,,,case rate,692.94,692.94,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,AETNA,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,BCBS,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,CIGNA,COM,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,TRICARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,UNITED HEALTHCARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,UNITED HEALTHCARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,VA,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,VA TRICARE,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,WELLMED,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,HUMANA,MGD,911.42,,,,,,,per diem,911.42,911.42,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,74080628,CDM,361,RC,,,,,,Inpatient,,,911.42,911.42,HUMANA CHOICE PLUS,MGD,911.42,,,,,,,case rate,911.42,911.42,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,AETNA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,BCBS,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,CIGNA,COM,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,UNITED HEALTHCARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,VA TRICARE,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,WELLMED,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA,MGD,4066.59,,,,,,,per diem,4066.59,4066.59,"Per diem rate, code is bundled with other services"
INS IVC FILTER ENDOVAS        ,74080629,CDM,361,RC,,,,,,Inpatient,,,4066.59,4066.59,HUMANA CHOICE PLUS,MGD,4066.59,,,,,,,case rate,4066.59,4066.59,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,AETNA,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,BCBS,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,CIGNA,COM,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,TRICARE,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,UNITED HEALTHCARE,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,UNITED HEALTHCARE,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,VA,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,VA TRICARE,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,WELLMED,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,HUMANA,MGD,1875.32,,,,,,,per diem,1875.32,1875.32,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE DIAGNOSTC     ,74080630,CDM,361,RC,,,,,,Inpatient,,,1875.32,1875.32,HUMANA CHOICE PLUS,MGD,1875.32,,,,,,,case rate,1875.32,1875.32,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
LUMBAR PUNCTURE THERA         ,74080631,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,AETNA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,BCBS,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,CIGNA,COM,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,UNITED HEALTHCARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,VA,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,VA TRICARE,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,WELLMED,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA,MGD,1201.66,,,,,,,per diem,1201.66,1201.66,"Per diem rate, code is bundled with other services"
LYMPHANGIOGRAM INJ            ,74080632,CDM,361,RC,,,,,,Inpatient,,,1201.66,1201.66,HUMANA CHOICE PLUS,MGD,1201.66,,,,,,,case rate,1201.66,1201.66,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,AETNA,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,BCBS,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,CIGNA,COM,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,TRICARE,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,UNITED HEALTHCARE,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,UNITED HEALTHCARE,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,VA,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,VA TRICARE,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,WELLMED,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,HUMANA,MGD,4636.36,,,,,,,per diem,4636.36,4636.36,"Per diem rate, code is bundled with other services"
MYELOGRAM/CT LUMBAR INJ       ,74080633,CDM,361,RC,,,,,,Inpatient,,,4636.36,4636.36,HUMANA CHOICE PLUS,MGD,4636.36,,,,,,,case rate,4636.36,4636.36,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,AETNA,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,BCBS,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,CIGNA,COM,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,TRICARE,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,UNITED HEALTHCARE,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,UNITED HEALTHCARE,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,VA,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,VA TRICARE,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,WELLMED,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,HUMANA,MGD,2794.24,,,,,,,per diem,2794.24,2794.24,"Per diem rate, code is bundled with other services"
PLACE NG/OG TUBE PHY SKIL     ,74080634,CDM,361,RC,,,,,,Inpatient,,,2794.24,2794.24,HUMANA CHOICE PLUS,MGD,2794.24,,,,,,,case rate,2794.24,2794.24,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,74080635,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,AETNA,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,BCBS,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,CIGNA,COM,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,TRICARE,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,UNITED HEALTHCARE,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,UNITED HEALTHCARE,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,VA,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,VA TRICARE,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,WELLMED,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,HUMANA,MGD,2803.88,,,,,,,per diem,2803.88,2803.88,"Per diem rate, code is bundled with other services"
REM TUBE OBSTR W FLUORO       ,74080636,CDM,361,RC,,,,,,Inpatient,,,2803.88,2803.88,HUMANA CHOICE PLUS,MGD,2803.88,,,,,,,case rate,2803.88,2803.88,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,74080637,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,AETNA,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,BCBS,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,CIGNA,COM,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,TRICARE,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,UNITED HEALTHCARE,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,UNITED HEALTHCARE,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,VA,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,VA TRICARE,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,WELLMED,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,HUMANA,MGD,1046.37,,,,,,,per diem,1046.37,1046.37,"Per diem rate, code is bundled with other services"
SIALOGRAM INJ                 ,74080638,CDM,361,RC,,,,,,Inpatient,,,1046.37,1046.37,HUMANA CHOICE PLUS,MGD,1046.37,,,,,,,case rate,1046.37,1046.37,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,AETNA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,BCBS,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,CIGNA,COM,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,UNITED HEALTHCARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,VA TRICARE,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,WELLMED,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA,MGD,218.48,,,,,,,per diem,218.48,218.48,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,74080639,CDM,361,RC,,,,,,Inpatient,,,218.48,218.48,HUMANA CHOICE PLUS,MGD,218.48,,,,,,,case rate,218.48,218.48,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST STEREO PERC 1ST     ,74080640,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST STEREO PERC EA AD     ,74080641,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,AETNA,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,BCBS,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,CIGNA,COM,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,TRICARE,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,UNITED HEALTHCARE,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,UNITED HEALTHCARE,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,VA,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,VA TRICARE,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,WELLMED,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,HUMANA,MGD,938.2,,,,,,,per diem,938.2,938.2,"Per diem rate, code is bundled with other services"
VENOGRAM EXTREMTY INJ         ,74080642,CDM,361,RC,,,,,,Inpatient,,,938.2,938.2,HUMANA CHOICE PLUS,MGD,938.2,,,,,,,case rate,938.2,938.2,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,AETNA,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,BCBS,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,CIGNA,COM,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,TRICARE,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,UNITED HEALTHCARE,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,UNITED HEALTHCARE,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,VA,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,VA TRICARE,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,WELLMED,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,HUMANA,MGD,1333.4,,,,,,,per diem,1333.4,1333.4,"Per diem rate, code is bundled with other services"
GI TUBE LONG INTRO            ,74080643,CDM,361,RC,,,,,,Inpatient,,,1333.4,1333.4,HUMANA CHOICE PLUS,MGD,1333.4,,,,,,,case rate,1333.4,1333.4,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,AETNA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,BCBS,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,CIGNA,COM,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,UNITED HEALTHCARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,VA,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,VA TRICARE,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,WELLMED,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA,MGD,489.45,,,,,,,per diem,489.45,489.45,"Per diem rate, code is bundled with other services"
SINUS TRACT INJ DIAG          ,74080644,CDM,361,RC,,,,,,Inpatient,,,489.45,489.45,HUMANA CHOICE PLUS,MGD,489.45,,,,,,,case rate,489.45,489.45,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA CERVIC W INJ LUM     ,74080645,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA THORAC W INJ LUM     ,74080646,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGRA LUMBOS W INJ LUM     ,74080647,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,AETNA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,BCBS,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,CIGNA,COM,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,UNITED HEALTHCARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,VA TRICARE,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,WELLMED,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA,MGD,3765.64,,,,,,,per diem,3765.64,3765.64,"Per diem rate, code is bundled with other services"
MYELOGR>= 2 REG W INJ LUM     ,74080648,CDM,361,RC,,,,,,Inpatient,,,3765.64,3765.64,HUMANA CHOICE PLUS,MGD,3765.64,,,,,,,case rate,3765.64,3765.64,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,74080649,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,74080650,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,74080651,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,AETNA,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,BCBS,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,CIGNA,COM,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,TRICARE,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,UNITED HEALTHCARE,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,UNITED HEALTHCARE,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,VA,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,VA TRICARE,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,WELLMED,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,HUMANA,MGD,1771.43,,,,,,,per diem,1771.43,1771.43,"Per diem rate, code is bundled with other services"
CHOLANG EX ACCES INJ IMAG     ,74080652,CDM,361,RC,,,,,,Inpatient,,,1771.43,1771.43,HUMANA CHOICE PLUS,MGD,1771.43,,,,,,,case rate,1771.43,1771.43,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CHOLANG NW ACCES INJ IMAG     ,74080653,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH EXT IMAG     ,74080654,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC BILI DRN CTH INT-EXT      ,74080655,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
CONV BILI DRN CTH INT-EXT     ,74080656,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
EXCH BILI DRN CATH W IMAG     ,74080657,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,AETNA,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,BCBS,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,CIGNA,COM,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,TRICARE,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,UNITED HEALTHCARE,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,UNITED HEALTHCARE,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,VA,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,VA TRICARE,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,WELLMED,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,HUMANA,MGD,2819.94,,,,,,,per diem,2819.94,2819.94,"Per diem rate, code is bundled with other services"
REM BILI DRN CTH W FLUORO     ,74080658,CDM,361,RC,,,,,,Inpatient,,,2819.94,2819.94,HUMANA CHOICE PLUS,MGD,2819.94,,,,,,,case rate,2819.94,2819.94,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STENT BILE DUCT EX EA     ,74080659,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PLC STNT BILE DUCT NEW EA     ,74080660,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,AETNA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,BCBS,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,CIGNA,COM,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,UNITED HEALTHCARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,VA TRICARE,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,WELLMED,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA,MGD,24053.59,,,,,,,per diem,24053.59,24053.59,"Per diem rate, code is bundled with other services"
PL ST BILE DUCT CTH NW EA     ,74080661,CDM,361,RC,,,,,,Inpatient,,,24053.59,24053.59,HUMANA CHOICE PLUS,MGD,24053.59,,,,,,,case rate,24053.59,24053.59,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,AETNA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,BCBS,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,CIGNA,COM,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,UNITED HEALTHCARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,VA TRICARE,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,WELLMED,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA,MGD,12715.98,,,,,,,per diem,12715.98,12715.98,"Per diem rate, code is bundled with other services"
PLC ACCESS BILI TREE SB       ,74080662,CDM,361,RC,,,,,,Inpatient,,,12715.98,12715.98,HUMANA CHOICE PLUS,MGD,12715.98,,,,,,,case rate,12715.98,12715.98,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,AETNA,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,BCBS,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,CIGNA,COM,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,TRICARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,UNITED HEALTHCARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,UNITED HEALTHCARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,VA,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,VA TRICARE,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,WELLMED,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,HUMANA,MGD,810.75,,,,,,,per diem,810.75,810.75,"Per diem rate, code is bundled with other services"
REM NONBIO DRUG DELIV IMP     ,74080663,CDM,361,RC,,,,,,Inpatient,,,810.75,810.75,HUMANA CHOICE PLUS,MGD,810.75,,,,,,,case rate,810.75,810.75,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,AETNA,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,BCBS,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,CIGNA,COM,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,TRICARE,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,UNITED HEALTHCARE,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,UNITED HEALTHCARE,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,VA,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,VA TRICARE,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,WELLMED,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,HUMANA,MGD,5135.55,,,,,,,per diem,5135.55,5135.55,"Per diem rate, code is bundled with other services"
UNLISTED RAD PROC OUTSIDE SERV,74099999,CDM,320,RC,76499,CPT,,,,Inpatient,,,5135.55,5135.55,HUMANA CHOICE PLUS,MGD,5135.55,,,,,,,case rate,5135.55,5135.55,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,AETNA,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,BCBS,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,CIGNA,COM,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,TRICARE,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,UNITED HEALTHCARE,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,UNITED HEALTHCARE,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,VA,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,VA TRICARE,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,WELLMED,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,HUMANA,MGD,3354.08,,,,,,,per diem,3354.08,3354.08,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/O CONT          ,74200010,CDM,610,RC,74181,CPT,,,,Inpatient,,,3354.08,3354.08,HUMANA CHOICE PLUS,MGD,3354.08,,,,,,,case rate,3354.08,3354.08,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,AETNA,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,BCBS,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,CIGNA,COM,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,TRICARE,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,UNITED HEALTHCARE,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,UNITED HEALTHCARE,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,VA,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,VA TRICARE,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,WELLMED,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,HUMANA,MGD,2808.75,,,,,,,per diem,2808.75,2808.75,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE WO CONTRAST  ,74200014,CDM,612,RC,72148,CPT,,,,Inpatient,,,2808.75,2808.75,HUMANA CHOICE PLUS,MGD,2808.75,,,,,,,case rate,2808.75,2808.75,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,AETNA,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,BCBS,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,CIGNA,COM,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,TRICARE,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,UNITED HEALTHCARE,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,UNITED HEALTHCARE,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,VA,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,VA TRICARE,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,WELLMED,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,HUMANA,MGD,3880.8,,,,,,,per diem,3880.8,3880.8,"Per diem rate, code is bundled with other services"
MRI BRAIN W/WO CONTRAST       ,74200020,CDM,611,RC,70553,CPT,,,,Inpatient,,,3880.8,3880.8,HUMANA CHOICE PLUS,MGD,3880.8,,,,,,,case rate,3880.8,3880.8,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,AETNA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,BCBS,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,CIGNA,COM,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,UNITED HEALTHCARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,VA,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,VA TRICARE,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,WELLMED,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,HUMANA,MGD,165.9,,,,,,,per diem,165.9,165.9,"Per diem rate, code is bundled with other services"
MRA LOWER EXTR W/WO BILAT     ,74200021,CDM,610,RC,73725,CPT,,,50,Inpatient,,,165.9,165.9,HUMANA CHOICE PLUS,MGD,165.9,,,,,,,case rate,165.9,165.9,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,AETNA,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,BCBS,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,CIGNA,COM,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,TRICARE,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,UNITED HEALTHCARE,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,UNITED HEALTHCARE,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,VA,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,VA TRICARE,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,WELLMED,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,HUMANA,MGD,3712.82,,,,,,,per diem,3712.82,3712.82,"Per diem rate, code is bundled with other services"
MRI BRAIN W/CONTRAST          ,74200030,CDM,611,RC,70552,CPT,,,,Inpatient,,,3712.82,3712.82,HUMANA CHOICE PLUS,MGD,3712.82,,,,,,,case rate,3712.82,3712.82,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,AETNA,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,BCBS,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,CIGNA,COM,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,TRICARE,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,UNITED HEALTHCARE,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,UNITED HEALTHCARE,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,VA,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,VA TRICARE,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,WELLMED,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,HUMANA,MGD,2443.43,,,,,,,per diem,2443.43,2443.43,"Per diem rate, code is bundled with other services"
MRI BRAIN W/O CONTRAST        ,74200040,CDM,611,RC,70551,CPT,,,,Inpatient,,,2443.43,2443.43,HUMANA CHOICE PLUS,MGD,2443.43,,,,,,,case rate,2443.43,2443.43,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,AETNA,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,BCBS,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,CIGNA,COM,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,TRICARE,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,UNITED HEALTHCARE,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,UNITED HEALTHCARE,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,VA,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,VA TRICARE,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,WELLMED,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,HUMANA,MGD,8413.36,,,,,,,per diem,8413.36,8413.36,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/CONTRAST       ,74200050,CDM,612,RC,72142,CPT,,,,Inpatient,,,8413.36,8413.36,HUMANA CHOICE PLUS,MGD,8413.36,,,,,,,case rate,8413.36,8413.36,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,AETNA,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,BCBS,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,CIGNA,COM,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,TRICARE,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,UNITED HEALTHCARE,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,UNITED HEALTHCARE,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,VA,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,VA TRICARE,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,WELLMED,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,HUMANA,MGD,2837.67,,,,,,,per diem,2837.67,2837.67,"Per diem rate, code is bundled with other services"
MRI CERVICAL WO CONTRAST      ,74200060,CDM,612,RC,72141,CPT,,,,Inpatient,,,2837.67,2837.67,HUMANA CHOICE PLUS,MGD,2837.67,,,,,,,case rate,2837.67,2837.67,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,AETNA,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,BCBS,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,CIGNA,COM,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,TRICARE,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,UNITED HEALTHCARE,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,UNITED HEALTHCARE,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,VA,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,VA TRICARE,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,WELLMED,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,HUMANA,MGD,2151.64,,,,,,,per diem,2151.64,2151.64,"Per diem rate, code is bundled with other services"
MRI CHEST WO CONTRAST         ,74200070,CDM,610,RC,71550,CPT,,,,Inpatient,,,2151.64,2151.64,HUMANA CHOICE PLUS,MGD,2151.64,,,,,,,case rate,2151.64,2151.64,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,AETNA,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,BCBS,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,CIGNA,COM,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,TRICARE,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,UNITED HEALTHCARE,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,UNITED HEALTHCARE,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,VA,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,VA TRICARE,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,WELLMED,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,HUMANA,MGD,269.43,,,,,,,per diem,269.43,269.43,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST BIL,74200100,CDM,610,RC,73718,CPT,,,50,Inpatient,,,269.43,269.43,HUMANA CHOICE PLUS,MGD,269.43,,,,,,,case rate,269.43,269.43,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,AETNA,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,BCBS,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,CIGNA,COM,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,TRICARE,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,UNITED HEALTHCARE,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,UNITED HEALTHCARE,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,VA,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,VA TRICARE,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,WELLMED,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,HUMANA,MGD,2192.06,,,,,,,per diem,2192.06,2192.06,"Per diem rate, code is bundled with other services"
MRI LOW EXT JOINT W/O CONT BIL,74200120,CDM,610,RC,73721,CPT,,,50,Inpatient,,,2192.06,2192.06,HUMANA CHOICE PLUS,MGD,2192.06,,,,,,,case rate,2192.06,2192.06,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,AETNA,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,BCBS,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,CIGNA,COM,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,TRICARE,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,UNITED HEALTHCARE,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,UNITED HEALTHCARE,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,VA,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,VA TRICARE,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,WELLMED,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,HUMANA,MGD,6029.44,,,,,,,per diem,6029.44,6029.44,"Per diem rate, code is bundled with other services"
MRI LUMBAR SP W/CONTRAST      ,74200130,CDM,612,RC,72149,CPT,,,,Inpatient,,,6029.44,6029.44,HUMANA CHOICE PLUS,MGD,6029.44,,,,,,,case rate,6029.44,6029.44,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,AETNA,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,BCBS,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,CIGNA,COM,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,TRICARE,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,UNITED HEALTHCARE,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,UNITED HEALTHCARE,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,VA,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,VA TRICARE,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,WELLMED,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,HUMANA,MGD,1985.63,,,,,,,per diem,1985.63,1985.63,"Per diem rate, code is bundled with other services"
MRI ORBIT-FAC-NECK W/O CONT   ,74200160,CDM,610,RC,70540,CPT,,,,Inpatient,,,1985.63,1985.63,HUMANA CHOICE PLUS,MGD,1985.63,,,,,,,case rate,1985.63,1985.63,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,AETNA,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,BCBS,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,CIGNA,COM,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,TRICARE,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,UNITED HEALTHCARE,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,UNITED HEALTHCARE,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,VA,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,VA TRICARE,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,WELLMED,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,HUMANA,MGD,5629.38,,,,,,,per diem,5629.38,5629.38,"Per diem rate, code is bundled with other services"
MRI PELVIS W/O CONTRAST       ,74200180,CDM,612,RC,72195,CPT,,,,Inpatient,,,5629.38,5629.38,HUMANA CHOICE PLUS,MGD,5629.38,,,,,,,case rate,5629.38,5629.38,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,AETNA,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,BCBS,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,CIGNA,COM,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,TRICARE,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,UNITED HEALTHCARE,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,UNITED HEALTHCARE,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,VA,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,VA TRICARE,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,WELLMED,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,HUMANA,MGD,5970.76,,,,,,,per diem,5970.76,5970.76,"Per diem rate, code is bundled with other services"
MRI THORACIC W CONTRAST       ,74200210,CDM,612,RC,72147,CPT,,,,Inpatient,,,5970.76,5970.76,HUMANA CHOICE PLUS,MGD,5970.76,,,,,,,case rate,5970.76,5970.76,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,AETNA,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,BCBS,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,CIGNA,COM,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,TRICARE,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,UNITED HEALTHCARE,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,UNITED HEALTHCARE,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,VA,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,VA TRICARE,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,WELLMED,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,HUMANA,MGD,3312.63,,,,,,,per diem,3312.63,3312.63,"Per diem rate, code is bundled with other services"
MRI THORACIC WO CONTRAST      ,74200220,CDM,612,RC,72146,CPT,,,,Inpatient,,,3312.63,3312.63,HUMANA CHOICE PLUS,MGD,3312.63,,,,,,,case rate,3312.63,3312.63,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,AETNA,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,BCBS,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,CIGNA,COM,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,TRICARE,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,UNITED HEALTHCARE,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,UNITED HEALTHCARE,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,VA,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,VA TRICARE,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,WELLMED,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,HUMANA,MGD,4820.4,,,,,,,per diem,4820.4,4820.4,"Per diem rate, code is bundled with other services"
MRI CERVICAL W/WO CONTRAST    ,74200250,CDM,612,RC,72156,CPT,,,,Inpatient,,,4820.4,4820.4,HUMANA CHOICE PLUS,MGD,4820.4,,,,,,,case rate,4820.4,4820.4,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,AETNA,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,BCBS,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,CIGNA,COM,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,TRICARE,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,UNITED HEALTHCARE,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,UNITED HEALTHCARE,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,VA,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,VA TRICARE,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,WELLMED,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,HUMANA,MGD,5022.21,,,,,,,per diem,5022.21,5022.21,"Per diem rate, code is bundled with other services"
MRI LUMBAR SPINE W/WO CONTRAST,74200260,CDM,612,RC,72158,CPT,,,,Inpatient,,,5022.21,5022.21,HUMANA CHOICE PLUS,MGD,5022.21,,,,,,,case rate,5022.21,5022.21,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,AETNA,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,BCBS,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,CIGNA,COM,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,TRICARE,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,UNITED HEALTHCARE,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,UNITED HEALTHCARE,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,VA,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,VA TRICARE,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,WELLMED,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,HUMANA,MGD,3066.16,,,,,,,per diem,3066.16,3066.16,"Per diem rate, code is bundled with other services"
MRI THORACIC W/WO CONTRAST    ,74200270,CDM,612,RC,72157,CPT,,,,Inpatient,,,3066.16,3066.16,HUMANA CHOICE PLUS,MGD,3066.16,,,,,,,case rate,3066.16,3066.16,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,AETNA,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,BCBS,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,CIGNA,COM,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,TRICARE,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,UNITED HEALTHCARE,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,UNITED HEALTHCARE,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,VA,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,VA TRICARE,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,WELLMED,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,HUMANA,MGD,6874.75,,,,,,,per diem,6874.75,6874.75,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/CONTRAST        ,74200281,CDM,610,RC,74182,CPT,,,,Inpatient,,,6874.75,6874.75,HUMANA CHOICE PLUS,MGD,6874.75,,,,,,,case rate,6874.75,6874.75,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,AETNA,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,BCBS,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,CIGNA,COM,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,TRICARE,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,UNITED HEALTHCARE,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,UNITED HEALTHCARE,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,VA,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,VA TRICARE,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,WELLMED,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,HUMANA,MGD,3208.72,,,,,,,per diem,3208.72,3208.72,"Per diem rate, code is bundled with other services"
MRI CHEST W/CONTRAST          ,74200289,CDM,610,RC,71551,CPT,,,,Inpatient,,,3208.72,3208.72,HUMANA CHOICE PLUS,MGD,3208.72,,,,,,,case rate,3208.72,3208.72,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,AETNA,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,BCBS,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,CIGNA,COM,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,TRICARE,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,UNITED HEALTHCARE,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,UNITED HEALTHCARE,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,VA,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,VA TRICARE,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,WELLMED,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,HUMANA,MGD,2962.39,,,,,,,per diem,2962.39,2962.39,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/CONT    ,74200292,CDM,610,RC,70542,CPT,,,,Inpatient,,,2962.39,2962.39,HUMANA CHOICE PLUS,MGD,2962.39,,,,,,,case rate,2962.39,2962.39,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,AETNA,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,BCBS,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,CIGNA,COM,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,TRICARE,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,UNITED HEALTHCARE,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,UNITED HEALTHCARE,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,VA,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,VA TRICARE,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,WELLMED,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,HUMANA,MGD,1710.29,,,,,,,per diem,1710.29,1710.29,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST RT ,74200303,CDM,610,RC,73718,CPT,,,RT,Inpatient,,,1710.29,1710.29,HUMANA CHOICE PLUS,MGD,1710.29,,,,,,,case rate,1710.29,1710.29,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,AETNA,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,BCBS,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,CIGNA,COM,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,TRICARE,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,UNITED HEALTHCARE,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,UNITED HEALTHCARE,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,VA,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,VA TRICARE,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,WELLMED,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,HUMANA,MGD,1149.32,,,,,,,per diem,1149.32,1149.32,"Per diem rate, code is bundled with other services"
MRI LOWER EXT W/O CONTRAST LT ,74200304,CDM,610,RC,73718,CPT,,,LT,Inpatient,,,1149.32,1149.32,HUMANA CHOICE PLUS,MGD,1149.32,,,,,,,case rate,1149.32,1149.32,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,AETNA,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,BCBS,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,CIGNA,COM,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,TRICARE,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,UNITED HEALTHCARE,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,UNITED HEALTHCARE,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,VA,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,VA TRICARE,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,WELLMED,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,HUMANA,MGD,4926.6,,,,,,,per diem,4926.6,4926.6,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST LT ,74200305,CDM,610,RC,73218,CPT,,,LT,Inpatient,,,4926.6,4926.6,HUMANA CHOICE PLUS,MGD,4926.6,,,,,,,case rate,4926.6,4926.6,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,AETNA,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,BCBS,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,CIGNA,COM,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,TRICARE,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,UNITED HEALTHCARE,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,UNITED HEALTHCARE,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,VA,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,VA TRICARE,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,WELLMED,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,HUMANA,MGD,3573.15,,,,,,,per diem,3573.15,3573.15,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/O CONTRAST RT ,74200306,CDM,610,RC,73218,CPT,,,RT,Inpatient,,,3573.15,3573.15,HUMANA CHOICE PLUS,MGD,3573.15,,,,,,,case rate,3573.15,3573.15,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,AETNA,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,BCBS,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,CIGNA,COM,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,TRICARE,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,UNITED HEALTHCARE,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,UNITED HEALTHCARE,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,VA,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,VA TRICARE,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,WELLMED,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,HUMANA,MGD,845.21,,,,,,,per diem,845.21,845.21,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT LT  ,74200307,CDM,610,RC,73723,CPT,,,LT,Inpatient,,,845.21,845.21,HUMANA CHOICE PLUS,MGD,845.21,,,,,,,case rate,845.21,845.21,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,AETNA,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,BCBS,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,CIGNA,COM,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,TRICARE,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,UNITED HEALTHCARE,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,UNITED HEALTHCARE,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,VA,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,VA TRICARE,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,WELLMED,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,HUMANA,MGD,5501.73,,,,,,,per diem,5501.73,5501.73,"Per diem rate, code is bundled with other services"
MRI PELVIS W/ CONTRAST        ,74200400,CDM,612,RC,72196,CPT,,,,Inpatient,,,5501.73,5501.73,HUMANA CHOICE PLUS,MGD,5501.73,,,,,,,case rate,5501.73,5501.73,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,AETNA,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,BCBS,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,CIGNA,COM,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,TRICARE,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,UNITED HEALTHCARE,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,UNITED HEALTHCARE,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,VA,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,VA TRICARE,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,WELLMED,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,HUMANA,MGD,3289.71,,,,,,,per diem,3289.71,3289.71,"Per diem rate, code is bundled with other services"
MRI PELVIS W/WO CONTRAST      ,74200401,CDM,612,RC,72197,CPT,,,,Inpatient,,,3289.71,3289.71,HUMANA CHOICE PLUS,MGD,3289.71,,,,,,,case rate,3289.71,3289.71,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,AETNA,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,BCBS,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,CIGNA,COM,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,TRICARE,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,UNITED HEALTHCARE,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,UNITED HEALTHCARE,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,VA,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,VA TRICARE,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,WELLMED,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,HUMANA,MGD,1811.06,,,,,,,per diem,1811.06,1811.06,"Per diem rate, code is bundled with other services"
MRI TMJ                       ,74200409,CDM,610,RC,70336,CPT,,,,Inpatient,,,1811.06,1811.06,HUMANA CHOICE PLUS,MGD,1811.06,,,,,,,case rate,1811.06,1811.06,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,AETNA,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,BCBS,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,CIGNA,COM,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,TRICARE,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,UNITED HEALTHCARE,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,UNITED HEALTHCARE,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,VA,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,VA TRICARE,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,WELLMED,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,HUMANA,MGD,3366.15,,,,,,,per diem,3366.15,3366.15,"Per diem rate, code is bundled with other services"
MRI ORBIT-FACE-NECK W/WO CONTR,74200410,CDM,610,RC,70543,CPT,,,,Inpatient,,,3366.15,3366.15,HUMANA CHOICE PLUS,MGD,3366.15,,,,,,,case rate,3366.15,3366.15,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,AETNA,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,BCBS,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,CIGNA,COM,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,TRICARE,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,UNITED HEALTHCARE,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,UNITED HEALTHCARE,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,VA,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,VA TRICARE,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,WELLMED,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,HUMANA,MGD,2091.08,,,,,,,per diem,2091.08,2091.08,"Per diem rate, code is bundled with other services"
MRA HEAD WITHOUT CONTRAST     ,74200411,CDM,610,RC,70544,CPT,,,,Inpatient,,,2091.08,2091.08,HUMANA CHOICE PLUS,MGD,2091.08,,,,,,,case rate,2091.08,2091.08,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,AETNA,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,BCBS,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,CIGNA,COM,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,TRICARE,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,UNITED HEALTHCARE,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,UNITED HEALTHCARE,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,VA,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,VA TRICARE,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,WELLMED,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,HUMANA,MGD,5712.71,,,,,,,per diem,5712.71,5712.71,"Per diem rate, code is bundled with other services"
MRA HEAD WITH CONTRAST        ,74200412,CDM,610,RC,70545,CPT,,,,Inpatient,,,5712.71,5712.71,HUMANA CHOICE PLUS,MGD,5712.71,,,,,,,case rate,5712.71,5712.71,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,AETNA,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,BCBS,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,CIGNA,COM,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,TRICARE,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,UNITED HEALTHCARE,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,UNITED HEALTHCARE,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,VA,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,VA TRICARE,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,WELLMED,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,HUMANA,MGD,6479.55,,,,,,,per diem,6479.55,6479.55,"Per diem rate, code is bundled with other services"
MRA HEAD W/WO CONTRAST        ,74200413,CDM,610,RC,70546,CPT,,,,Inpatient,,,6479.55,6479.55,HUMANA CHOICE PLUS,MGD,6479.55,,,,,,,case rate,6479.55,6479.55,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,AETNA,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,BCBS,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,CIGNA,COM,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,TRICARE,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,UNITED HEALTHCARE,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,UNITED HEALTHCARE,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,VA,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,VA TRICARE,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,WELLMED,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,HUMANA,MGD,2922.76,,,,,,,per diem,2922.76,2922.76,"Per diem rate, code is bundled with other services"
MRA NECK WITHOUT CONTRAST     ,74200414,CDM,610,RC,70547,CPT,,,,Inpatient,,,2922.76,2922.76,HUMANA CHOICE PLUS,MGD,2922.76,,,,,,,case rate,2922.76,2922.76,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,AETNA,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,BCBS,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,CIGNA,COM,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,TRICARE,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,UNITED HEALTHCARE,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,UNITED HEALTHCARE,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,VA,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,VA TRICARE,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,WELLMED,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,HUMANA,MGD,4358.97,,,,,,,per diem,4358.97,4358.97,"Per diem rate, code is bundled with other services"
MRA NECK WITH CONTRAST        ,74200415,CDM,610,RC,70548,CPT,,,,Inpatient,,,4358.97,4358.97,HUMANA CHOICE PLUS,MGD,4358.97,,,,,,,case rate,4358.97,4358.97,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,AETNA,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,BCBS,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,CIGNA,COM,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,TRICARE,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,UNITED HEALTHCARE,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,UNITED HEALTHCARE,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,VA,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,VA TRICARE,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,WELLMED,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,HUMANA,MGD,4953.38,,,,,,,per diem,4953.38,4953.38,"Per diem rate, code is bundled with other services"
MRA NECK W/WO CONTRAST        ,74200416,CDM,610,RC,70549,CPT,,,,Inpatient,,,4953.38,4953.38,HUMANA CHOICE PLUS,MGD,4953.38,,,,,,,case rate,4953.38,4953.38,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,AETNA,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,BCBS,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,CIGNA,COM,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,TRICARE,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,UNITED HEALTHCARE,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,UNITED HEALTHCARE,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,VA,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,VA TRICARE,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,WELLMED,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,HUMANA,MGD,845.25,,,,,,,per diem,845.25,845.25,"Per diem rate, code is bundled with other services"
MRI LOW EXT JNT W/WO CONT BIL ,74200424,CDM,610,RC,73723,CPT,,,50,Inpatient,,,845.25,845.25,HUMANA CHOICE PLUS,MGD,845.25,,,,,,,case rate,845.25,845.25,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,AETNA,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,BCBS,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,CIGNA,COM,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,TRICARE,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,UNITED HEALTHCARE,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,UNITED HEALTHCARE,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,VA,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,VA TRICARE,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,WELLMED,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,HUMANA,MGD,5489.65,,,,,,,per diem,5489.65,5489.65,"Per diem rate, code is bundled with other services"
MRI ABDOMEN W/WO CONTRAST     ,74200425,CDM,610,RC,74183,CPT,,,,Inpatient,,,5489.65,5489.65,HUMANA CHOICE PLUS,MGD,5489.65,,,,,,,case rate,5489.65,5489.65,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,AETNA,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,BCBS,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,CIGNA,COM,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,TRICARE,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,UNITED HEALTHCARE,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,UNITED HEALTHCARE,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,VA,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,VA TRICARE,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,WELLMED,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,HUMANA,MGD,747.5,,,,,,,per diem,747.5,747.5,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT RT  ,74210019,CDM,610,RC,73221,CPT,,,RT,Inpatient,,,747.5,747.5,HUMANA CHOICE PLUS,MGD,747.5,,,,,,,case rate,747.5,747.5,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,AETNA,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,BCBS,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,CIGNA,COM,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,TRICARE,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,UNITED HEALTHCARE,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,UNITED HEALTHCARE,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,VA,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,VA TRICARE,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,WELLMED,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,HUMANA,MGD,706.05,,,,,,,per diem,706.05,706.05,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/O CONT LT  ,74210020,CDM,610,RC,73221,CPT,,,LT,Inpatient,,,706.05,706.05,HUMANA CHOICE PLUS,MGD,706.05,,,,,,,case rate,706.05,706.05,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,AETNA,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,CIGNA,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,TRICARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,UNITED HEALTHCARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,UNITED HEALTHCARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,VA,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,VA TRICARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,WELLMED,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,HUMANA,MGD,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MRA ABDOMEN  W/CONT           ,74210027,CDM,618,RC,74185,CPT,C8900,HCPCS,,Inpatient,,,3851.32,3851.32,HUMANA CHOICE PLUS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,AETNA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,CIGNA,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,VA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,VA TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,WELLMED,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,HUMANA,MGD,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MRA CHEST W/CONT              ,74210036,CDM,618,RC,71555,CPT,C8909,HCPCS,,Inpatient,,,2091.66,2091.66,HUMANA CHOICE PLUS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,AETNA,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,BCBS,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,CIGNA,COM,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,TRICARE,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,UNITED HEALTHCARE,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,UNITED HEALTHCARE,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,VA,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,VA TRICARE,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,WELLMED,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,HUMANA,MGD,3646.76,,,,,,,per diem,3646.76,3646.76,"Per diem rate, code is bundled with other services"
MRI CHEST W/WO CONTRAST       ,74210100,CDM,610,RC,71552,CPT,,,,Inpatient,,,3646.76,3646.76,HUMANA CHOICE PLUS,MGD,3646.76,,,,,,,case rate,3646.76,3646.76,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,AETNA,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,BCBS,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,CIGNA,COM,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,TRICARE,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,UNITED HEALTHCARE,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,UNITED HEALTHCARE,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,VA,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,VA TRICARE,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,WELLMED,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,HUMANA,MGD,507.23,,,,,,,per diem,507.23,507.23,"Per diem rate, code is bundled with other services"
MRI UPPER EXT W/WO CONT BILAT ,74210103,CDM,610,RC,73220,CPT,,,50,Inpatient,,,507.23,507.23,HUMANA CHOICE PLUS,MGD,507.23,,,,,,,case rate,507.23,507.23,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,AETNA,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,BCBS,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,CIGNA,COM,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,TRICARE,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,UNITED HEALTHCARE,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,UNITED HEALTHCARE,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,VA,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,VA TRICARE,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,WELLMED,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,HUMANA,MGD,1322.78,,,,,,,per diem,1322.78,1322.78,"Per diem rate, code is bundled with other services"
MRI UP EXT JOINT W/WO CON BIL ,74210106,CDM,610,RC,73223,CPT,,,50,Inpatient,,,1322.78,1322.78,HUMANA CHOICE PLUS,MGD,1322.78,,,,,,,case rate,1322.78,1322.78,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,AETNA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,BCBS,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,CIGNA,COM,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,UNITED HEALTHCARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,VA,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,VA TRICARE,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,WELLMED,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA,MGD,427.33,,,,,,,per diem,427.33,427.33,"Per diem rate, code is bundled with other services"
XR BONE DENSITYDXAAPEND       ,74250000,CDM,320,RC,,,,,,Inpatient,,,427.33,427.33,HUMANA CHOICE PLUS,MGD,427.33,,,,,,,case rate,427.33,427.33,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,AETNA,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,BCBS,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,CIGNA,COM,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,TRICARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,UNITED HEALTHCARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,UNITED HEALTHCARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,VA,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,VA TRICARE,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,WELLMED,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,HUMANA,MGD,3851.32,,,,,,,per diem,3851.32,3851.32,"Per diem rate, code is bundled with other services"
MR ANGIO ABDOMEN WO CON       ,74250001,CDM,618,RC,,,,,,Inpatient,,,3851.32,3851.32,HUMANA CHOICE PLUS,MGD,3851.32,,,,,,,case rate,3851.32,3851.32,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,AETNA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,CIGNA,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,VA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,VA TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,WELLMED,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,HUMANA,MGD,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST WO CON         ,74250002,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,HUMANA CHOICE PLUS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,AETNA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,BCBS,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,CIGNA,COM,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,UNITED HEALTHCARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,VA,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,VA TRICARE,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,WELLMED,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,HUMANA,MGD,2091.66,,,,,,,per diem,2091.66,2091.66,"Per diem rate, code is bundled with other services"
MR ANGIO CHEST W CON          ,74250003,CDM,618,RC,,,,,,Inpatient,,,2091.66,2091.66,HUMANA CHOICE PLUS,MGD,2091.66,,,,,,,case rate,2091.66,2091.66,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,AETNA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,CIGNA,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,VA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,VA TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,WELLMED,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,HUMANA,MGD,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
MR 3D WO SEPARATE WKSTATN     ,74250004,CDM,610,RC,,,,,,Inpatient,,,1254.14,1254.14,HUMANA CHOICE PLUS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,AETNA,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,CIGNA,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,TRICARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,UNITED HEALTHCARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,UNITED HEALTHCARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,VA,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,VA TRICARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,WELLMED,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,HUMANA,MGD,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
MR 3D W SEPARATE WKSTATN      ,74250005,CDM,610,RC,,,,,,Inpatient,,,3485.03,3485.03,HUMANA CHOICE PLUS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,AETNA,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,BCBS,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,CIGNA,COM,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,TRICARE,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,UNITED HEALTHCARE,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,UNITED HEALTHCARE,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,VA,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,VA TRICARE,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,WELLMED,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,HUMANA,MGD,471.24,,,,,,,per diem,471.24,471.24,"Per diem rate, code is bundled with other services"
GADOLINIUM-BAS MR CON/ML      ,74250006,CDM,636,RC,,,,,,Inpatient,1,EA,471.24,471.24,HUMANA CHOICE PLUS,MGD,471.24,,,,,,,case rate,471.24,471.24,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,AETNA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,CIGNA,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,VA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,VA TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,WELLMED,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA,MGD,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
MR VENOGRAM SUP SAGITTAL      ,74250007,CDM,320,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA CHOICE PLUS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,AETNA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,CIGNA,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,WELLMED,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA,MGD,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,74250008,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA CHOICE PLUS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,AETNA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,CIGNA,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,WELLMED,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA,MGD,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,74250009,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA CHOICE PLUS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,74250010,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,74250011,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,AETNA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,CIGNA,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,WELLMED,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA,MGD,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,74250012,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA CHOICE PLUS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,AETNA,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,BCBS,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,CIGNA,COM,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,TRICARE,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,UNITED HEALTHCARE,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,UNITED HEALTHCARE,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,VA,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,VA TRICARE,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,WELLMED,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,HUMANA,MGD,3770.99,,,,,,,per diem,3770.99,3770.99,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W BIL     ,74250013,CDM,616,RC,,,,,,Inpatient,,,3770.99,3770.99,HUMANA CHOICE PLUS,MGD,3770.99,,,,,,,case rate,3770.99,3770.99,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,AETNA,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,BCBS,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,CIGNA,COM,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,TRICARE,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,UNITED HEALTHCARE,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,UNITED HEALTHCARE,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,VA,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,VA TRICARE,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,WELLMED,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,HUMANA,MGD,2709.63,,,,,,,per diem,2709.63,2709.63,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS W CON         ,74250014,CDM,618,RC,,,,,,Inpatient,,,2709.63,2709.63,HUMANA CHOICE PLUS,MGD,2709.63,,,,,,,case rate,2709.63,2709.63,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,AETNA,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,BCBS,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,CIGNA,COM,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,TRICARE,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,UNITED HEALTHCARE,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,UNITED HEALTHCARE,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,VA,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,VA TRICARE,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,WELLMED,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,HUMANA,MGD,3041.64,,,,,,,per diem,3041.64,3041.64,"Per diem rate, code is bundled with other services"
MR ANGIO SPINE WO&W CON       ,74250015,CDM,618,RC,,,,,,Inpatient,,,3041.64,3041.64,HUMANA CHOICE PLUS,MGD,3041.64,,,,,,,case rate,3041.64,3041.64,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,AETNA,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,BCBS,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,CIGNA,COM,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,TRICARE,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,UNITED HEALTHCARE,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,UNITED HEALTHCARE,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,VA,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,VA TRICARE,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,WELLMED,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,HUMANA,MGD,2726.77,,,,,,,per diem,2726.77,2726.77,"Per diem rate, code is bundled with other services"
MR BONE MARROW BLD/SUPL       ,74250016,CDM,610,RC,,,,,,Inpatient,,,2726.77,2726.77,HUMANA CHOICE PLUS,MGD,2726.77,,,,,,,case rate,2726.77,2726.77,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,AETNA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,CIGNA,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,WELLMED,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA,MGD,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST W CON BIL           ,74250017,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA CHOICE PLUS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,AETNA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,CIGNA,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,WELLMED,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA,MGD,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST W CON UNI           ,74250018,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA CHOICE PLUS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,AETNA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,CIGNA,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,WELLMED,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA,MGD,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO CON BIL          ,74250019,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA CHOICE PLUS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,AETNA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,CIGNA,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,WELLMED,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA,MGD,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO CON UNI          ,74250020,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA CHOICE PLUS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,AETNA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,BCBS,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,CIGNA,COM,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,UNITED HEALTHCARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,VA TRICARE,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,WELLMED,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA,MGD,3497.89,,,,,,,per diem,3497.89,3497.89,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON BIL        ,74250021,CDM,610,RC,,,,,,Inpatient,,,3497.89,3497.89,HUMANA CHOICE PLUS,MGD,3497.89,,,,,,,case rate,3497.89,3497.89,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,AETNA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,BCBS,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,CIGNA,COM,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,UNITED HEALTHCARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,VA TRICARE,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,WELLMED,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA,MGD,2343.35,,,,,,,per diem,2343.35,2343.35,"Per diem rate, code is bundled with other services"
MR BREAST WO&W CON UNI        ,74250022,CDM,610,RC,,,,,,Inpatient,,,2343.35,2343.35,HUMANA CHOICE PLUS,MGD,2343.35,,,,,,,case rate,2343.35,2343.35,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,AETNA,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,CIGNA,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,TRICARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,UNITED HEALTHCARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,UNITED HEALTHCARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,VA,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,VA TRICARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,WELLMED,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,HUMANA,MGD,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC STRES WO&W CON     ,74250023,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,HUMANA CHOICE PLUS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,AETNA,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,BCBS,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,CIGNA,COM,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,TRICARE,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,UNITED HEALTHCARE,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,UNITED HEALTHCARE,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,VA,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,VA TRICARE,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,WELLMED,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,HUMANA,MGD,2683.93,,,,,,,per diem,2683.93,2683.93,"Per diem rate, code is bundled with other services"
MR CARDIAC VELOCITY FLOW      ,74250024,CDM,610,RC,,,,,,Inpatient,,,2683.93,2683.93,HUMANA CHOICE PLUS,MGD,2683.93,,,,,,,case rate,2683.93,2683.93,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,AETNA,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,CIGNA,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,TRICARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,UNITED HEALTHCARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,UNITED HEALTHCARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,VA,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,VA TRICARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,WELLMED,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,HUMANA,MGD,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC W STRESS IMG       ,74250025,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,HUMANA CHOICE PLUS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,AETNA,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,BCBS,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,CIGNA,COM,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,TRICARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,UNITED HEALTHCARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,UNITED HEALTHCARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,VA,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,VA TRICARE,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,WELLMED,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,HUMANA,MGD,3155.17,,,,,,,per diem,3155.17,3155.17,"Per diem rate, code is bundled with other services"
MR CARDIAC WO CON             ,74250026,CDM,610,RC,,,,,,Inpatient,,,3155.17,3155.17,HUMANA CHOICE PLUS,MGD,3155.17,,,,,,,case rate,3155.17,3155.17,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,AETNA,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,BCBS,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,CIGNA,COM,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,TRICARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,UNITED HEALTHCARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,UNITED HEALTHCARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,VA,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,VA TRICARE,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,WELLMED,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,HUMANA,MGD,3626.41,,,,,,,per diem,3626.41,3626.41,"Per diem rate, code is bundled with other services"
MR CARDIAC WO&W CON           ,74250027,CDM,610,RC,,,,,,Inpatient,,,3626.41,3626.41,HUMANA CHOICE PLUS,MGD,3626.41,,,,,,,case rate,3626.41,3626.41,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,AETNA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,CIGNA,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,VA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,VA TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,WELLMED,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA,MGD,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDE TISSUE ABLATION      ,74250028,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA CHOICE PLUS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,AETNA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,BCBS,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,CIGNA,COM,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,UNITED HEALTHCARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,VA,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,VA TRICARE,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,WELLMED,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA,MGD,2362.63,,,,,,,per diem,2362.63,2362.63,"Per diem rate, code is bundled with other services"
MR GUIDED NDL BX/ASP/INJ      ,74250029,CDM,610,RC,,,,,,Inpatient,,,2362.63,2362.63,HUMANA CHOICE PLUS,MGD,2362.63,,,,,,,case rate,2362.63,2362.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,AETNA,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,CIGNA,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,TRICARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,UNITED HEALTHCARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,UNITED HEALTHCARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,VA,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,VA TRICARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,WELLMED,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,HUMANA,MGD,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W RT        ,74250030,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,HUMANA CHOICE PLUS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,AETNA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,CIGNA,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,WELLMED,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA,MGD,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO BIL      ,74250031,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA CHOICE PLUS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,AETNA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,CIGNA,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,WELLMED,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA,MGD,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO LT       ,74250032,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA CHOICE PLUS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,AETNA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,BCBS,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,CIGNA,COM,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,UNITED HEALTHCARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,VA TRICARE,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,WELLMED,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA,MGD,6566.3,,,,,,,per diem,6566.3,6566.3,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO RT       ,74250033,CDM,610,RC,,,,,,Inpatient,,,6566.3,6566.3,HUMANA CHOICE PLUS,MGD,6566.3,,,,,,,case rate,6566.3,6566.3,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,AETNA,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,CIGNA,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,TRICARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,UNITED HEALTHCARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,UNITED HEALTHCARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,VA,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,VA TRICARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,WELLMED,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,HUMANA,MGD,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W RT     ,74250034,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,HUMANA CHOICE PLUS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,AETNA,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,CIGNA,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,TRICARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,UNITED HEALTHCARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,UNITED HEALTHCARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,VA,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,VA TRICARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,WELLMED,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,HUMANA,MGD,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON RT        ,74250035,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,HUMANA CHOICE PLUS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,AETNA,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,CIGNA,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,TRICARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,UNITED HEALTHCARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,UNITED HEALTHCARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,VA,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,VA TRICARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,WELLMED,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,HUMANA,MGD,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON RT       ,74250036,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,HUMANA CHOICE PLUS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,AETNA,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,CIGNA,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,TRICARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,UNITED HEALTHCARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,UNITED HEALTHCARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,VA,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,VA TRICARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,WELLMED,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,HUMANA,MGD,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON RT     ,74250037,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,HUMANA CHOICE PLUS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,AETNA,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,BCBS,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,CIGNA,COM,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,TRICARE,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,UNITED HEALTHCARE,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,UNITED HEALTHCARE,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,VA,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,VA TRICARE,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,WELLMED,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,HUMANA,MGD,2520.06,,,,,,,per diem,2520.06,2520.06,"Per diem rate, code is bundled with other services"
MR SPECTROSCOPY               ,74250038,CDM,614,RC,,,,,,Inpatient,,,2520.06,2520.06,HUMANA CHOICE PLUS,MGD,2520.06,,,,,,,case rate,2520.06,2520.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,AETNA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,CIGNA,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,WELLMED,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA,MGD,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W BIL       ,74250039,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA CHOICE PLUS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,AETNA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,CIGNA,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,WELLMED,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA,MGD,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W LT        ,74250040,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA CHOICE PLUS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,AETNA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,BCBS,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,CIGNA,COM,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,UNITED HEALTHCARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,VA TRICARE,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,WELLMED,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA,MGD,5649.53,,,,,,,per diem,5649.53,5649.53,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT W RT        ,74250041,CDM,610,RC,,,,,,Inpatient,,,5649.53,5649.53,HUMANA CHOICE PLUS,MGD,5649.53,,,,,,,case rate,5649.53,5649.53,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,AETNA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,CIGNA,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,WELLMED,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA,MGD,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO BIL      ,74250042,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA CHOICE PLUS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,AETNA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,CIGNA,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,WELLMED,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA,MGD,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO LT       ,74250043,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA CHOICE PLUS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,AETNA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,BCBS,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,CIGNA,COM,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,UNITED HEALTHCARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,VA TRICARE,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,WELLMED,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA,MGD,3791.34,,,,,,,per diem,3791.34,3791.34,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO RT       ,74250044,CDM,610,RC,,,,,,Inpatient,,,3791.34,3791.34,HUMANA CHOICE PLUS,MGD,3791.34,,,,,,,case rate,3791.34,3791.34,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,AETNA,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,CIGNA,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,TRICARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,UNITED HEALTHCARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,UNITED HEALTHCARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,VA,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,VA TRICARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,WELLMED,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,HUMANA,MGD,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W RT     ,74250045,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,HUMANA CHOICE PLUS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,AETNA,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,CIGNA,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,TRICARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,UNITED HEALTHCARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,UNITED HEALTHCARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,VA,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,VA TRICARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,WELLMED,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,HUMANA,MGD,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON RT        ,74250046,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,HUMANA CHOICE PLUS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,AETNA,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,CIGNA,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,TRICARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,UNITED HEALTHCARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,UNITED HEALTHCARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,VA,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,VA TRICARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,WELLMED,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,HUMANA,MGD,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON RT       ,74250047,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,HUMANA CHOICE PLUS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,AETNA,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,CIGNA,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,TRICARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,UNITED HEALTHCARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,UNITED HEALTHCARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,VA,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,VA TRICARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,WELLMED,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,HUMANA,MGD,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON RT     ,74250048,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,HUMANA CHOICE PLUS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,AETNA,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,BCBS,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,CIGNA,COM,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,TRICARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,UNITED HEALTHCARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,UNITED HEALTHCARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,VA,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,VA TRICARE,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,WELLMED,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,HUMANA,MGD,2528.63,,,,,,,per diem,2528.63,2528.63,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO CON LT       ,74250049,CDM,610,RC,,,,,,Inpatient,,,2528.63,2528.63,HUMANA CHOICE PLUS,MGD,2528.63,,,,,,,case rate,2528.63,2528.63,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,AETNA,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,BCBS,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,CIGNA,COM,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,TRICARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,UNITED HEALTHCARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,UNITED HEALTHCARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,VA,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,VA TRICARE,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,WELLMED,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,HUMANA,MGD,3772.06,,,,,,,per diem,3772.06,3772.06,"Per diem rate, code is bundled with other services"
MR UPP EXTREM W CON LT        ,74250050,CDM,610,RC,,,,,,Inpatient,,,3772.06,3772.06,HUMANA CHOICE PLUS,MGD,3772.06,,,,,,,case rate,3772.06,3772.06,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,AETNA,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,BCBS,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,CIGNA,COM,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,TRICARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,UNITED HEALTHCARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,UNITED HEALTHCARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,VA,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,VA TRICARE,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,WELLMED,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,HUMANA,MGD,4286.14,,,,,,,per diem,4286.14,4286.14,"Per diem rate, code is bundled with other services"
MR UPP EXTREM WO&W CON LT     ,74250051,CDM,610,RC,,,,,,Inpatient,,,4286.14,4286.14,HUMANA CHOICE PLUS,MGD,4286.14,,,,,,,case rate,4286.14,4286.14,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,AETNA,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,BCBS,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,CIGNA,COM,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,TRICARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,UNITED HEALTHCARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,UNITED HEALTHCARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,VA,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,VA TRICARE,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,WELLMED,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,HUMANA,MGD,6407.79,,,,,,,per diem,6407.79,6407.79,"Per diem rate, code is bundled with other services"
MR UPP EXTREM JNT WO&W LT     ,74250052,CDM,610,RC,,,,,,Inpatient,,,6407.79,6407.79,HUMANA CHOICE PLUS,MGD,6407.79,,,,,,,case rate,6407.79,6407.79,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,AETNA,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,BCBS,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,CIGNA,COM,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,TRICARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,UNITED HEALTHCARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,UNITED HEALTHCARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,VA,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,VA TRICARE,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,WELLMED,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,HUMANA,MGD,2842.43,,,,,,,per diem,2842.43,2842.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO CON LT       ,74250053,CDM,610,RC,,,,,,Inpatient,,,2842.43,2842.43,HUMANA CHOICE PLUS,MGD,2842.43,,,,,,,case rate,2842.43,2842.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,AETNA,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,BCBS,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,CIGNA,COM,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,TRICARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,UNITED HEALTHCARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,UNITED HEALTHCARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,VA,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,VA TRICARE,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,WELLMED,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,HUMANA,MGD,4240.09,,,,,,,per diem,4240.09,4240.09,"Per diem rate, code is bundled with other services"
MR LOW EXTREM W CON LT        ,74250054,CDM,610,RC,,,,,,Inpatient,,,4240.09,4240.09,HUMANA CHOICE PLUS,MGD,4240.09,,,,,,,case rate,4240.09,4240.09,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,AETNA,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,BCBS,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,CIGNA,COM,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,TRICARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,UNITED HEALTHCARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,UNITED HEALTHCARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,VA,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,VA TRICARE,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,WELLMED,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,HUMANA,MGD,4818.43,,,,,,,per diem,4818.43,4818.43,"Per diem rate, code is bundled with other services"
MR LOW EXTREM WO&W CON LT     ,74250055,CDM,610,RC,,,,,,Inpatient,,,4818.43,4818.43,HUMANA CHOICE PLUS,MGD,4818.43,,,,,,,case rate,4818.43,4818.43,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,AETNA,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,BCBS,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,CIGNA,COM,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,TRICARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,UNITED HEALTHCARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,UNITED HEALTHCARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,VA,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,VA TRICARE,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,WELLMED,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,HUMANA,MGD,9783.59,,,,,,,per diem,9783.59,9783.59,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT W LT        ,74250056,CDM,610,RC,,,,,,Inpatient,,,9783.59,9783.59,HUMANA CHOICE PLUS,MGD,9783.59,,,,,,,case rate,9783.59,9783.59,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,AETNA,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,BCBS,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,CIGNA,COM,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,TRICARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,UNITED HEALTHCARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,UNITED HEALTHCARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,VA,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,VA TRICARE,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,WELLMED,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,HUMANA,MGD,11096.63,,,,,,,per diem,11096.63,11096.63,"Per diem rate, code is bundled with other services"
MR LOW EXTREM JNT WO&W LT     ,74250057,CDM,610,RC,,,,,,Inpatient,,,11096.63,11096.63,HUMANA CHOICE PLUS,MGD,11096.63,,,,,,,case rate,11096.63,11096.63,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,AETNA,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,CIGNA,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,TRICARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,UNITED HEALTHCARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,UNITED HEALTHCARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,VA,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,VA TRICARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,WELLMED,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,HUMANA,MGD,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W RT      ,74250058,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,HUMANA CHOICE PLUS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,AETNA,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,BCBS,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,CIGNA,COM,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,TRICARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,UNITED HEALTHCARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,UNITED HEALTHCARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,VA,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,VA TRICARE,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,WELLMED,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,HUMANA,MGD,2732.12,,,,,,,per diem,2732.12,2732.12,"Per diem rate, code is bundled with other services"
MR ANGIO LOW EXTREM W LT      ,74250059,CDM,616,RC,,,,,,Inpatient,,,2732.12,2732.12,HUMANA CHOICE PLUS,MGD,2732.12,,,,,,,case rate,2732.12,2732.12,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,AETNA,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,CIGNA,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,TRICARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,UNITED HEALTHCARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,UNITED HEALTHCARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,VA,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,VA TRICARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,WELLMED,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,HUMANA,MGD,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W LT        ,74250060,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,HUMANA CHOICE PLUS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,AETNA,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,BCBS,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,CIGNA,COM,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,TRICARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,UNITED HEALTHCARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,UNITED HEALTHCARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,VA,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,VA TRICARE,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,WELLMED,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,HUMANA,MGD,2614.31,,,,,,,per diem,2614.31,2614.31,"Per diem rate, code is bundled with other services"
MR ANGIO UPP EXTR W RT        ,74250061,CDM,618,RC,,,,,,Inpatient,,,2614.31,2614.31,HUMANA CHOICE PLUS,MGD,2614.31,,,,,,,case rate,2614.31,2614.31,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,AETNA,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,BCBS,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,CIGNA,COM,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,TRICARE,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,UNITED HEALTHCARE,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,UNITED HEALTHCARE,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,VA,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,VA TRICARE,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,WELLMED,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,HUMANA,MGD,3025.58,,,,,,,per diem,3025.58,3025.58,"Per diem rate, code is bundled with other services"
MR ANGIO PELVIS WO&W CON      ,74250062,CDM,618,RC,,,,,,Inpatient,,,3025.58,3025.58,HUMANA CHOICE PLUS,MGD,3025.58,,,,,,,case rate,3025.58,3025.58,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,AETNA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,BCBS,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,CIGNA,COM,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,UNITED HEALTHCARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,VA,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,VA TRICARE,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,WELLMED,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,HUMANA,MGD,124.24,,,,,,,per diem,124.24,124.24,"Per diem rate, code is bundled with other services"
GADOXETATE /1ML 10ML SDV      ,74250063,CDM,636,RC,,,,,,Inpatient,1,EA,124.24,124.24,HUMANA CHOICE PLUS,MGD,124.24,,,,,,,case rate,124.24,124.24,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,AETNA,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,BCBS,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,CIGNA,COM,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,TRICARE,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,UNITED HEALTHCARE,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,UNITED HEALTHCARE,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,VA,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,VA TRICARE,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,WELLMED,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,HUMANA,MGD,1016.61,,,,,,,per diem,1016.61,1016.61,"Per diem rate, code is bundled with other services"
ARTHROGRAM HIP W ANES INJ     ,74250064,CDM,361,RC,,,,,,Inpatient,,,1016.61,1016.61,HUMANA CHOICE PLUS,MGD,1016.61,,,,,,,case rate,1016.61,1016.61,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,AETNA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,CIGNA,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,WELLMED,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA,MGD,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM KNEE CON INJ       ,74250065,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA CHOICE PLUS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,AETNA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,BCBS,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,CIGNA,COM,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,UNITED HEALTHCARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,VA TRICARE,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,WELLMED,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA,MGD,1247.72,,,,,,,per diem,1247.72,1247.72,"Per diem rate, code is bundled with other services"
ARTHROGRAM SHOULDER INJ       ,74250066,CDM,361,RC,,,,,,Inpatient,,,1247.72,1247.72,HUMANA CHOICE PLUS,MGD,1247.72,,,,,,,case rate,1247.72,1247.72,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC 1ST        ,74250067,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST MRI PERC EA ADD     ,74250068,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,AETNA,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,CIGNA,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,TRICARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,UNITED HEALTHCARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,UNITED HEALTHCARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,VA,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,VA TRICARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,WELLMED,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,HUMANA,MGD,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI 1ST      ,74250069,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,HUMANA CHOICE PLUS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,AETNA,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,BCBS,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,CIGNA,COM,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,TRICARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,UNITED HEALTHCARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,UNITED HEALTHCARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,VA,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,VA TRICARE,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,WELLMED,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,HUMANA,MGD,626.54,,,,,,,per diem,626.54,626.54,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV MRI ADD      ,74250070,CDM,361,RC,,,,,,Inpatient,,,626.54,626.54,HUMANA CHOICE PLUS,MGD,626.54,,,,,,,case rate,626.54,626.54,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,AETNA,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,BCBS,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,CIGNA,COM,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,TRICARE,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,UNITED HEALTHCARE,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,UNITED HEALTHCARE,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,VA,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,VA TRICARE,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,WELLMED,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,HUMANA,MGD,2621.02,,,,,,,per diem,2621.02,2621.02,"Per diem rate, code is bundled with other services"
RAD 60250 MRI CERVICAL SP     ,74250071,CDM,612,RC,,,,,,Inpatient,,,2621.02,2621.02,HUMANA CHOICE PLUS,MGD,2621.02,,,,,,,case rate,2621.02,2621.02,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,AETNA,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,BCBS,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,CIGNA,COM,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,TRICARE,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,UNITED HEALTHCARE,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,UNITED HEALTHCARE,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,VA,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,VA TRICARE,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,WELLMED,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,HUMANA,MGD,600.6,,,,,,,per diem,600.6,600.6,"Per diem rate, code is bundled with other services"
MRI EXTR LOWER JT W/O CON LEFT,74250072,CDM,614,RC,,,,,,Inpatient,,,600.6,600.6,HUMANA CHOICE PLUS,MGD,600.6,,,,,,,case rate,600.6,600.6,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,AETNA,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,BCBS,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,CIGNA,COM,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,TRICARE,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,UNITED HEALTHCARE,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,UNITED HEALTHCARE,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,VA,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,VA TRICARE,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,WELLMED,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,HUMANA,MGD,5341.88,,,,,,,per diem,5341.88,5341.88,"Per diem rate, code is bundled with other services"
MRI EXTR UPPR JT WO           ,74250074,CDM,610,RC,,,,,,Inpatient,,,5341.88,5341.88,HUMANA CHOICE PLUS,MGD,5341.88,,,,,,,case rate,5341.88,5341.88,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,AETNA,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,BCBS,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,CIGNA,COM,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,TRICARE,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,UNITED HEALTHCARE,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,UNITED HEALTHCARE,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,VA,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,VA TRICARE,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,WELLMED,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,HUMANA,MGD,754.56,,,,,,,per diem,754.56,754.56,"Per diem rate, code is bundled with other services"
MRI EXTR LWR NON JT           ,74250075,CDM,610,RC,,,,,,Inpatient,,,754.56,754.56,HUMANA CHOICE PLUS,MGD,754.56,,,,,,,case rate,754.56,754.56,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,AETNA,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,BCBS,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,CIGNA,COM,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,TRICARE,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,UNITED HEALTHCARE,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,UNITED HEALTHCARE,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,VA,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,VA TRICARE,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,WELLMED,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,HUMANA,MGD,700.62,,,,,,,per diem,700.62,700.62,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT WO C          ,74250076,CDM,610,RC,,,,,,Inpatient,,,700.62,700.62,HUMANA CHOICE PLUS,MGD,700.62,,,,,,,case rate,700.62,700.62,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,AETNA,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,BCBS,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,CIGNA,COM,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,TRICARE,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,UNITED HEALTHCARE,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,UNITED HEALTHCARE,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,VA,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,VA TRICARE,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,WELLMED,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,HUMANA,MGD,3024,,,,,,,per diem,3024,3024,"Per diem rate, code is bundled with other services"
MRI EXTR LWR JT W/WO          ,74250077,CDM,610,RC,,,,,,Inpatient,,,3024,3024,HUMANA CHOICE PLUS,MGD,3024,,,,,,,case rate,3024,3024,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US ABDOMEN COMPLETE           ,75000010,CDM,402,RC,76700,CPT,,,,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,AETNA,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,BCBS,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,CIGNA,COM,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,TRICARE,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,UNITED HEALTHCARE,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,UNITED HEALTHCARE,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,VA,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,VA TRICARE,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,WELLMED,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,HUMANA,MGD,340.14,,,,,,,per diem,340.14,340.14,"Per diem rate, code is bundled with other services"
US BLADDER POSTVOID RESIDUAL  ,75000011,CDM,920,RC,51798,CPT,,,,Inpatient,,,340.14,340.14,HUMANA CHOICE PLUS,MGD,340.14,,,,,,,case rate,340.14,340.14,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,AETNA,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,BCBS,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,CIGNA,COM,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,TRICARE,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,UNITED HEALTHCARE,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,UNITED HEALTHCARE,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,VA,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,VA TRICARE,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,WELLMED,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,HUMANA,MGD,963.38,,,,,,,per diem,963.38,963.38,"Per diem rate, code is bundled with other services"
US TRANSVAGINAL               ,75000018,CDM,402,RC,76830,CPT,,,,Inpatient,,,963.38,963.38,HUMANA CHOICE PLUS,MGD,963.38,,,,,,,case rate,963.38,963.38,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,AETNA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,CIGNA,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,VA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,VA TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,WELLMED,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,HUMANA,MGD,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST UNIL COMPLT         ,75000022,CDM,402,RC,76641,CPT,,,,Inpatient,,,428.4,428.4,HUMANA CHOICE PLUS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,AETNA,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,BCBS,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,CIGNA,COM,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,TRICARE,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,UNITED HEALTHCARE,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,UNITED HEALTHCARE,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,VA,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,VA TRICARE,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,WELLMED,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,HUMANA,MGD,387.49,,,,,,,per diem,387.49,387.49,"Per diem rate, code is bundled with other services"
US BREAST UNIL LIMITED        ,75000023,CDM,402,RC,76642,CPT,,,,Inpatient,,,387.49,387.49,HUMANA CHOICE PLUS,MGD,387.49,,,,,,,case rate,387.49,387.49,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,AETNA,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,BCBS,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,CIGNA,COM,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,TRICARE,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,UNITED HEALTHCARE,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,UNITED HEALTHCARE,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,VA,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,VA TRICARE,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,WELLMED,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,HUMANA,MGD,1549.81,,,,,,,per diem,1549.81,1549.81,"Per diem rate, code is bundled with other services"
US GUIDE FOR NEEDLE PLACEMENT ,75000025,CDM,402,RC,76942,CPT,,,,Inpatient,,,1549.81,1549.81,HUMANA CHOICE PLUS,MGD,1549.81,,,,,,,case rate,1549.81,1549.81,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,AETNA,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,BCBS,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,CIGNA,COM,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,TRICARE,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,UNITED HEALTHCARE,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,UNITED HEALTHCARE,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,VA,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,VA TRICARE,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,WELLMED,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,HUMANA,MGD,942.84,,,,,,,per diem,942.84,942.84,"Per diem rate, code is bundled with other services"
US GUIDE FOR VASCULAR ACCESS  ,75000028,CDM,402,RC,76937,CPT,,,,Inpatient,,,942.84,942.84,HUMANA CHOICE PLUS,MGD,942.84,,,,,,,case rate,942.84,942.84,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US DOPPLER ECHO HEART COMP ADD,75000040,CDM,483,RC,93320,CPT,,,,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,AETNA,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,BCBS,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,CIGNA,COM,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,TRICARE,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,UNITED HEALTHCARE,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,UNITED HEALTHCARE,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,VA,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,VA TRICARE,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,WELLMED,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,HUMANA,MGD,1259.97,,,,,,,per diem,1259.97,1259.97,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D COMPL,75000050,CDM,483,RC,93307,CPT,,,,Inpatient,,,1259.97,1259.97,HUMANA CHOICE PLUS,MGD,1259.97,,,,,,,case rate,1259.97,1259.97,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,AETNA,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,BCBS,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,CIGNA,COM,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,TRICARE,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,UNITED HEALTHCARE,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,UNITED HEALTHCARE,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,VA,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,VA TRICARE,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,WELLMED,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,HUMANA,MGD,988.05,,,,,,,per diem,988.05,988.05,"Per diem rate, code is bundled with other services"
US 2D ECHO DOPPLER/COLOR FLOW ,75000052,CDM,483,RC,93306,CPT,,,,Inpatient,,,988.05,988.05,HUMANA CHOICE PLUS,MGD,988.05,,,,,,,case rate,988.05,988.05,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,AETNA,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,BCBS,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,CIGNA,COM,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,TRICARE,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,UNITED HEALTHCARE,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,UNITED HEALTHCARE,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,VA,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,VA TRICARE,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,WELLMED,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,HUMANA,MGD,882.66,,,,,,,per diem,882.66,882.66,"Per diem rate, code is bundled with other services"
US ECHO TRANSTHORACIC 2D LIMIT,75000060,CDM,483,RC,93308,CPT,,,,Inpatient,,,882.66,882.66,HUMANA CHOICE PLUS,MGD,882.66,,,,,,,case rate,882.66,882.66,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,AETNA,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,BCBS,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,CIGNA,COM,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,TRICARE,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,UNITED HEALTHCARE,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,UNITED HEALTHCARE,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,VA,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,VA TRICARE,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,WELLMED,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,HUMANA,MGD,422.33,,,,,,,per diem,422.33,422.33,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL LIMITED    ,75000080,CDM,402,RC,76775,CPT,,,,Inpatient,,,422.33,422.33,HUMANA CHOICE PLUS,MGD,422.33,,,,,,,case rate,422.33,422.33,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,AETNA,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,BCBS,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,CIGNA,COM,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,TRICARE,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,UNITED HEALTHCARE,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,UNITED HEALTHCARE,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,VA,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,VA TRICARE,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,WELLMED,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,HUMANA,MGD,875.19,,,,,,,per diem,875.19,875.19,"Per diem rate, code is bundled with other services"
US PELVIC COMPLETE            ,75000110,CDM,402,RC,76856,CPT,,,,Inpatient,,,875.19,875.19,HUMANA CHOICE PLUS,MGD,875.19,,,,,,,case rate,875.19,875.19,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,AETNA,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,BCBS,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,CIGNA,COM,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,TRICARE,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,UNITED HEALTHCARE,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,UNITED HEALTHCARE,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,VA,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,VA TRICARE,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,WELLMED,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,HUMANA,MGD,890.28,,,,,,,per diem,890.28,890.28,"Per diem rate, code is bundled with other services"
US VASCULAR DUP VISCERAL COMP ,75000115,CDM,921,RC,93975,CPT,,,,Inpatient,,,890.28,890.28,HUMANA CHOICE PLUS,MGD,890.28,,,,,,,case rate,890.28,890.28,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,AETNA,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,BCBS,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,CIGNA,COM,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,TRICARE,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,UNITED HEALTHCARE,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,UNITED HEALTHCARE,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,VA,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,VA TRICARE,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,WELLMED,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,HUMANA,MGD,409.92,,,,,,,per diem,409.92,409.92,"Per diem rate, code is bundled with other services"
US VASC LTD-ABD/PELV/RETRPERI ,75000120,CDM,921,RC,93976,CPT,,,,Inpatient,,,409.92,409.92,HUMANA CHOICE PLUS,MGD,409.92,,,,,,,case rate,409.92,409.92,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,AETNA,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,BCBS,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,CIGNA,COM,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,TRICARE,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,UNITED HEALTHCARE,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,UNITED HEALTHCARE,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,VA,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,VA TRICARE,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,WELLMED,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,HUMANA,MGD,609.69,,,,,,,per diem,609.69,609.69,"Per diem rate, code is bundled with other services"
US PELVIS LIMITED OR FOLLOWUP ,75000126,CDM,402,RC,76857,CPT,,,,Inpatient,,,609.69,609.69,HUMANA CHOICE PLUS,MGD,609.69,,,,,,,case rate,609.69,609.69,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,AETNA,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,BCBS,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,CIGNA,COM,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,TRICARE,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,UNITED HEALTHCARE,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,UNITED HEALTHCARE,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,VA,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,VA TRICARE,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,WELLMED,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,HUMANA,MGD,1063.5,,,,,,,per diem,1063.5,1063.5,"Per diem rate, code is bundled with other services"
US PREG UTERUS LIMITED        ,75000127,CDM,402,RC,76815,CPT,,,,Inpatient,,,1063.5,1063.5,HUMANA CHOICE PLUS,MGD,1063.5,,,,,,,case rate,1063.5,1063.5,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,AETNA,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,CIGNA,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,TRICARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,UNITED HEALTHCARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,UNITED HEALTHCARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,VA,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,VA TRICARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,WELLMED,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,HUMANA,MGD,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US PREG UTERUS >14 WEEKS      ,75000130,CDM,402,RC,76805,CPT,,,,Inpatient,,,903.92,903.92,HUMANA CHOICE PLUS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,AETNA,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,BCBS,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,CIGNA,COM,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,TRICARE,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,UNITED HEALTHCARE,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,UNITED HEALTHCARE,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,VA,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,VA TRICARE,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,WELLMED,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,HUMANA,MGD,786.11,,,,,,,per diem,786.11,786.11,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS 1ST G,75000131,CDM,402,RC,76801,CPT,,,,Inpatient,,,786.11,786.11,HUMANA CHOICE PLUS,MGD,786.11,,,,,,,case rate,786.11,786.11,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,AETNA,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,BCBS,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,CIGNA,COM,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,TRICARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,UNITED HEALTHCARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,UNITED HEALTHCARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,VA,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,VA TRICARE,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,WELLMED,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,HUMANA,MGD,416.62,,,,,,,per diem,416.62,416.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS <14 WEEKS ADD G,75000132,CDM,402,RC,76802,CPT,,,,Inpatient,,,416.62,416.62,HUMANA CHOICE PLUS,MGD,416.62,,,,,,,case rate,416.62,416.62,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,AETNA,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,BCBS,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,CIGNA,COM,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,TRICARE,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,UNITED HEALTHCARE,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,UNITED HEALTHCARE,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,VA,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,VA TRICARE,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,WELLMED,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,HUMANA,MGD,1223.08,,,,,,,per diem,1223.08,1223.08,"Per diem rate, code is bundled with other services"
US PREGNANT UTERUS TRANSVAGINA,75000133,CDM,402,RC,76817,CPT,,,,Inpatient,,,1223.08,1223.08,HUMANA CHOICE PLUS,MGD,1223.08,,,,,,,case rate,1223.08,1223.08,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,AETNA,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,BCBS,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,CIGNA,COM,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,TRICARE,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,UNITED HEALTHCARE,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,UNITED HEALTHCARE,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,VA,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,VA TRICARE,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,WELLMED,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,HUMANA,MGD,382.07,,,,,,,per diem,382.07,382.07,"Per diem rate, code is bundled with other services"
US RETROPERITONEAL COMPLETE   ,75000140,CDM,402,RC,76770,CPT,,,,Inpatient,,,382.07,382.07,HUMANA CHOICE PLUS,MGD,382.07,,,,,,,case rate,382.07,382.07,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,AETNA,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,BCBS,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,CIGNA,COM,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,TRICARE,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,UNITED HEALTHCARE,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,UNITED HEALTHCARE,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,VA,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,VA TRICARE,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,WELLMED,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,HUMANA,MGD,440.17,,,,,,,per diem,440.17,440.17,"Per diem rate, code is bundled with other services"
US SCROTUM                    ,75000160,CDM,402,RC,76870,CPT,,,,Inpatient,,,440.17,440.17,HUMANA CHOICE PLUS,MGD,440.17,,,,,,,case rate,440.17,440.17,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,AETNA,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,BCBS,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,CIGNA,COM,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,TRICARE,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,UNITED HEALTHCARE,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,UNITED HEALTHCARE,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,VA,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,VA TRICARE,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,WELLMED,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,HUMANA,MGD,495.86,,,,,,,per diem,495.86,495.86,"Per diem rate, code is bundled with other services"
US CHEST                      ,75000170,CDM,402,RC,76604,CPT,,,,Inpatient,,,495.86,495.86,HUMANA CHOICE PLUS,MGD,495.86,,,,,,,case rate,495.86,495.86,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,AETNA,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,BCBS,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,CIGNA,COM,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,TRICARE,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,UNITED HEALTHCARE,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,UNITED HEALTHCARE,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,VA,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,VA TRICARE,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,WELLMED,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,HUMANA,MGD,1096.81,,,,,,,per diem,1096.81,1096.81,"Per diem rate, code is bundled with other services"
US HEAD/NECK SOFT TISSUE      ,75000175,CDM,402,RC,76536,CPT,,,,Inpatient,,,1096.81,1096.81,HUMANA CHOICE PLUS,MGD,1096.81,,,,,,,case rate,1096.81,1096.81,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,AETNA,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,BCBS,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,CIGNA,COM,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,TRICARE,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,UNITED HEALTHCARE,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,UNITED HEALTHCARE,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,VA,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,VA TRICARE,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,WELLMED,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,HUMANA,MGD,405.56,,,,,,,per diem,405.56,405.56,"Per diem rate, code is bundled with other services"
US LOW EXT ART DUPLEX COMP BIL,75000198,CDM,921,RC,93925,CPT,,,,Inpatient,,,405.56,405.56,HUMANA CHOICE PLUS,MGD,405.56,,,,,,,case rate,405.56,405.56,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,AETNA,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,BCBS,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,CIGNA,COM,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,TRICARE,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,UNITED HEALTHCARE,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,UNITED HEALTHCARE,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,VA,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,VA TRICARE,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,WELLMED,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,HUMANA,MGD,585.32,,,,,,,per diem,585.32,585.32,"Per diem rate, code is bundled with other services"
US EXT ARTERY SINGLE LEVEL BIL,75000199,CDM,921,RC,93922,CPT,,,,Inpatient,,,585.32,585.32,HUMANA CHOICE PLUS,MGD,585.32,,,,,,,case rate,585.32,585.32,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,AETNA,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,BCBS,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,CIGNA,COM,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,TRICARE,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,UNITED HEALTHCARE,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,UNITED HEALTHCARE,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,VA,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,VA TRICARE,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,WELLMED,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,HUMANA,MGD,789.6,,,,,,,per diem,789.6,789.6,"Per diem rate, code is bundled with other services"
US EXT VEIN STUDY COMPLETE BIL,75000200,CDM,921,RC,93965,CPT,,,,Inpatient,,,789.6,789.6,HUMANA CHOICE PLUS,MGD,789.6,,,,,,,case rate,789.6,789.6,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,AETNA,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,BCBS,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,CIGNA,COM,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,TRICARE,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,UNITED HEALTHCARE,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,UNITED HEALTHCARE,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,VA,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,VA TRICARE,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,WELLMED,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,HUMANA,MGD,977.55,,,,,,,per diem,977.55,977.55,"Per diem rate, code is bundled with other services"
US EXT VEIN DUPLEX COMPLETE BI,75000220,CDM,921,RC,93970,CPT,,,,Inpatient,,,977.55,977.55,HUMANA CHOICE PLUS,MGD,977.55,,,,,,,case rate,977.55,977.55,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,AETNA,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,BCBS,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,CIGNA,COM,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,TRICARE,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,UNITED HEALTHCARE,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,UNITED HEALTHCARE,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,VA,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,VA TRICARE,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,WELLMED,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,HUMANA,MGD,695.63,,,,,,,per diem,695.63,695.63,"Per diem rate, code is bundled with other services"
US EXT ARTERY COMPLETE BIL    ,75000230,CDM,921,RC,93923,CPT,,,,Inpatient,,,695.63,695.63,HUMANA CHOICE PLUS,MGD,695.63,,,,,,,case rate,695.63,695.63,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,AETNA,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,BCBS,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,CIGNA,COM,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,TRICARE,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,UNITED HEALTHCARE,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,UNITED HEALTHCARE,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,VA,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,VA TRICARE,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,WELLMED,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,HUMANA,MGD,565.48,,,,,,,per diem,565.48,565.48,"Per diem rate, code is bundled with other services"
US ABDOMEN LIMITED            ,75000250,CDM,402,RC,76705,CPT,,,,Inpatient,,,565.48,565.48,HUMANA CHOICE PLUS,MGD,565.48,,,,,,,case rate,565.48,565.48,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,AETNA,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,BCBS,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,CIGNA,COM,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,TRICARE,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,UNITED HEALTHCARE,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,UNITED HEALTHCARE,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,VA,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,VA TRICARE,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,WELLMED,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,HUMANA,MGD,479.43,,,,,,,per diem,479.43,479.43,"Per diem rate, code is bundled with other services"
US DOPPLER COLOR FLOW ADD-ON  ,75000255,CDM,480,RC,93325,CPT,,,,Inpatient,,,479.43,479.43,HUMANA CHOICE PLUS,MGD,479.43,,,,,,,case rate,479.43,479.43,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,AETNA,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,BCBS,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,CIGNA,COM,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,TRICARE,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,UNITED HEALTHCARE,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,UNITED HEALTHCARE,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,VA,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,VA TRICARE,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,WELLMED,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,HUMANA,MGD,2543.95,,,,,,,per diem,2543.95,2543.95,"Per diem rate, code is bundled with other services"
US TEE 2D W/PROBE PLACE COMP  ,75000260,CDM,483,RC,93312,CPT,,,,Inpatient,,,2543.95,2543.95,HUMANA CHOICE PLUS,MGD,2543.95,,,,,,,case rate,2543.95,2543.95,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,AETNA,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,BCBS,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,CIGNA,COM,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,TRICARE,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,UNITED HEALTHCARE,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,UNITED HEALTHCARE,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,VA,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,VA TRICARE,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,WELLMED,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,HUMANA,MGD,931.06,,,,,,,per diem,931.06,931.06,"Per diem rate, code is bundled with other services"
DUPLEX AORTA/IVC/GRAFT COMPL  ,75000280,CDM,921,RC,93978,CPT,,,,Inpatient,,,931.06,931.06,HUMANA CHOICE PLUS,MGD,931.06,,,,,,,case rate,931.06,931.06,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,AETNA,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,BCBS,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,CIGNA,COM,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,TRICARE,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,UNITED HEALTHCARE,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,UNITED HEALTHCARE,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,VA,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,VA TRICARE,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,WELLMED,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,HUMANA,MGD,517.3,,,,,,,per diem,517.3,517.3,"Per diem rate, code is bundled with other services"
DUPLEX AOTRA/IVC/GRAFT LTD    ,75000290,CDM,921,RC,93979,CPT,,,,Inpatient,,,517.3,517.3,HUMANA CHOICE PLUS,MGD,517.3,,,,,,,case rate,517.3,517.3,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,AETNA,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,BCBS,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,CIGNA,COM,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,TRICARE,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,UNITED HEALTHCARE,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,UNITED HEALTHCARE,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,VA,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,VA TRICARE,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,WELLMED,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,HUMANA,MGD,597.62,,,,,,,per diem,597.62,597.62,"Per diem rate, code is bundled with other services"
US PREG UTERUS MULTI GEST COMP,75000305,CDM,402,RC,76810,CPT,,,,Inpatient,,,597.62,597.62,HUMANA CHOICE PLUS,MGD,597.62,,,,,,,case rate,597.62,597.62,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,AETNA,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,BCBS,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,CIGNA,COM,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,TRICARE,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,UNITED HEALTHCARE,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,UNITED HEALTHCARE,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,VA,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,VA TRICARE,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,WELLMED,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,HUMANA,MGD,1750.01,,,,,,,per diem,1750.01,1750.01,"Per diem rate, code is bundled with other services"
US FETAL BIOPHYSICAL PROFILE  ,75000310,CDM,402,RC,76819,CPT,,,,Inpatient,,,1750.01,1750.01,HUMANA CHOICE PLUS,MGD,1750.01,,,,,,,case rate,1750.01,1750.01,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,AETNA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,BCBS,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,CIGNA,COM,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,UNITED HEALTHCARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,VA,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,VA TRICARE,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,WELLMED,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,HUMANA,MGD,317.02,,,,,,,per diem,317.02,317.02,"Per diem rate, code is bundled with other services"
US SPINAL CANAL               ,75005076,CDM,402,RC,76800,CPT,,,,Inpatient,,,317.02,317.02,HUMANA CHOICE PLUS,MGD,317.02,,,,,,,case rate,317.02,317.02,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,AETNA,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,BCBS,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,CIGNA,COM,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,TRICARE,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,UNITED HEALTHCARE,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,UNITED HEALTHCARE,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,VA,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,VA TRICARE,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,WELLMED,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,HUMANA,MGD,1617.22,,,,,,,per diem,1617.22,1617.22,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP BIL ,75010001,CDM,921,RC,93930,CPT,,,,Inpatient,,,1617.22,1617.22,HUMANA CHOICE PLUS,MGD,1617.22,,,,,,,case rate,1617.22,1617.22,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,AETNA,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,BCBS,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,CIGNA,COM,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,TRICARE,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,UNITED HEALTHCARE,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,UNITED HEALTHCARE,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,VA,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,VA TRICARE,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,WELLMED,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,HUMANA,MGD,1147.65,,,,,,,per diem,1147.65,1147.65,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP RT  ,75010009,CDM,921,RC,93931,CPT,,,RT,Inpatient,,,1147.65,1147.65,HUMANA CHOICE PLUS,MGD,1147.65,,,,,,,case rate,1147.65,1147.65,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,AETNA,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,BCBS,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,CIGNA,COM,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,TRICARE,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,UNITED HEALTHCARE,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,UNITED HEALTHCARE,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,VA,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,VA TRICARE,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,WELLMED,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,HUMANA,MGD,1306.73,,,,,,,per diem,1306.73,1306.73,"Per diem rate, code is bundled with other services"
US UP EXT ART DUPLEX COMP LT  ,75010010,CDM,921,RC,93931,CPT,,,LT,Inpatient,,,1306.73,1306.73,HUMANA CHOICE PLUS,MGD,1306.73,,,,,,,case rate,1306.73,1306.73,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,AETNA,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,BCBS,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,CIGNA,COM,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,TRICARE,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,UNITED HEALTHCARE,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,UNITED HEALTHCARE,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,VA,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,VA TRICARE,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,WELLMED,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,HUMANA,MGD,713.48,,,,,,,per diem,713.48,713.48,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP RT    ,75010013,CDM,921,RC,93926,CPT,,,RT,Inpatient,,,713.48,713.48,HUMANA CHOICE PLUS,MGD,713.48,,,,,,,case rate,713.48,713.48,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,AETNA,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,BCBS,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,CIGNA,COM,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,TRICARE,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,UNITED HEALTHCARE,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,UNITED HEALTHCARE,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,VA,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,VA TRICARE,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,WELLMED,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,HUMANA,MGD,731.85,,,,,,,per diem,731.85,731.85,"Per diem rate, code is bundled with other services"
LOW EXT ART DUPLEX COMP LT    ,75010014,CDM,921,RC,93926,CPT,,,LT,Inpatient,,,731.85,731.85,HUMANA CHOICE PLUS,MGD,731.85,,,,,,,case rate,731.85,731.85,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,AETNA,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,BCBS,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,CIGNA,COM,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,TRICARE,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,UNITED HEALTHCARE,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,UNITED HEALTHCARE,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,VA,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,VA TRICARE,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,WELLMED,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,HUMANA,MGD,430.03,,,,,,,per diem,430.03,430.03,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT RT,75010015,CDM,921,RC,93971,CPT,,,RT,Inpatient,,,430.03,430.03,HUMANA CHOICE PLUS,MGD,430.03,,,,,,,case rate,430.03,430.03,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,AETNA,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,BCBS,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,CIGNA,COM,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,TRICARE,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,UNITED HEALTHCARE,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,UNITED HEALTHCARE,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,VA,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,VA TRICARE,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,WELLMED,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,HUMANA,MGD,496.22,,,,,,,per diem,496.22,496.22,"Per diem rate, code is bundled with other services"
EXT VEIN DUPLEX STUDY LIMIT LT,75010016,CDM,921,RC,93971,CPT,,,LT,Inpatient,,,496.22,496.22,HUMANA CHOICE PLUS,MGD,496.22,,,,,,,case rate,496.22,496.22,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,AETNA,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,BCBS,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,CIGNA,COM,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,TRICARE,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,UNITED HEALTHCARE,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,UNITED HEALTHCARE,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,VA,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,VA TRICARE,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,WELLMED,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,HUMANA,MGD,898.7,,,,,,,per diem,898.7,898.7,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT BILAT        ,75010026,CDM,402,RC,76881,CPT,,,50,Inpatient,,,898.7,898.7,HUMANA CHOICE PLUS,MGD,898.7,,,,,,,case rate,898.7,898.7,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,AETNA,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,BCBS,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,CIGNA,COM,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,TRICARE,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,UNITED HEALTHCARE,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,UNITED HEALTHCARE,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,VA,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,VA TRICARE,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,WELLMED,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,HUMANA,MGD,729.75,,,,,,,per diem,729.75,729.75,"Per diem rate, code is bundled with other services"
US EXTREM COMPLT RT           ,75010027,CDM,402,RC,76881,CPT,,,RT,Inpatient,,,729.75,729.75,HUMANA CHOICE PLUS,MGD,729.75,,,,,,,case rate,729.75,729.75,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,AETNA,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,BCBS,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,CIGNA,COM,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,TRICARE,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,UNITED HEALTHCARE,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,UNITED HEALTHCARE,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,VA,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,VA TRICARE,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,WELLMED,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,HUMANA,MGD,727.65,,,,,,,per diem,727.65,727.65,"Per diem rate, code is bundled with other services"
US STREM COMPLT LT            ,75010028,CDM,402,RC,76881,CPT,,,LT,Inpatient,,,727.65,727.65,HUMANA CHOICE PLUS,MGD,727.65,,,,,,,case rate,727.65,727.65,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED BILAT       ,75010029,CDM,402,RC,76882,CPT,,,50,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,AETNA,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,BCBS,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,CIGNA,COM,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,TRICARE,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,UNITED HEALTHCARE,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,UNITED HEALTHCARE,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,VA,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,VA TRICARE,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,WELLMED,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,HUMANA,MGD,114.47,,,,,,,per diem,114.47,114.47,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED RT          ,75010030,CDM,402,RC,76882,CPT,,,RT,Inpatient,,,114.47,114.47,HUMANA CHOICE PLUS,MGD,114.47,,,,,,,case rate,114.47,114.47,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US EXTREM LIMITED LT          ,75010031,CDM,402,RC,76882,CPT,,,LT,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,AETNA,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,BCBS,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,CIGNA,COM,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,TRICARE,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,UNITED HEALTHCARE,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,UNITED HEALTHCARE,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,VA,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,VA TRICARE,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,WELLMED,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,HUMANA,MGD,1774.83,,,,,,,per diem,1774.83,1774.83,"Per diem rate, code is bundled with other services"
US GUIDE CATH DRAIN           ,75020000,CDM,402,RC,,,,,,Inpatient,,,1774.83,1774.83,HUMANA CHOICE PLUS,MGD,1774.83,,,,,,,case rate,1774.83,1774.83,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,AETNA,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,BCBS,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,CIGNA,COM,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,TRICARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,UNITED HEALTHCARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,UNITED HEALTHCARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,VA,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,VA TRICARE,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,WELLMED,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,HUMANA,MGD,755.06,,,,,,,per diem,755.06,755.06,"Per diem rate, code is bundled with other services"
US SURGICAL SPECIMEN EA       ,75020001,CDM,320,RC,,,,,,Inpatient,,,755.06,755.06,HUMANA CHOICE PLUS,MGD,755.06,,,,,,,case rate,755.06,755.06,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,AETNA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,CIGNA,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,VA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,VA TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,WELLMED,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA,MGD,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE LT         ,75020002,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA CHOICE PLUS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,AETNA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,BCBS,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,CIGNA,COM,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,UNITED HEALTHCARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,VA,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,VA TRICARE,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,WELLMED,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA,MGD,428.4,,,,,,,per diem,428.4,428.4,"Per diem rate, code is bundled with other services"
US BREAST COMPLETE RT         ,75020003,CDM,402,RC,,,,,,Inpatient,,,428.4,428.4,HUMANA CHOICE PLUS,MGD,428.4,,,,,,,case rate,428.4,428.4,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,AETNA,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,CIGNA,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,TRICARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,UNITED HEALTHCARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,UNITED HEALTHCARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,VA,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,VA TRICARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,WELLMED,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,HUMANA,MGD,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED LT          ,75020004,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,HUMANA CHOICE PLUS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,AETNA,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,BCBS,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,CIGNA,COM,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,TRICARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,UNITED HEALTHCARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,UNITED HEALTHCARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,VA,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,VA TRICARE,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,WELLMED,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,HUMANA,MGD,351.29,,,,,,,per diem,351.29,351.29,"Per diem rate, code is bundled with other services"
US BREAST LIMITED RT          ,75020005,CDM,402,RC,,,,,,Inpatient,,,351.29,351.29,HUMANA CHOICE PLUS,MGD,351.29,,,,,,,case rate,351.29,351.29,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,AETNA,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,BCBS,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,CIGNA,COM,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,TRICARE,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,UNITED HEALTHCARE,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,UNITED HEALTHCARE,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,VA,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,VA TRICARE,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,WELLMED,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,HUMANA,MGD,1616.14,,,,,,,per diem,1616.14,1616.14,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,75020006,CDM,402,RC,,,,,,Inpatient,,,1616.14,1616.14,HUMANA CHOICE PLUS,MGD,1616.14,,,,,,,case rate,1616.14,1616.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,AETNA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,CIGNA,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,VA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,VA TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,WELLMED,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,HUMANA,MGD,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
US 3D WO SEPARATE WKSTATN     ,75020007,CDM,402,RC,,,,,,Inpatient,,,1254.14,1254.14,HUMANA CHOICE PLUS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,AETNA,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,BCBS,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,CIGNA,COM,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,TRICARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,UNITED HEALTHCARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,UNITED HEALTHCARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,VA,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,VA TRICARE,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,WELLMED,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,HUMANA,MGD,3485.03,,,,,,,per diem,3485.03,3485.03,"Per diem rate, code is bundled with other services"
US 3D W SEPARATE WKSTATN      ,75020008,CDM,402,RC,,,,,,Inpatient,,,3485.03,3485.03,HUMANA CHOICE PLUS,MGD,3485.03,,,,,,,case rate,3485.03,3485.03,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,AETNA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,CIGNA,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,WELLMED,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA,MGD,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,75020009,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA CHOICE PLUS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,AETNA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,CIGNA,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,WELLMED,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA,MGD,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,75020010,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA CHOICE PLUS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,75020011,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,75020012,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,AETNA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,CIGNA,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,WELLMED,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA,MGD,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,75020013,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA CHOICE PLUS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,AETNA,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,BCBS,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,CIGNA,COM,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,TRICARE,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,UNITED HEALTHCARE,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,UNITED HEALTHCARE,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,VA,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,VA TRICARE,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,WELLMED,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,HUMANA,MGD,1541.17,,,,,,,per diem,1541.17,1541.17,"Per diem rate, code is bundled with other services"
US DPLX EXTRACRAN LTD UNI     ,75020014,CDM,921,RC,,,,,,Inpatient,,,1541.17,1541.17,HUMANA CHOICE PLUS,MGD,1541.17,,,,,,,case rate,1541.17,1541.17,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,AETNA,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,BCBS,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,CIGNA,COM,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,TRICARE,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,UNITED HEALTHCARE,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,UNITED HEALTHCARE,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,VA,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,VA TRICARE,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,WELLMED,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,HUMANA,MGD,619.04,,,,,,,per diem,619.04,619.04,"Per diem rate, code is bundled with other services"
US ENCEPHALOGRAM              ,75020015,CDM,402,RC,,,,,,Inpatient,,,619.04,619.04,HUMANA CHOICE PLUS,MGD,619.04,,,,,,,case rate,619.04,619.04,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,AETNA,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,BCBS,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,CIGNA,COM,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,TRICARE,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,UNITED HEALTHCARE,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,UNITED HEALTHCARE,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,VA,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,VA TRICARE,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,WELLMED,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,HUMANA,MGD,1083.85,,,,,,,per diem,1083.85,1083.85,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP LT      ,75020016,CDM,402,RC,,,,,,Inpatient,,,1083.85,1083.85,HUMANA CHOICE PLUS,MGD,1083.85,,,,,,,case rate,1083.85,1083.85,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,AETNA,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,BCBS,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,CIGNA,COM,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,TRICARE,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,UNITED HEALTHCARE,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,UNITED HEALTHCARE,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,VA,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,VA TRICARE,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,WELLMED,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,HUMANA,MGD,1076.76,,,,,,,per diem,1076.76,1076.76,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMP RT      ,75020017,CDM,402,RC,,,,,,Inpatient,,,1076.76,1076.76,HUMANA CHOICE PLUS,MGD,1076.76,,,,,,,case rate,1076.76,1076.76,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,AETNA,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,BCBS,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,CIGNA,COM,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,TRICARE,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,UNITED HEALTHCARE,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,UNITED HEALTHCARE,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,VA,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,VA TRICARE,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,WELLMED,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,HUMANA,MGD,736.05,,,,,,,per diem,736.05,736.05,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS COMPLETE     ,75020018,CDM,402,RC,,,,,,Inpatient,,,736.05,736.05,HUMANA CHOICE PLUS,MGD,736.05,,,,,,,case rate,736.05,736.05,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,AETNA,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,CIGNA,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,TRICARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,UNITED HEALTHCARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,UNITED HEALTHCARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,VA,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,VA TRICARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,WELLMED,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,HUMANA,MGD,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD LT       ,75020019,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,HUMANA CHOICE PLUS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,AETNA,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,BCBS,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,CIGNA,COM,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,TRICARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,UNITED HEALTHCARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,UNITED HEALTHCARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,VA,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,VA TRICARE,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,WELLMED,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,HUMANA,MGD,336.29,,,,,,,per diem,336.29,336.29,"Per diem rate, code is bundled with other services"
US EXTREM NONVAS LTD RT       ,75020020,CDM,402,RC,,,,,,Inpatient,,,336.29,336.29,HUMANA CHOICE PLUS,MGD,336.29,,,,,,,case rate,336.29,336.29,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,AETNA,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,BCBS,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,CIGNA,COM,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,TRICARE,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,UNITED HEALTHCARE,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,UNITED HEALTHCARE,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,VA,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,VA TRICARE,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,WELLMED,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,HUMANA,MGD,380.44,,,,,,,per diem,380.44,380.44,"Per diem rate, code is bundled with other services"
US EXTREM NONVASCULAR LTD     ,75020021,CDM,402,RC,,,,,,Inpatient,,,380.44,380.44,HUMANA CHOICE PLUS,MGD,380.44,,,,,,,case rate,380.44,380.44,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,AETNA,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,BCBS,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,CIGNA,COM,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,TRICARE,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,UNITED HEALTHCARE,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,UNITED HEALTHCARE,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,VA,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,VA TRICARE,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,WELLMED,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,HUMANA,MGD,2397.97,,,,,,,per diem,2397.97,2397.97,"Per diem rate, code is bundled with other services"
US FETAL BIOPH PROF W NST     ,75020022,CDM,402,RC,,,,,,Inpatient,,,2397.97,2397.97,HUMANA CHOICE PLUS,MGD,2397.97,,,,,,,case rate,2397.97,2397.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,AETNA,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,BCBS,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,CIGNA,COM,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,TRICARE,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,UNITED HEALTHCARE,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,UNITED HEALTHCARE,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,VA,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,VA TRICARE,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,WELLMED,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,HUMANA,MGD,3161.59,,,,,,,per diem,3161.59,3161.59,"Per diem rate, code is bundled with other services"
US FETAL ECHO 2D              ,75020023,CDM,402,RC,,,,,,Inpatient,,,3161.59,3161.59,HUMANA CHOICE PLUS,MGD,3161.59,,,,,,,case rate,3161.59,3161.59,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,AETNA,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,CIGNA,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,TRICARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,UNITED HEALTHCARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,UNITED HEALTHCARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,VA,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,VA TRICARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,WELLMED,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,HUMANA,MGD,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO MID CEREBRL     ,75020024,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,HUMANA CHOICE PLUS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,AETNA,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,BCBS,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,CIGNA,COM,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,TRICARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,UNITED HEALTHCARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,UNITED HEALTHCARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,VA,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,VA TRICARE,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,WELLMED,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,HUMANA,MGD,602.97,,,,,,,per diem,602.97,602.97,"Per diem rate, code is bundled with other services"
US FETAL ECHO UMBIL ART       ,75020025,CDM,402,RC,,,,,,Inpatient,,,602.97,602.97,HUMANA CHOICE PLUS,MGD,602.97,,,,,,,case rate,602.97,602.97,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,AETNA,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,CIGNA,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,TRICARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,UNITED HEALTHCARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,UNITED HEALTHCARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,VA,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,VA TRICARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,WELLMED,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,HUMANA,MGD,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOP F/UP      ,75020026,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,HUMANA CHOICE PLUS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,AETNA,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,BCBS,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,CIGNA,COM,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,TRICARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,UNITED HEALTHCARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,UNITED HEALTHCARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,VA,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,VA TRICARE,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,WELLMED,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,HUMANA,MGD,350.22,,,,,,,per diem,350.22,350.22,"Per diem rate, code is bundled with other services"
US FETAL ECHO W/DOPPLER       ,75020027,CDM,402,RC,,,,,,Inpatient,,,350.22,350.22,HUMANA CHOICE PLUS,MGD,350.22,,,,,,,case rate,350.22,350.22,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,AETNA,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,BCBS,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,CIGNA,COM,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,TRICARE,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,UNITED HEALTHCARE,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,UNITED HEALTHCARE,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,VA,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,VA TRICARE,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,WELLMED,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,HUMANA,MGD,2263.02,,,,,,,per diem,2263.02,2263.02,"Per diem rate, code is bundled with other services"
US FETAL ECHO/FOLLOW-UP       ,75020028,CDM,402,RC,,,,,,Inpatient,,,2263.02,2263.02,HUMANA CHOICE PLUS,MGD,2263.02,,,,,,,case rate,2263.02,2263.02,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,AETNA,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,BCBS,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,CIGNA,COM,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,TRICARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,UNITED HEALTHCARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,UNITED HEALTHCARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,VA,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,VA TRICARE,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,WELLMED,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,HUMANA,MGD,903.92,,,,,,,per diem,903.92,903.92,"Per diem rate, code is bundled with other services"
US GUIDANCE ASPIRATE OVA      ,75020029,CDM,402,RC,,,,,,Inpatient,,,903.92,903.92,HUMANA CHOICE PLUS,MGD,903.92,,,,,,,case rate,903.92,903.92,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,AETNA,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,BCBS,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,CIGNA,COM,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,TRICARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,UNITED HEALTHCARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,UNITED HEALTHCARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,VA,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,VA TRICARE,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,WELLMED,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,HUMANA,MGD,861.08,,,,,,,per diem,861.08,861.08,"Per diem rate, code is bundled with other services"
US GUIDE INTERSTITL THRPY     ,75020030,CDM,402,RC,,,,,,Inpatient,,,861.08,861.08,HUMANA CHOICE PLUS,MGD,861.08,,,,,,,case rate,861.08,861.08,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,AETNA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,CIGNA,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,WELLMED,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA,MGD,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 1-2 HOUR     ,75020031,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA CHOICE PLUS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,AETNA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,BCBS,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,CIGNA,COM,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,UNITED HEALTHCARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,VA TRICARE,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,WELLMED,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA,MGD,1015.31,,,,,,,per diem,1015.31,1015.31,"Per diem rate, code is bundled with other services"
US GUIDE INTRAOP 2-3 HOUR     ,75020032,CDM,402,RC,,,,,,Inpatient,,,1015.31,1015.31,HUMANA CHOICE PLUS,MGD,1015.31,,,,,,,case rate,1015.31,1015.31,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,AETNA,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,BCBS,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,CIGNA,COM,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,TRICARE,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,UNITED HEALTHCARE,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,UNITED HEALTHCARE,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,VA,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,VA TRICARE,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,WELLMED,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,HUMANA,MGD,1178.1,,,,,,,per diem,1178.1,1178.1,"Per diem rate, code is bundled with other services"
US GUIDED AMNIOCENTESIS       ,75020033,CDM,402,RC,,,,,,Inpatient,,,1178.1,1178.1,HUMANA CHOICE PLUS,MGD,1178.1,,,,,,,case rate,1178.1,1178.1,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,AETNA,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,BCBS,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,CIGNA,COM,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,TRICARE,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,UNITED HEALTHCARE,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,UNITED HEALTHCARE,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,VA,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,VA TRICARE,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,WELLMED,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,HUMANA,MGD,887.86,,,,,,,per diem,887.86,887.86,"Per diem rate, code is bundled with other services"
US GUIDED COMPRESS REPAR      ,75020034,CDM,402,RC,,,,,,Inpatient,,,887.86,887.86,HUMANA CHOICE PLUS,MGD,887.86,,,,,,,case rate,887.86,887.86,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,AETNA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,BCBS,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,CIGNA,COM,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,UNITED HEALTHCARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,VA,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,VA TRICARE,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,WELLMED,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,HUMANA,MGD,371.64,,,,,,,per diem,371.64,371.64,"Per diem rate, code is bundled with other services"
US GUIDED TISSUE ABLATION     ,75020035,CDM,402,RC,,,,,,Inpatient,,,371.64,371.64,HUMANA CHOICE PLUS,MGD,371.64,,,,,,,case rate,371.64,371.64,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,AETNA,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,BCBS,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,CIGNA,COM,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,TRICARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,UNITED HEALTHCARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,UNITED HEALTHCARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,VA,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,VA TRICARE,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,WELLMED,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,HUMANA,MGD,402.7,,,,,,,per diem,402.7,402.7,"Per diem rate, code is bundled with other services"
US HIPS INFANT DYNAMIC        ,75020036,CDM,402,RC,,,,,,Inpatient,,,402.7,402.7,HUMANA CHOICE PLUS,MGD,402.7,,,,,,,case rate,402.7,402.7,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,AETNA,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,CIGNA,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,TRICARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,UNITED HEALTHCARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,UNITED HEALTHCARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,VA,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,VA TRICARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,WELLMED,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,HUMANA,MGD,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
US HIPS INFANT LTD STATIC     ,75020037,CDM,402,RC,,,,,,Inpatient,,,290.24,290.24,HUMANA CHOICE PLUS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,AETNA,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,BCBS,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,CIGNA,COM,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,TRICARE,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,UNITED HEALTHCARE,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,UNITED HEALTHCARE,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,VA,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,VA TRICARE,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,WELLMED,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,HUMANA,MGD,815.03,,,,,,,per diem,815.03,815.03,"Per diem rate, code is bundled with other services"
US KIDNEY TRANSPLANT          ,75020038,CDM,402,RC,,,,,,Inpatient,,,815.03,815.03,HUMANA CHOICE PLUS,MGD,815.03,,,,,,,case rate,815.03,815.03,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,AETNA,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,BCBS,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,CIGNA,COM,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,TRICARE,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,UNITED HEALTHCARE,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,UNITED HEALTHCARE,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,VA,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,VA TRICARE,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,WELLMED,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,HUMANA,MGD,586.91,,,,,,,per diem,586.91,586.91,"Per diem rate, code is bundled with other services"
US OPTHAL DX B & QUANT A      ,75020039,CDM,402,RC,,,,,,Inpatient,,,586.91,586.91,HUMANA CHOICE PLUS,MGD,586.91,,,,,,,case rate,586.91,586.91,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,AETNA,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,BCBS,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,CIGNA,COM,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,TRICARE,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,UNITED HEALTHCARE,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,UNITED HEALTHCARE,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,VA,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,VA TRICARE,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,WELLMED,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,HUMANA,MGD,1445.85,,,,,,,per diem,1445.85,1445.85,"Per diem rate, code is bundled with other services"
US PREG FOLLOWUP/EA GEST      ,75020040,CDM,402,RC,,,,,,Inpatient,,,1445.85,1445.85,HUMANA CHOICE PLUS,MGD,1445.85,,,,,,,case rate,1445.85,1445.85,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,AETNA,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,CIGNA,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,TRICARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,UNITED HEALTHCARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,UNITED HEALTHCARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,VA,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,VA TRICARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,WELLMED,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,HUMANA,MGD,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSL ADD      ,75020041,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,HUMANA CHOICE PLUS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,AETNA,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,BCBS,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,CIGNA,COM,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,TRICARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,UNITED HEALTHCARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,UNITED HEALTHCARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,VA,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,VA TRICARE,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,WELLMED,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,HUMANA,MGD,357.71,,,,,,,per diem,357.71,357.71,"Per diem rate, code is bundled with other services"
US PREG NUCAL TRANSLU 1ST     ,75020042,CDM,402,RC,,,,,,Inpatient,,,357.71,357.71,HUMANA CHOICE PLUS,MGD,357.71,,,,,,,case rate,357.71,357.71,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,AETNA,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,BCBS,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,CIGNA,COM,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,TRICARE,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,UNITED HEALTHCARE,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,UNITED HEALTHCARE,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,VA,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,VA TRICARE,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,WELLMED,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,HUMANA,MGD,557.99,,,,,,,per diem,557.99,557.99,"Per diem rate, code is bundled with other services"
US PREGDETL EA ADDL GEST      ,75020043,CDM,402,RC,,,,,,Inpatient,,,557.99,557.99,HUMANA CHOICE PLUS,MGD,557.99,,,,,,,case rate,557.99,557.99,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,AETNA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,BCBS,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,CIGNA,COM,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,UNITED HEALTHCARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,VA,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,VA TRICARE,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,WELLMED,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA,MGD,493.73,,,,,,,per diem,493.73,493.73,"Per diem rate, code is bundled with other services"
US PREGDETL SNGL1ST GEST      ,75020044,CDM,402,RC,,,,,,Inpatient,,,493.73,493.73,HUMANA CHOICE PLUS,MGD,493.73,,,,,,,case rate,493.73,493.73,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,AETNA,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,BCBS,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,CIGNA,COM,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,TRICARE,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,UNITED HEALTHCARE,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,UNITED HEALTHCARE,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,VA,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,VA TRICARE,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,WELLMED,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,HUMANA,MGD,277.39,,,,,,,per diem,277.39,277.39,"Per diem rate, code is bundled with other services"
US SONOHYSTEROGRAM            ,75020045,CDM,402,RC,,,,,,Inpatient,,,277.39,277.39,HUMANA CHOICE PLUS,MGD,277.39,,,,,,,case rate,277.39,277.39,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,AETNA,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,CIGNA,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,TRICARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,UNITED HEALTHCARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,UNITED HEALTHCARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,VA,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,VA TRICARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,WELLMED,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,HUMANA,MGD,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,75020046,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,HUMANA CHOICE PLUS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,AETNA,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,BCBS,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,CIGNA,COM,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,TRICARE,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,UNITED HEALTHCARE,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,UNITED HEALTHCARE,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,VA,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,VA TRICARE,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,WELLMED,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,HUMANA,MGD,1284.13,,,,,,,per diem,1284.13,1284.13,"Per diem rate, code is bundled with other services"
US TRANSRECTAL                ,75020047,CDM,402,RC,,,,,,Inpatient,,,1284.13,1284.13,HUMANA CHOICE PLUS,MGD,1284.13,,,,,,,case rate,1284.13,1284.13,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,AETNA,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,BCBS,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,CIGNA,COM,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,TRICARE,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,UNITED HEALTHCARE,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,UNITED HEALTHCARE,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,VA,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,VA TRICARE,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,WELLMED,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,HUMANA,MGD,964.97,,,,,,,per diem,964.97,964.97,"Per diem rate, code is bundled with other services"
US V DPLX AB/PEL/RET LTD      ,75020048,CDM,921,RC,,,,,,Inpatient,,,964.97,964.97,HUMANA CHOICE PLUS,MGD,964.97,,,,,,,case rate,964.97,964.97,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,AETNA,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,BCBS,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,CIGNA,COM,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,TRICARE,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,UNITED HEALTHCARE,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,UNITED HEALTHCARE,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,VA,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,VA TRICARE,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,WELLMED,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,HUMANA,MGD,1479.05,,,,,,,per diem,1479.05,1479.05,"Per diem rate, code is bundled with other services"
US V DPLX ART LOW EXT UNI     ,75020049,CDM,921,RC,,,,,,Inpatient,,,1479.05,1479.05,HUMANA CHOICE PLUS,MGD,1479.05,,,,,,,case rate,1479.05,1479.05,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,AETNA,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,BCBS,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,CIGNA,COM,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,TRICARE,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,UNITED HEALTHCARE,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,UNITED HEALTHCARE,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,VA,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,VA TRICARE,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,WELLMED,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,HUMANA,MGD,1499.26,,,,,,,per diem,1499.26,1499.26,"Per diem rate, code is bundled with other services"
US V DPLX ART UP EXT UNI      ,75020050,CDM,921,RC,,,,,,Inpatient,,,1499.26,1499.26,HUMANA CHOICE PLUS,MGD,1499.26,,,,,,,case rate,1499.26,1499.26,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,AETNA,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,BCBS,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,CIGNA,COM,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,TRICARE,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,UNITED HEALTHCARE,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,UNITED HEALTHCARE,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,VA,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,VA TRICARE,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,WELLMED,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,HUMANA,MGD,1158.82,,,,,,,per diem,1158.82,1158.82,"Per diem rate, code is bundled with other services"
US V DPLX PENILE VES CMP      ,75020051,CDM,921,RC,,,,,,Inpatient,,,1158.82,1158.82,HUMANA CHOICE PLUS,MGD,1158.82,,,,,,,case rate,1158.82,1158.82,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT LT       ,75020052,CDM,921,RC,,,,,,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
US V DPLX VENOUS EXT RT       ,75020053,CDM,921,RC,,,,,,Inpatient,,,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,AETNA,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,BCBS,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,CIGNA,COM,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,TRICARE,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,UNITED HEALTHCARE,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,UNITED HEALTHCARE,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,VA,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,VA TRICARE,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,WELLMED,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,HUMANA,MGD,757.2,,,,,,,per diem,757.2,757.2,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,75020054,CDM,361,RC,,,,,,Inpatient,,,757.2,757.2,HUMANA CHOICE PLUS,MGD,757.2,,,,,,,case rate,757.2,757.2,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,75020055,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,AETNA,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,BCBS,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,CIGNA,COM,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,TRICARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,UNITED HEALTHCARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,UNITED HEALTHCARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,VA,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,VA TRICARE,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,WELLMED,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,HUMANA,MGD,472.31,,,,,,,per diem,472.31,472.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,75020056,CDM,361,RC,,,,,,Inpatient,,,472.31,472.31,HUMANA CHOICE PLUS,MGD,472.31,,,,,,,case rate,472.31,472.31,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,AETNA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,CIGNA,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,WELLMED,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA,MGD,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,75020057,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA CHOICE PLUS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,AETNA,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,BCBS,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,CIGNA,COM,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,TRICARE,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,UNITED HEALTHCARE,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,UNITED HEALTHCARE,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,VA,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,VA TRICARE,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,WELLMED,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,HUMANA,MGD,2664.65,,,,,,,per diem,2664.65,2664.65,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,75020058,CDM,361,RC,,,,,,Inpatient,,,2664.65,2664.65,HUMANA CHOICE PLUS,MGD,2664.65,,,,,,,case rate,2664.65,2664.65,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,AETNA,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,CIGNA,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,TRICARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,UNITED HEALTHCARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,UNITED HEALTHCARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,VA,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,VA TRICARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,WELLMED,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,HUMANA,MGD,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,75020059,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,HUMANA CHOICE PLUS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,AETNA,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,BCBS,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,CIGNA,COM,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,TRICARE,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,UNITED HEALTHCARE,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,UNITED HEALTHCARE,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,VA,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,VA TRICARE,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,WELLMED,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,HUMANA,MGD,2093.81,,,,,,,per diem,2093.81,2093.81,"Per diem rate, code is bundled with other services"
BIOPSY PROSTATE NDL/PUNCH     ,75020060,CDM,361,RC,,,,,,Inpatient,,,2093.81,2093.81,HUMANA CHOICE PLUS,MGD,2093.81,,,,,,,case rate,2093.81,2093.81,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,AETNA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,BCBS,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,CIGNA,COM,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,UNITED HEALTHCARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,VA,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,VA TRICARE,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,WELLMED,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA,MGD,565.49,,,,,,,per diem,565.49,565.49,"Per diem rate, code is bundled with other services"
BIOPSY SKIN SINGLE LESION     ,75020061,CDM,361,RC,,,,,,Inpatient,,,565.49,565.49,HUMANA CHOICE PLUS,MGD,565.49,,,,,,,case rate,565.49,565.49,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,AETNA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,CIGNA,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,WELLMED,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA,MGD,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,75020062,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA CHOICE PLUS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,AETNA,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,BCBS,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,CIGNA,COM,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,TRICARE,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,UNITED HEALTHCARE,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,UNITED HEALTHCARE,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,VA,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,VA TRICARE,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,WELLMED,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,HUMANA,MGD,179.93,,,,,,,per diem,179.93,179.93,"Per diem rate, code is bundled with other services"
BREAST CYST ASP EA ADDL       ,75020063,CDM,361,RC,,,,,,Inpatient,,,179.93,179.93,HUMANA CHOICE PLUS,MGD,179.93,,,,,,,case rate,179.93,179.93,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,AETNA,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,CIGNA,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,TRICARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,UNITED HEALTHCARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,UNITED HEALTHCARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,VA,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,VA TRICARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,WELLMED,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,HUMANA,MGD,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
BREAST CYST PUNC ASPIRATE     ,75020064,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,HUMANA CHOICE PLUS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,AETNA,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,BCBS,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,CIGNA,COM,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,TRICARE,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,UNITED HEALTHCARE,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,UNITED HEALTHCARE,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,VA,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,VA TRICARE,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,WELLMED,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,HUMANA,MGD,2507.21,,,,,,,per diem,2507.21,2507.21,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,75020065,CDM,361,RC,,,,,,Inpatient,,,2507.21,2507.21,HUMANA CHOICE PLUS,MGD,2507.21,,,,,,,case rate,2507.21,2507.21,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,AETNA,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,BCBS,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,CIGNA,COM,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,TRICARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,UNITED HEALTHCARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,UNITED HEALTHCARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,VA,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,VA TRICARE,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,WELLMED,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,HUMANA,MGD,2422.6,,,,,,,per diem,2422.6,2422.6,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,75020066,CDM,361,RC,,,,,,Inpatient,,,2422.6,2422.6,HUMANA CHOICE PLUS,MGD,2422.6,,,,,,,case rate,2422.6,2422.6,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,AETNA,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,CIGNA,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,TRICARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,UNITED HEALTHCARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,UNITED HEALTHCARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,VA,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,VA TRICARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,WELLMED,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,HUMANA,MGD,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,75020067,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,HUMANA CHOICE PLUS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX NECK/THORAX SOFT TISS      ,75020068,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,AETNA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,BCBS,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,CIGNA,COM,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,UNITED HEALTHCARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,VA TRICARE,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,WELLMED,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA,MGD,1009.95,,,,,,,per diem,1009.95,1009.95,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,75020069,CDM,361,RC,,,,,,Inpatient,,,1009.95,1009.95,HUMANA CHOICE PLUS,MGD,1009.95,,,,,,,case rate,1009.95,1009.95,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,AETNA,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,BCBS,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,CIGNA,COM,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,TRICARE,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,UNITED HEALTHCARE,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,UNITED HEALTHCARE,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,VA,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,VA TRICARE,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,WELLMED,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,HUMANA,MGD,1516.54,,,,,,,per diem,1516.54,1516.54,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,75020070,CDM,361,RC,,,,,,Inpatient,,,1516.54,1516.54,HUMANA CHOICE PLUS,MGD,1516.54,,,,,,,case rate,1516.54,1516.54,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,AETNA,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,BCBS,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,CIGNA,COM,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,TRICARE,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,UNITED HEALTHCARE,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,UNITED HEALTHCARE,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,VA,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,VA TRICARE,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,WELLMED,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,HUMANA,MGD,1169.53,,,,,,,per diem,1169.53,1169.53,"Per diem rate, code is bundled with other services"
BX SALIVARY GLAND NDL         ,75020071,CDM,361,RC,,,,,,Inpatient,,,1169.53,1169.53,HUMANA CHOICE PLUS,MGD,1169.53,,,,,,,case rate,1169.53,1169.53,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,AETNA,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,BCBS,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,CIGNA,COM,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,TRICARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,UNITED HEALTHCARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,UNITED HEALTHCARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,VA,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,VA TRICARE,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,WELLMED,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,HUMANA,MGD,2660.36,,,,,,,per diem,2660.36,2660.36,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,75020072,CDM,361,RC,,,,,,Inpatient,,,2660.36,2660.36,HUMANA CHOICE PLUS,MGD,2660.36,,,,,,,case rate,2660.36,2660.36,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,75020073,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,75020074,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
EXTERNAL CEPHALIC VERSION     ,75020075,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,AETNA,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,BCBS,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,CIGNA,COM,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,TRICARE,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,UNITED HEALTHCARE,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,UNITED HEALTHCARE,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,VA,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,VA TRICARE,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,WELLMED,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,HUMANA,MGD,875.01,,,,,,,per diem,875.01,875.01,"Per diem rate, code is bundled with other services"
HYSTERO NS/CON INTRO          ,75020076,CDM,361,RC,,,,,,Inpatient,,,875.01,875.01,HUMANA CHOICE PLUS,MGD,875.01,,,,,,,case rate,875.01,875.01,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,AETNA,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,BCBS,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,CIGNA,COM,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,TRICARE,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,UNITED HEALTHCARE,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,UNITED HEALTHCARE,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,VA,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,VA TRICARE,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,WELLMED,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,HUMANA,MGD,1156.68,,,,,,,per diem,1156.68,1156.68,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,75020077,CDM,361,RC,,,,,,Inpatient,,,1156.68,1156.68,HUMANA CHOICE PLUS,MGD,1156.68,,,,,,,case rate,1156.68,1156.68,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,AETNA,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,BCBS,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,CIGNA,COM,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,TRICARE,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,UNITED HEALTHCARE,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,UNITED HEALTHCARE,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,VA,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,VA TRICARE,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,WELLMED,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,HUMANA,MGD,4082.6,,,,,,,per diem,4082.6,4082.6,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,75020078,CDM,361,RC,,,,,,Inpatient,,,4082.6,4082.6,HUMANA CHOICE PLUS,MGD,4082.6,,,,,,,case rate,4082.6,4082.6,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,AETNA,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,BCBS,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,CIGNA,COM,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,TRICARE,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,UNITED HEALTHCARE,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,UNITED HEALTHCARE,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,VA,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,VA TRICARE,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,WELLMED,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,HUMANA,MGD,8037.86,,,,,,,per diem,8037.86,8037.86,"Per diem rate, code is bundled with other services"
PELVIS/HIP ABS DRAIN DEEP     ,75020079,CDM,361,RC,,,,,,Inpatient,,,8037.86,8037.86,HUMANA CHOICE PLUS,MGD,8037.86,,,,,,,case rate,8037.86,8037.86,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,AETNA,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,BCBS,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,CIGNA,COM,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,TRICARE,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,UNITED HEALTHCARE,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,UNITED HEALTHCARE,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,VA,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,VA TRICARE,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,WELLMED,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,HUMANA,MGD,1396.58,,,,,,,per diem,1396.58,1396.58,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,75020080,CDM,361,RC,,,,,,Inpatient,,,1396.58,1396.58,HUMANA CHOICE PLUS,MGD,1396.58,,,,,,,case rate,1396.58,1396.58,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,AETNA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,BCBS,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,CIGNA,COM,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,UNITED HEALTHCARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,VA,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,VA TRICARE,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,WELLMED,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA,MGD,997.1,,,,,,,per diem,997.1,997.1,"Per diem rate, code is bundled with other services"
PSEUDOANEURY TX EXTRM INJ     ,75020081,CDM,361,RC,,,,,,Inpatient,,,997.1,997.1,HUMANA CHOICE PLUS,MGD,997.1,,,,,,,case rate,997.1,997.1,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,AETNA,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,BCBS,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,CIGNA,COM,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,TRICARE,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,UNITED HEALTHCARE,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,UNITED HEALTHCARE,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,VA,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,VA TRICARE,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,WELLMED,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,HUMANA,MGD,2598.25,,,,,,,per diem,2598.25,2598.25,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,75020082,CDM,361,RC,,,,,,Inpatient,,,2598.25,2598.25,HUMANA CHOICE PLUS,MGD,2598.25,,,,,,,case rate,2598.25,2598.25,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,AETNA,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,BCBS,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,CIGNA,COM,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,TRICARE,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,UNITED HEALTHCARE,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,UNITED HEALTHCARE,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,VA,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,VA TRICARE,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,WELLMED,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,HUMANA,MGD,2523.28,,,,,,,per diem,2523.28,2523.28,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,75020083,CDM,361,RC,,,,,,Inpatient,,,2523.28,2523.28,HUMANA CHOICE PLUS,MGD,2523.28,,,,,,,case rate,2523.28,2523.28,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,AETNA,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,BCBS,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,CIGNA,COM,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,TRICARE,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,UNITED HEALTHCARE,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,UNITED HEALTHCARE,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,VA,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,VA TRICARE,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,WELLMED,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,HUMANA,MGD,2623.95,,,,,,,per diem,2623.95,2623.95,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,75020084,CDM,361,RC,,,,,,Inpatient,,,2623.95,2623.95,HUMANA CHOICE PLUS,MGD,2623.95,,,,,,,case rate,2623.95,2623.95,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,AETNA,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,BCBS,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,CIGNA,COM,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,TRICARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,UNITED HEALTHCARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,UNITED HEALTHCARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,VA,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,VA TRICARE,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,WELLMED,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,HUMANA,MGD,796.82,,,,,,,per diem,796.82,796.82,"Per diem rate, code is bundled with other services"
THYROID CYST ASPIRATE/INJ     ,75020085,CDM,361,RC,,,,,,Inpatient,,,796.82,796.82,HUMANA CHOICE PLUS,MGD,796.82,,,,,,,case rate,796.82,796.82,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,AETNA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,BCBS,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,CIGNA,COM,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,UNITED HEALTHCARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,VA,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,VA TRICARE,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,WELLMED,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA,MGD,204.56,,,,,,,per diem,204.56,204.56,"Per diem rate, code is bundled with other services"
VENIPUNCT >3YR PHY SKILL      ,75020086,CDM,361,RC,,,,,,Inpatient,,,204.56,204.56,HUMANA CHOICE PLUS,MGD,204.56,,,,,,,case rate,204.56,204.56,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,AETNA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,CIGNA,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,VA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,VA TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,WELLMED,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA,MGD,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,75020087,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA CHOICE PLUS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BREAST US PERC 1ST         ,75020088,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,AETNA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,BCBS,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,CIGNA,COM,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,UNITED HEALTHCARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,VA TRICARE,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,WELLMED,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA,MGD,4477.85,,,,,,,per diem,4477.85,4477.85,"Per diem rate, code is bundled with other services"
BX BRST US PERC EA ADD        ,75020089,CDM,361,RC,,,,,,Inpatient,,,4477.85,4477.85,HUMANA CHOICE PLUS,MGD,4477.85,,,,,,,case rate,4477.85,4477.85,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US 1ST       ,75020090,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,AETNA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,BCBS,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,CIGNA,COM,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,UNITED HEALTHCARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,VA,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,VA TRICARE,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,WELLMED,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA,MGD,832.17,,,,,,,per diem,832.17,832.17,"Per diem rate, code is bundled with other services"
PLC BRST LOC DEV US ADD       ,75020091,CDM,361,RC,,,,,,Inpatient,,,832.17,832.17,HUMANA CHOICE PLUS,MGD,832.17,,,,,,,case rate,832.17,832.17,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,75020092,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,75020093,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,AETNA,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,BCBS,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,CIGNA,COM,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,TRICARE,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,UNITED HEALTHCARE,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,UNITED HEALTHCARE,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,VA,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,VA TRICARE,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,WELLMED,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,HUMANA,MGD,13759.14,,,,,,,per diem,13759.14,13759.14,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,75020094,CDM,361,RC,,,,,,Inpatient,,,13759.14,13759.14,HUMANA CHOICE PLUS,MGD,13759.14,,,,,,,case rate,13759.14,13759.14,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,AETNA,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,BCBS,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,CIGNA,COM,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,TRICARE,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,UNITED HEALTHCARE,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,UNITED HEALTHCARE,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,VA,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,VA TRICARE,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,WELLMED,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,HUMANA,MGD,11128.76,,,,,,,per diem,11128.76,11128.76,"Per diem rate, code is bundled with other services"
BX BACK/FLNK SFT TIS DEEP     ,75020095,CDM,361,RC,21925,CPT,,,,Inpatient,,,11128.76,11128.76,HUMANA CHOICE PLUS,MGD,11128.76,,,,,,,case rate,11128.76,11128.76,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,AETNA,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,BCBS,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,CIGNA,COM,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,TRICARE,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,UNITED HEALTHCARE,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,UNITED HEALTHCARE,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,VA,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,VA TRICARE,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,WELLMED,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,HUMANA,MGD,1843.19,,,,,,,per diem,1843.19,1843.19,"Per diem rate, code is bundled with other services"
AMNIOCENTESIS                 ,75020096,CDM,361,RC,,,,,,Inpatient,,,1843.19,1843.19,HUMANA CHOICE PLUS,MGD,1843.19,,,,,,,case rate,1843.19,1843.19,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,AETNA,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,BCBS,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,CIGNA,COM,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,TRICARE,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,UNITED HEALTHCARE,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,UNITED HEALTHCARE,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,VA,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,VA TRICARE,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,WELLMED,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,HUMANA,MGD,4107.29,,,,,,,per diem,4107.29,4107.29,"Per diem rate, code is bundled with other services"
BIOPSY PELVIS/HIP DEEP        ,75020097,CDM,361,RC,,,,,,Inpatient,,,4107.29,4107.29,HUMANA CHOICE PLUS,MGD,4107.29,,,,,,,case rate,4107.29,4107.29,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,AETNA,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,BCBS,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,CIGNA,COM,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,TRICARE,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,UNITED HEALTHCARE,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,UNITED HEALTHCARE,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,VA,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,VA TRICARE,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,WELLMED,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,HUMANA,MGD,5285.39,,,,,,,per diem,5285.39,5285.39,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID SOFT TIS     ,75020098,CDM,361,RC,,,,,,Inpatient,,,5285.39,5285.39,HUMANA CHOICE PLUS,MGD,5285.39,,,,,,,case rate,5285.39,5285.39,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,75020099,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,AETNA,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,BCBS,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,CIGNA,COM,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,TRICARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,UNITED HEALTHCARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,UNITED HEALTHCARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,VA,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,VA TRICARE,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,WELLMED,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,HUMANA,MGD,1388.02,,,,,,,per diem,1388.02,1388.02,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,75020100,CDM,361,RC,,,,,,Inpatient,,,1388.02,1388.02,HUMANA CHOICE PLUS,MGD,1388.02,,,,,,,case rate,1388.02,1388.02,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,AETNA,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,CIGNA,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,TRICARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,UNITED HEALTHCARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,UNITED HEALTHCARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,VA,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,VA TRICARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,WELLMED,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,HUMANA,MGD,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,75020101,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,HUMANA CHOICE PLUS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,AETNA,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,CIGNA,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,TRICARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,UNITED HEALTHCARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,UNITED HEALTHCARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,VA,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,VA TRICARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,WELLMED,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,HUMANA,MGD,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,75020102,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,HUMANA CHOICE PLUS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,AETNA,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,BCBS,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,CIGNA,COM,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,TRICARE,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,UNITED HEALTHCARE,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,UNITED HEALTHCARE,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,VA,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,VA TRICARE,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,WELLMED,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,HUMANA,MGD,312.55,,,,,,,per diem,312.55,312.55,"Per diem rate, code is bundled with other services"
US ABD PARACENTESIS INTIA     ,75020103,CDM,361,RC,49080,CPT,,,,Inpatient,,,312.55,312.55,HUMANA CHOICE PLUS,MGD,312.55,,,,,,,case rate,312.55,312.55,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,AETNA,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,BCBS,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,CIGNA,COM,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,TRICARE,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,UNITED HEALTHCARE,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,UNITED HEALTHCARE,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,VA,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,VA TRICARE,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,WELLMED,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,HUMANA,MGD,361.42,,,,,,,per diem,361.42,361.42,"Per diem rate, code is bundled with other services"
CHECK FEEDING TUBE (ANY)      ,75020104,CDM,361,RC,49465,CPT,,,,Inpatient,,,361.42,361.42,HUMANA CHOICE PLUS,MGD,361.42,,,,,,,case rate,361.42,361.42,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,AETNA,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,BCBS,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,CIGNA,COM,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,TRICARE,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,UNITED HEALTHCARE,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,UNITED HEALTHCARE,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,VA,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,VA TRICARE,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,WELLMED,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,HUMANA,MGD,478.22,,,,,,,per diem,478.22,478.22,"Per diem rate, code is bundled with other services"
US ARTER UNILATER LWR EXT     ,75020105,CDM,402,RC,93926,CPT,,,,Inpatient,,,478.22,478.22,HUMANA CHOICE PLUS,MGD,478.22,,,,,,,case rate,478.22,478.22,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,AETNA,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,BCBS,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,CIGNA,COM,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,TRICARE,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,UNITED HEALTHCARE,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,UNITED HEALTHCARE,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,VA,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,VA TRICARE,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,WELLMED,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,HUMANA,MGD,423.83,,,,,,,per diem,423.83,423.83,"Per diem rate, code is bundled with other services"
US ASTERIAL UNILAT UPPER EXT  ,75020106,CDM,402,RC,93931,CPT,,,,Inpatient,,,423.83,423.83,HUMANA CHOICE PLUS,MGD,423.83,,,,,,,case rate,423.83,423.83,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,AETNA,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,BCBS,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,CIGNA,COM,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,TRICARE,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,UNITED HEALTHCARE,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,UNITED HEALTHCARE,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,VA,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,VA TRICARE,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,WELLMED,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,HUMANA,MGD,860.87,,,,,,,per diem,860.87,860.87,"Per diem rate, code is bundled with other services"
US DUPLEX ABD PELV RENAL COM  ,75020108,CDM,921,RC,93975,CPT,,,,Inpatient,,,860.87,860.87,HUMANA CHOICE PLUS,MGD,860.87,,,,,,,case rate,860.87,860.87,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
DOPPLER STUDY TRANSC          ,75020109,CDM,921,RC,93886,CPT,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,AETNA,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,CIGNA,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,TRICARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,UNITED HEALTHCARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,UNITED HEALTHCARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,VA,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,VA TRICARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,WELLMED,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,HUMANA,MGD,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART LWR EXTR DUPLEX           ,75020110,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,HUMANA CHOICE PLUS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,AETNA,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,BCBS,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,CIGNA,COM,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,TRICARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,UNITED HEALTHCARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,UNITED HEALTHCARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,VA,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,VA TRICARE,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,WELLMED,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,HUMANA,MGD,453.6,,,,,,,per diem,453.6,453.6,"Per diem rate, code is bundled with other services"
ART UPR EXTR DUPLEX           ,75020111,CDM,921,RC,,,,,,Inpatient,,,453.6,453.6,HUMANA CHOICE PLUS,MGD,453.6,,,,,,,case rate,453.6,453.6,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,AETNA,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,BCBS,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,CIGNA,COM,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,TRICARE,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,UNITED HEALTHCARE,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,UNITED HEALTHCARE,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,VA,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,VA TRICARE,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,WELLMED,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,HUMANA,MGD,837.35,,,,,,,per diem,837.35,837.35,"Per diem rate, code is bundled with other services"
DOPP PULSED/CONT WAGE         ,75020112,CDM,483,RC,93321,CPT,,,,Inpatient,,,837.35,837.35,HUMANA CHOICE PLUS,MGD,837.35,,,,,,,case rate,837.35,837.35,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
ULTRASOUND EXTREMITY          ,75020113,CDM,402,RC,,,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,AETNA,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,BCBS,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,CIGNA,COM,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,TRICARE,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,UNITED HEALTHCARE,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,UNITED HEALTHCARE,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,VA,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,VA TRICARE,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,WELLMED,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,HUMANA,MGD,296.89,,,,,,,per diem,296.89,296.89,"Per diem rate, code is bundled with other services"
ABD VASC DOPP-LIMITED         ,75020114,CDM,921,RC,,,,,,Inpatient,,,296.89,296.89,HUMANA CHOICE PLUS,MGD,296.89,,,,,,,case rate,296.89,296.89,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,AETNA,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,BCBS,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,CIGNA,COM,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,TRICARE,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,UNITED HEALTHCARE,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,UNITED HEALTHCARE,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,VA,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,VA TRICARE,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,WELLMED,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,HUMANA,MGD,1868.83,,,,,,,per diem,1868.83,1868.83,"Per diem rate, code is bundled with other services"
DRAINAGE CATHETER EXCHANGE    ,75020115,CDM,361,RC,49423,CPT,,,,Inpatient,,,1868.83,1868.83,HUMANA CHOICE PLUS,MGD,1868.83,,,,,,,case rate,1868.83,1868.83,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,AETNA,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,BCBS,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,CIGNA,COM,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,TRICARE,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,UNITED HEALTHCARE,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,UNITED HEALTHCARE,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,VA,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,VA TRICARE,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,WELLMED,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,HUMANA,MGD,427.35,,,,,,,per diem,427.35,427.35,"Per diem rate, code is bundled with other services"
NM TC99M MACROAGG UP          ,75085092,CDM,343,RC,,,,,,Inpatient,,,427.35,427.35,HUMANA CHOICE PLUS,MGD,427.35,,,,,,,case rate,427.35,427.35,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,AETNA,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,BCBS,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,CIGNA,COM,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,TRICARE,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,UNITED HEALTHCARE,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,UNITED HEALTHCARE,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,VA,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,VA TRICARE,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,WELLMED,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,HUMANA,MGD,1291.63,,,,,,,per diem,1291.63,1291.63,"Per diem rate, code is bundled with other services"
US LOWEXTART RST/STRSS COMPBIL,75093924,CDM,921,RC,93924,CPT,,,,Inpatient,,,1291.63,1291.63,HUMANA CHOICE PLUS,MGD,1291.63,,,,,,,case rate,1291.63,1291.63,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,AETNA,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,BCBS,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,CIGNA,COM,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,TRICARE,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,UNITED HEALTHCARE,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,UNITED HEALTHCARE,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,VA,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,VA TRICARE,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,WELLMED,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,HUMANA,MGD,1055.1,,,,,,,per diem,1055.1,1055.1,"Per diem rate, code is bundled with other services"
US CAROTID BILATERAL          ,75094002,CDM,921,RC,93880,CPT,,,,Inpatient,,,1055.1,1055.1,HUMANA CHOICE PLUS,MGD,1055.1,,,,,,,case rate,1055.1,1055.1,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,AETNA,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,BCBS,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,CIGNA,COM,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,TRICARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,UNITED HEALTHCARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,UNITED HEALTHCARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,VA,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,VA TRICARE,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,WELLMED,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,HUMANA,MGD,350.41,,,,,,,per diem,350.41,350.41,"Per diem rate, code is bundled with other services"
SHUNT EVALUATION              ,75099982,CDM,921,RC,93990,CPT,,,,Inpatient,,,350.41,350.41,HUMANA CHOICE PLUS,MGD,350.41,,,,,,,case rate,350.41,350.41,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,AETNA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,BCBS,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,CIGNA,COM,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,UNITED HEALTHCARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,VA,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,VA TRICARE,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,WELLMED,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,HUMANA,MGD,315,,,,,,,per diem,315,315,"Per diem rate, code is bundled with other services"
US UNLISTED PROC OUTSIDE SERV ,75099999,CDM,402,RC,76999,CPT,,,,Inpatient,,,315,315,HUMANA CHOICE PLUS,MGD,315,,,,,,,case rate,315,315,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,AETNA,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,BCBS,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,CIGNA,COM,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,TRICARE,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,UNITED HEALTHCARE,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,UNITED HEALTHCARE,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,VA,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,VA TRICARE,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,WELLMED,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,HUMANA,MGD,2747.12,,,,,,,per diem,2747.12,2747.12,"Per diem rate, code is bundled with other services"
NM BONE/JOINT WHOLE BODY      ,76000010,CDM,341,RC,78306,CPT,,,,Inpatient,,,2747.12,2747.12,HUMANA CHOICE PLUS,MGD,2747.12,,,,,,,case rate,2747.12,2747.12,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,AETNA,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,BCBS,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,CIGNA,COM,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,TRICARE,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,UNITED HEALTHCARE,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,UNITED HEALTHCARE,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,VA,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,VA TRICARE,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,WELLMED,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,HUMANA,MGD,2472.94,,,,,,,per diem,2472.94,2472.94,"Per diem rate, code is bundled with other services"
NM BONE IMAGING SPECT         ,76000011,CDM,341,RC,78320,CPT,,,,Inpatient,,,2472.94,2472.94,HUMANA CHOICE PLUS,MGD,2472.94,,,,,,,case rate,2472.94,2472.94,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,AETNA,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,BCBS,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,CIGNA,COM,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,TRICARE,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,UNITED HEALTHCARE,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,UNITED HEALTHCARE,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,VA,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,VA TRICARE,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,WELLMED,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,HUMANA,MGD,1597,,,,,,,per diem,1597,1597,"Per diem rate, code is bundled with other services"
NM BONE/JOINT LIMITED         ,76000015,CDM,341,RC,78300,CPT,,,,Inpatient,,,1597,1597,HUMANA CHOICE PLUS,MGD,1597,,,,,,,case rate,1597,1597,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,AETNA,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,BCBS,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,CIGNA,COM,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,TRICARE,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,UNITED HEALTHCARE,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,UNITED HEALTHCARE,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,VA,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,VA TRICARE,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,WELLMED,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,HUMANA,MGD,1792.85,,,,,,,per diem,1792.85,1792.85,"Per diem rate, code is bundled with other services"
NM LIVER/SPLEEN IMAGING       ,76000020,CDM,341,RC,78215,CPT,,,,Inpatient,,,1792.85,1792.85,HUMANA CHOICE PLUS,MGD,1792.85,,,,,,,case rate,1792.85,1792.85,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,AETNA,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,BCBS,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,CIGNA,COM,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,TRICARE,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,UNITED HEALTHCARE,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,UNITED HEALTHCARE,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,VA,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,VA TRICARE,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,WELLMED,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,HUMANA,MGD,1433.58,,,,,,,per diem,1433.58,1433.58,"Per diem rate, code is bundled with other services"
NM LUNG PERFUSION ONLY        ,76000029,CDM,341,RC,78580,CPT,,,,Inpatient,,,1433.58,1433.58,HUMANA CHOICE PLUS,MGD,1433.58,,,,,,,case rate,1433.58,1433.58,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,AETNA,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,CIGNA,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,TRICARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,UNITED HEALTHCARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,UNITED HEALTHCARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,VA,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,VA TRICARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,WELLMED,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,HUMANA,MGD,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM VENTILATION/PERFUSION QUANT,76000030,CDM,341,RC,78598,CPT,,,,Inpatient,,,2587.54,2587.54,HUMANA CHOICE PLUS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,AETNA,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,BCBS,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,CIGNA,COM,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,TRICARE,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,UNITED HEALTHCARE,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,UNITED HEALTHCARE,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,VA,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,VA TRICARE,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,WELLMED,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,HUMANA,MGD,2317.64,,,,,,,per diem,2317.64,2317.64,"Per diem rate, code is bundled with other services"
NM BRAIN COMPLETE W/FLOW      ,76000035,CDM,341,RC,78606,CPT,,,,Inpatient,,,2317.64,2317.64,HUMANA CHOICE PLUS,MGD,2317.64,,,,,,,case rate,2317.64,2317.64,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,AETNA,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,CIGNA,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,TRICARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,UNITED HEALTHCARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,UNITED HEALTHCARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,VA,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,VA TRICARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,WELLMED,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,HUMANA,MGD,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM CARDIAC MUGA               ,76000045,CDM,341,RC,78472,CPT,,,,Inpatient,,,4346.12,4346.12,HUMANA CHOICE PLUS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,AETNA,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,BCBS,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,CIGNA,COM,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,TRICARE,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,UNITED HEALTHCARE,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,UNITED HEALTHCARE,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,VA,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,VA TRICARE,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,WELLMED,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,HUMANA,MGD,2143.07,,,,,,,per diem,2143.07,2143.07,"Per diem rate, code is bundled with other services"
NM CEREBROSPINAL FLUID FLOW   ,76000046,CDM,341,RC,78630,CPT,,,,Inpatient,,,2143.07,2143.07,HUMANA CHOICE PLUS,MGD,2143.07,,,,,,,case rate,2143.07,2143.07,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,AETNA,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,BCBS,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,CIGNA,COM,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,TRICARE,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,UNITED HEALTHCARE,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,UNITED HEALTHCARE,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,VA,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,VA TRICARE,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,WELLMED,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,HUMANA,MGD,3262.27,,,,,,,per diem,3262.27,3262.27,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW              ,76000050,CDM,341,RC,78701,CPT,,,,Inpatient,,,3262.27,3262.27,HUMANA CHOICE PLUS,MGD,3262.27,,,,,,,case rate,3262.27,3262.27,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,AETNA,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,BCBS,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,CIGNA,COM,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,TRICARE,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,UNITED HEALTHCARE,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,UNITED HEALTHCARE,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,VA,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,VA TRICARE,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,WELLMED,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,HUMANA,MGD,1651.48,,,,,,,per diem,1651.48,1651.48,"Per diem rate, code is bundled with other services"
NM GASTROESOPHAGEAL REFLUX    ,76000051,CDM,341,RC,78262,CPT,,,,Inpatient,,,1651.48,1651.48,HUMANA CHOICE PLUS,MGD,1651.48,,,,,,,case rate,1651.48,1651.48,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,AETNA,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,BCBS,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,CIGNA,COM,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,TRICARE,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,UNITED HEALTHCARE,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,UNITED HEALTHCARE,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,VA,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,VA TRICARE,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,WELLMED,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,HUMANA,MGD,2897.06,,,,,,,per diem,2897.06,2897.06,"Per diem rate, code is bundled with other services"
NM URETERAL REFLUX            ,76000058,CDM,341,RC,78740,CPT,,,,Inpatient,,,2897.06,2897.06,HUMANA CHOICE PLUS,MGD,2897.06,,,,,,,case rate,2897.06,2897.06,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,AETNA,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,BCBS,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,CIGNA,COM,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,TRICARE,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,UNITED HEALTHCARE,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,UNITED HEALTHCARE,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,VA,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,VA TRICARE,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,WELLMED,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,HUMANA,MGD,2022.97,,,,,,,per diem,2022.97,2022.97,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY              ,76000059,CDM,341,RC,78226,CPT,,,,Inpatient,,,2022.97,2022.97,HUMANA CHOICE PLUS,MGD,2022.97,,,,,,,case rate,2022.97,2022.97,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,AETNA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,CIGNA,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,VA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,VA TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,WELLMED,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,HUMANA,MGD,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIOPHARM TX-ORAL ADMIN   ,76000115,CDM,342,RC,79005,CPT,,,,Inpatient,,,1540.1,1540.1,HUMANA CHOICE PLUS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,AETNA,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,BCBS,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,CIGNA,COM,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,TRICARE,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,UNITED HEALTHCARE,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,UNITED HEALTHCARE,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,VA,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,VA TRICARE,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,WELLMED,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,HUMANA,MGD,3033.07,,,,,,,per diem,3033.07,3033.07,"Per diem rate, code is bundled with other services"
NM VENOUS THROMBOSIS BILATERAL,76000140,CDM,341,RC,78458,CPT,,,,Inpatient,,,3033.07,3033.07,HUMANA CHOICE PLUS,MGD,3033.07,,,,,,,case rate,3033.07,3033.07,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,AETNA,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,BCBS,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,CIGNA,COM,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,TRICARE,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,UNITED HEALTHCARE,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,UNITED HEALTHCARE,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,VA,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,VA TRICARE,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,WELLMED,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,HUMANA,MGD,2694.64,,,,,,,per diem,2694.64,2694.64,"Per diem rate, code is bundled with other services"
NM ABSCESS LOCAL WHOLE BODY   ,76000180,CDM,341,RC,78806,CPT,,,,Inpatient,,,2694.64,2694.64,HUMANA CHOICE PLUS,MGD,2694.64,,,,,,,case rate,2694.64,2694.64,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,AETNA,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,BCBS,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,CIGNA,COM,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,TRICARE,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,UNITED HEALTHCARE,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,UNITED HEALTHCARE,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,VA,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,VA TRICARE,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,WELLMED,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,HUMANA,MGD,2836.6,,,,,,,per diem,2836.6,2836.6,"Per diem rate, code is bundled with other services"
NM BONE IMAGING 3 PHASE       ,76000240,CDM,341,RC,78315,CPT,,,,Inpatient,,,2836.6,2836.6,HUMANA CHOICE PLUS,MGD,2836.6,,,,,,,case rate,2836.6,2836.6,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,AETNA,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,BCBS,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,CIGNA,COM,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,TRICARE,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,UNITED HEALTHCARE,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,UNITED HEALTHCARE,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,VA,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,VA TRICARE,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,WELLMED,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,HUMANA,MGD,2349.77,,,,,,,per diem,2349.77,2349.77,"Per diem rate, code is bundled with other services"
NM BRAIN SPECT                ,76000250,CDM,341,RC,78607,CPT,,,,Inpatient,,,2349.77,2349.77,HUMANA CHOICE PLUS,MGD,2349.77,,,,,,,case rate,2349.77,2349.77,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,AETNA,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,BCBS,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,CIGNA,COM,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,TRICARE,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,UNITED HEALTHCARE,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,UNITED HEALTHCARE,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,VA,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,VA TRICARE,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,WELLMED,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,HUMANA,MGD,3049.14,,,,,,,per diem,3049.14,3049.14,"Per diem rate, code is bundled with other services"
NM KIDNEY SPECT               ,76000350,CDM,341,RC,78710,CPT,,,,Inpatient,,,3049.14,3049.14,HUMANA CHOICE PLUS,MGD,3049.14,,,,,,,case rate,3049.14,3049.14,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,AETNA,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,BCBS,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,CIGNA,COM,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,TRICARE,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,UNITED HEALTHCARE,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,UNITED HEALTHCARE,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,VA,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,VA TRICARE,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,WELLMED,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,HUMANA,MGD,1954.58,,,,,,,per diem,1954.58,1954.58,"Per diem rate, code is bundled with other services"
NM LIVER IMAGING SPECT        ,76000360,CDM,341,RC,78205,CPT,,,,Inpatient,,,1954.58,1954.58,HUMANA CHOICE PLUS,MGD,1954.58,,,,,,,case rate,1954.58,1954.58,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,AETNA,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,BCBS,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,CIGNA,COM,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,TRICARE,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,UNITED HEALTHCARE,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,UNITED HEALTHCARE,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,VA,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,VA TRICARE,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,WELLMED,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,HUMANA,MGD,2025.26,,,,,,,per diem,2025.26,2025.26,"Per diem rate, code is bundled with other services"
NM INTESTINAL IMAGING         ,76000370,CDM,341,RC,78290,CPT,,,,Inpatient,,,2025.26,2025.26,HUMANA CHOICE PLUS,MGD,2025.26,,,,,,,case rate,2025.26,2025.26,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,AETNA,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,BCBS,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,CIGNA,COM,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,TRICARE,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,UNITED HEALTHCARE,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,UNITED HEALTHCARE,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,VA,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,VA TRICARE,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,WELLMED,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,HUMANA,MGD,1724.31,,,,,,,per diem,1724.31,1724.31,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT SPECT   ,76000390,CDM,341,RC,78469,CPT,,,,Inpatient,,,1724.31,1724.31,HUMANA CHOICE PLUS,MGD,1724.31,,,,,,,case rate,1724.31,1724.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,AETNA,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,BCBS,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,CIGNA,COM,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,TRICARE,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,UNITED HEALTHCARE,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,UNITED HEALTHCARE,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,VA,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,VA TRICARE,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,WELLMED,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,HUMANA,MGD,550.65,,,,,,,per diem,550.65,550.65,"Per diem rate, code is bundled with other services"
CHEMO VIA IV EA ADDL HOUR     ,76000470,CDM,335,RC,96415,CPT,,,,Inpatient,,,550.65,550.65,HUMANA CHOICE PLUS,MGD,550.65,,,,,,,case rate,550.65,550.65,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,AETNA,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,BCBS,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,CIGNA,COM,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,TRICARE,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,UNITED HEALTHCARE,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,UNITED HEALTHCARE,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,VA,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,VA TRICARE,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,WELLMED,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,HUMANA,MGD,743.31,,,,,,,per diem,743.31,743.31,"Per diem rate, code is bundled with other services"
CHEMO VIA IV UP TO 1 HOUR     ,76000471,CDM,335,RC,96413,CPT,,,,Inpatient,,,743.31,743.31,HUMANA CHOICE PLUS,MGD,743.31,,,,,,,case rate,743.31,743.31,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,AETNA,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,BCBS,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,CIGNA,COM,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,TRICARE,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,UNITED HEALTHCARE,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,UNITED HEALTHCARE,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,VA,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,VA TRICARE,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,WELLMED,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,HUMANA,MGD,3958.42,,,,,,,per diem,3958.42,3958.42,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTYING STUDY     ,76000790,CDM,341,RC,78264,CPT,,,,Inpatient,,,3958.42,3958.42,HUMANA CHOICE PLUS,MGD,3958.42,,,,,,,case rate,3958.42,3958.42,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,AETNA,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,CIGNA,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,TRICARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,UNITED HEALTHCARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,UNITED HEALTHCARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,VA,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,VA TRICARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,WELLMED,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,HUMANA,MGD,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
NM GI ACUTE BLOOD LOSS IMAGING,76000862,CDM,341,RC,78278,CPT,,,,Inpatient,,,2220.18,2220.18,HUMANA CHOICE PLUS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,AETNA,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,BCBS,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,CIGNA,COM,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,TRICARE,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,UNITED HEALTHCARE,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,UNITED HEALTHCARE,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,VA,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,VA TRICARE,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,WELLMED,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,HUMANA,MGD,2593.96,,,,,,,per diem,2593.96,2593.96,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW&FUNC W/O PH  ,76000880,CDM,341,RC,78707,CPT,,,,Inpatient,,,2593.96,2593.96,HUMANA CHOICE PLUS,MGD,2593.96,,,,,,,case rate,2593.96,2593.96,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,AETNA,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,BCBS,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,CIGNA,COM,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,TRICARE,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,UNITED HEALTHCARE,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,UNITED HEALTHCARE,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,VA,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,VA TRICARE,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,WELLMED,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,HUMANA,MGD,7966.35,,,,,,,per diem,7966.35,7966.35,"Per diem rate, code is bundled with other services"
IN-111 OXYQUINOLINE PER.5MCI  ,76020002,CDM,343,RC,A9547,HCPCS,,,,Inpatient,,,7966.35,7966.35,HUMANA CHOICE PLUS,MGD,7966.35,,,,,,,case rate,7966.35,7966.35,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,AETNA,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,BCBS,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,CIGNA,COM,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,TRICARE,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,UNITED HEALTHCARE,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,UNITED HEALTHCARE,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,VA,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,VA TRICARE,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,WELLMED,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,HUMANA,MGD,2121.32,,,,,,,per diem,2121.32,2121.32,"Per diem rate, code is bundled with other services"
TC-99M ALBUMIN AGGR <10 MCI   ,76020004,CDM,343,RC,A9540,HCPCS,,,,Inpatient,,,2121.32,2121.32,HUMANA CHOICE PLUS,MGD,2121.32,,,,,,,case rate,2121.32,2121.32,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,AETNA,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,BCBS,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,CIGNA,COM,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,TRICARE,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,UNITED HEALTHCARE,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,UNITED HEALTHCARE,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,VA,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,VA TRICARE,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,WELLMED,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,HUMANA,MGD,59.97,,,,,,,per diem,59.97,59.97,"Per diem rate, code is bundled with other services"
TC-99M OXIDRONATE <30 MCI     ,76020010,CDM,343,RC,A9561,HCPCS,,,,Inpatient,,,59.97,59.97,HUMANA CHOICE PLUS,MGD,59.97,,,,,,,case rate,59.97,59.97,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,AETNA,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,BCBS,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,CIGNA,COM,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,TRICARE,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,UNITED HEALTHCARE,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,UNITED HEALTHCARE,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,VA,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,VA TRICARE,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,WELLMED,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,HUMANA,MGD,287.7,,,,,,,per diem,287.7,287.7,"Per diem rate, code is bundled with other services"
XENON XE-133 GAS PER 10 MCI   ,76020015,CDM,343,RC,A9558,HCPCS,,,,Inpatient,,,287.7,287.7,HUMANA CHOICE PLUS,MGD,287.7,,,,,,,case rate,287.7,287.7,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,AETNA,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,BCBS,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,CIGNA,COM,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,TRICARE,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,UNITED HEALTHCARE,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,UNITED HEALTHCARE,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,VA,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,VA TRICARE,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,WELLMED,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,HUMANA,MGD,30.38,,,,,,,per diem,30.38,30.38,"Per diem rate, code is bundled with other services"
GAB DIMEGLUMINE MULTIHANCE 1ML,76020017,CDM,343,RC,A9577,HCPCS,,,,Inpatient,,,30.38,30.38,HUMANA CHOICE PLUS,MGD,30.38,,,,,,,case rate,30.38,30.38,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,AETNA,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,BCBS,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,CIGNA,COM,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,TRICARE,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,UNITED HEALTHCARE,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,UNITED HEALTHCARE,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,VA,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,VA TRICARE,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,WELLMED,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,HUMANA,MGD,522.89,,,,,,,per diem,522.89,522.89,"Per diem rate, code is bundled with other services"
F-18 FDG PER STUDY DOSE <45MCI,76020019,CDM,343,RC,A9552,CPT,A9552,HCPCS,,Inpatient,,,522.89,522.89,HUMANA CHOICE PLUS,MGD,522.89,,,,,,,case rate,522.89,522.89,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,AETNA,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,BCBS,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,CIGNA,COM,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,TRICARE,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,UNITED HEALTHCARE,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,UNITED HEALTHCARE,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,VA,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,VA TRICARE,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,WELLMED,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,HUMANA,MGD,2055.25,,,,,,,per diem,2055.25,2055.25,"Per diem rate, code is bundled with other services"
NM PARATHYROID                ,76078070,CDM,341,RC,78070,CPT,,,,Inpatient,,,2055.25,2055.25,HUMANA CHOICE PLUS,MGD,2055.25,,,,,,,case rate,2055.25,2055.25,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,AETNA,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,BCBS,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,CIGNA,COM,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,TRICARE,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,UNITED HEALTHCARE,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,UNITED HEALTHCARE,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,VA,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,VA TRICARE,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,WELLMED,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,HUMANA,MGD,1144.41,,,,,,,per diem,1144.41,1144.41,"Per diem rate, code is bundled with other services"
NM LUNG VENT AEROSOL MULTI    ,76078587,CDM,341,RC,78579,CPT,,,,Inpatient,,,1144.41,1144.41,HUMANA CHOICE PLUS,MGD,1144.41,,,,,,,case rate,1144.41,1144.41,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,AETNA,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,BCBS,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,CIGNA,COM,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,TRICARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,UNITED HEALTHCARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,UNITED HEALTHCARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,VA,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,VA TRICARE,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,WELLMED,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,HUMANA,MGD,4346.12,,,,,,,per diem,4346.12,4346.12,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZATION SPECT   ,76078803,CDM,341,RC,78803,CPT,,,,Inpatient,,,4346.12,4346.12,HUMANA CHOICE PLUS,MGD,4346.12,,,,,,,case rate,4346.12,4346.12,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,AETNA,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,BCBS,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,CIGNA,COM,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,TRICARE,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,UNITED HEALTHCARE,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,UNITED HEALTHCARE,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,VA,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,VA TRICARE,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,WELLMED,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,HUMANA,MGD,4128.71,,,,,,,per diem,4128.71,4128.71,"Per diem rate, code is bundled with other services"
NM TUMOR LOCAL WHOLE BODY     ,76078832,CDM,341,RC,78802,CPT,,,,Inpatient,,,4128.71,4128.71,HUMANA CHOICE PLUS,MGD,4128.71,,,,,,,case rate,4128.71,4128.71,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,AETNA,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,BCBS,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,CIGNA,COM,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,TRICARE,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,UNITED HEALTHCARE,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,UNITED HEALTHCARE,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,VA,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,VA TRICARE,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,WELLMED,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,HUMANA,MGD,2674.29,,,,,,,per diem,2674.29,2674.29,"Per diem rate, code is bundled with other services"
NM KIDNEY W/FLOW & FUNC W/PH  ,76078833,CDM,341,RC,78708,CPT,,,,Inpatient,,,2674.29,2674.29,HUMANA CHOICE PLUS,MGD,2674.29,,,,,,,case rate,2674.29,2674.29,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,AETNA,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,BCBS,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,CIGNA,COM,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,TRICARE,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,UNITED HEALTHCARE,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,UNITED HEALTHCARE,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,VA,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,VA TRICARE,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,WELLMED,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,HUMANA,MGD,7258.17,,,,,,,per diem,7258.17,7258.17,"Per diem rate, code is bundled with other services"
NM TUMOR LOC WHOLE BODY 2+DAYS,76078834,CDM,341,RC,78804,CPT,,,,Inpatient,,,7258.17,7258.17,HUMANA CHOICE PLUS,MGD,7258.17,,,,,,,case rate,7258.17,7258.17,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,AETNA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,CIGNA,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,VA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,VA TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,WELLMED,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA,MGD,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG LIMITED AREA   ,76080027,CDM,404,RC,78811,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA CHOICE PLUS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,AETNA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,CIGNA,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,VA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,VA TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,WELLMED,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA,MGD,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR IMAG WHOLE BODY     ,76080029,CDM,404,RC,78813,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA CHOICE PLUS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,AETNA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,CIGNA,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,VA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,VA TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,WELLMED,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA,MGD,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT LIMITED AREA   ,76080030,CDM,404,RC,78814,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA CHOICE PLUS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,AETNA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,CIGNA,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,VA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,VA TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,WELLMED,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA,MGD,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT SKULL-MIDTHIGH ,76080031,CDM,404,RC,78815,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA CHOICE PLUS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,AETNA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,BCBS,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,CIGNA,COM,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,UNITED HEALTHCARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,VA,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,VA TRICARE,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,WELLMED,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA,MGD,4991.93,,,,,,,per diem,4991.93,4991.93,"Per diem rate, code is bundled with other services"
PET TUMOR W/CT WHOLE BODY     ,76080032,CDM,404,RC,78816,CPT,,,,Inpatient,,,4991.93,4991.93,HUMANA CHOICE PLUS,MGD,4991.93,,,,,,,case rate,4991.93,4991.93,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,AETNA,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,CIGNA,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,TRICARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,UNITED HEALTHCARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,UNITED HEALTHCARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,VA,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,VA TRICARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,WELLMED,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,HUMANA,MGD,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
MYOCARD PERF MULTI SPECT      ,76080038,CDM,340,RC,78452,CPT,,,,Inpatient,,,7499.14,7499.14,HUMANA CHOICE PLUS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,AETNA,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,CIGNA,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,TRICARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,UNITED HEALTHCARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,UNITED HEALTHCARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,VA,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,VA TRICARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,WELLMED,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,HUMANA,MGD,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
MYOCARD PERF SGL SPECT        ,76080039,CDM,340,RC,78451,CPT,,,,Inpatient,,,6224.65,6224.65,HUMANA CHOICE PLUS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,AETNA,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,BCBS,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,CIGNA,COM,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,TRICARE,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,UNITED HEALTHCARE,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,UNITED HEALTHCARE,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,VA,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,VA TRICARE,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,WELLMED,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,HUMANA,MGD,2894.91,,,,,,,per diem,2894.91,2894.91,"Per diem rate, code is bundled with other services"
NM BONE MARROW WHOLE BODY     ,76085000,CDM,341,RC,,,,,,Inpatient,,,2894.91,2894.91,HUMANA CHOICE PLUS,MGD,2894.91,,,,,,,case rate,2894.91,2894.91,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,AETNA,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,BCBS,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,CIGNA,COM,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,TRICARE,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,UNITED HEALTHCARE,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,UNITED HEALTHCARE,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,VA,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,VA TRICARE,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,WELLMED,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,HUMANA,MGD,1370.88,,,,,,,per diem,1370.88,1370.88,"Per diem rate, code is bundled with other services"
NM CSF LEAK DETECTION         ,76085001,CDM,341,RC,,,,,,Inpatient,,,1370.88,1370.88,HUMANA CHOICE PLUS,MGD,1370.88,,,,,,,case rate,1370.88,1370.88,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,AETNA,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,BCBS,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,CIGNA,COM,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,TRICARE,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,UNITED HEALTHCARE,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,UNITED HEALTHCARE,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,VA,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,VA TRICARE,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,WELLMED,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,HUMANA,MGD,1363.38,,,,,,,per diem,1363.38,1363.38,"Per diem rate, code is bundled with other services"
NM CSF SHUNT EVALUATION       ,76085002,CDM,341,RC,,,,,,Inpatient,,,1363.38,1363.38,HUMANA CHOICE PLUS,MGD,1363.38,,,,,,,case rate,1363.38,1363.38,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,AETNA,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,BCBS,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,CIGNA,COM,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,TRICARE,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,UNITED HEALTHCARE,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,UNITED HEALTHCARE,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,VA,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,VA TRICARE,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,WELLMED,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,HUMANA,MGD,3382.22,,,,,,,per diem,3382.22,3382.22,"Per diem rate, code is bundled with other services"
NM HEPATOBILIARY SYS W/RX     ,76085003,CDM,341,RC,,,,,,Inpatient,,,3382.22,3382.22,HUMANA CHOICE PLUS,MGD,3382.22,,,,,,,case rate,3382.22,3382.22,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,AETNA,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,BCBS,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,CIGNA,COM,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,TRICARE,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,UNITED HEALTHCARE,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,UNITED HEALTHCARE,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,VA,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,VA TRICARE,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,WELLMED,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,HUMANA,MGD,2748.19,,,,,,,per diem,2748.19,2748.19,"Per diem rate, code is bundled with other services"
NM INFLAM PROCES LOC SPEC     ,76085004,CDM,341,RC,,,,,,Inpatient,,,2748.19,2748.19,HUMANA CHOICE PLUS,MGD,2748.19,,,,,,,case rate,2748.19,2748.19,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,AETNA,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,BCBS,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,CIGNA,COM,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,TRICARE,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,UNITED HEALTHCARE,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,UNITED HEALTHCARE,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,VA,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,VA TRICARE,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,WELLMED,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,HUMANA,MGD,2744.97,,,,,,,per diem,2744.97,2744.97,"Per diem rate, code is bundled with other services"
NM INTERSTITIAL COMPLEX       ,76085005,CDM,342,RC,,,,,,Inpatient,,,2744.97,2744.97,HUMANA CHOICE PLUS,MGD,2744.97,,,,,,,case rate,2744.97,2744.97,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,AETNA,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,BCBS,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,CIGNA,COM,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,TRICARE,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,UNITED HEALTHCARE,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,UNITED HEALTHCARE,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,VA,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,VA TRICARE,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,WELLMED,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,HUMANA,MGD,15686.94,,,,,,,per diem,15686.94,15686.94,"Per diem rate, code is bundled with other services"
NM IOBENGUAN I-131/0.5MCI     ,76085006,CDM,343,RC,,,,,,Inpatient,,,15686.94,15686.94,HUMANA CHOICE PLUS,MGD,15686.94,,,,,,,case rate,15686.94,15686.94,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,AETNA,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,BCBS,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,CIGNA,COM,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,TRICARE,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,UNITED HEALTHCARE,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,UNITED HEALTHCARE,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,VA,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,VA TRICARE,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,WELLMED,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,HUMANA,MGD,5562.77,,,,,,,per diem,5562.77,5562.77,"Per diem rate, code is bundled with other services"
NM KID W FLO/FN MULT WO&W     ,76085007,CDM,341,RC,,,,,,Inpatient,,,5562.77,5562.77,HUMANA CHOICE PLUS,MGD,5562.77,,,,,,,case rate,5562.77,5562.77,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,AETNA,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,BCBS,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,CIGNA,COM,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,TRICARE,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,UNITED HEALTHCARE,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,UNITED HEALTHCARE,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,VA,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,VA TRICARE,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,WELLMED,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,HUMANA,MGD,2647.51,,,,,,,per diem,2647.51,2647.51,"Per diem rate, code is bundled with other services"
NM KIDNEY SCAN                ,76085008,CDM,341,RC,,,,,,Inpatient,,,2647.51,2647.51,HUMANA CHOICE PLUS,MGD,2647.51,,,,,,,case rate,2647.51,2647.51,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,AETNA,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,CIGNA,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,TRICARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,UNITED HEALTHCARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,UNITED HEALTHCARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,VA,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,VA TRICARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,WELLMED,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,HUMANA,MGD,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER SPECT W VAS FLOW     ,76085009,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,HUMANA CHOICE PLUS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,AETNA,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,BCBS,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,CIGNA,COM,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,TRICARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,UNITED HEALTHCARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,UNITED HEALTHCARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,VA,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,VA TRICARE,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,WELLMED,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,HUMANA,MGD,1801.42,,,,,,,per diem,1801.42,1801.42,"Per diem rate, code is bundled with other services"
NM LIVER W FLOW               ,76085010,CDM,341,RC,,,,,,Inpatient,,,1801.42,1801.42,HUMANA CHOICE PLUS,MGD,1801.42,,,,,,,case rate,1801.42,1801.42,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,AETNA,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,BCBS,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,CIGNA,COM,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,TRICARE,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,UNITED HEALTHCARE,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,UNITED HEALTHCARE,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,VA,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,VA TRICARE,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,WELLMED,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,HUMANA,MGD,6702.32,,,,,,,per diem,6702.32,6702.32,"Per diem rate, code is bundled with other services"
NM LYMPH SYSTEM               ,76085011,CDM,341,RC,,,,,,Inpatient,,,6702.32,6702.32,HUMANA CHOICE PLUS,MGD,6702.32,,,,,,,case rate,6702.32,6702.32,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,AETNA,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,BCBS,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,CIGNA,COM,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,TRICARE,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,UNITED HEALTHCARE,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,UNITED HEALTHCARE,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,VA,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,VA TRICARE,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,WELLMED,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,HUMANA,MGD,3507.53,,,,,,,per diem,3507.53,3507.53,"Per diem rate, code is bundled with other services"
NM MONOCLONAL AB THRPY IV     ,76085012,CDM,342,RC,,,,,,Inpatient,,,3507.53,3507.53,HUMANA CHOICE PLUS,MGD,3507.53,,,,,,,case rate,3507.53,3507.53,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,AETNA,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,BCBS,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,CIGNA,COM,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,TRICARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,UNITED HEALTHCARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,UNITED HEALTHCARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,VA,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,VA TRICARE,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,WELLMED,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,HUMANA,MGD,7499.14,,,,,,,per diem,7499.14,7499.14,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL MULT      ,76085013,CDM,341,RC,,,,,,Inpatient,,,7499.14,7499.14,HUMANA CHOICE PLUS,MGD,7499.14,,,,,,,case rate,7499.14,7499.14,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,AETNA,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,BCBS,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,CIGNA,COM,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,TRICARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,UNITED HEALTHCARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,UNITED HEALTHCARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,VA,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,VA TRICARE,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,WELLMED,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,HUMANA,MGD,6224.65,,,,,,,per diem,6224.65,6224.65,"Per diem rate, code is bundled with other services"
NM MYOCAR PLNR WALL SNGL      ,76085014,CDM,341,RC,,,,,,Inpatient,,,6224.65,6224.65,HUMANA CHOICE PLUS,MGD,6224.65,,,,,,,case rate,6224.65,6224.65,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,AETNA,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,BCBS,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,CIGNA,COM,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,TRICARE,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,UNITED HEALTHCARE,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,UNITED HEALTHCARE,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,VA,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,VA TRICARE,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,WELLMED,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,HUMANA,MGD,2138.79,,,,,,,per diem,2138.79,2138.79,"Per diem rate, code is bundled with other services"
NM MYOCARDIAL INFARCT         ,76085015,CDM,341,RC,,,,,,Inpatient,,,2138.79,2138.79,HUMANA CHOICE PLUS,MGD,2138.79,,,,,,,case rate,2138.79,2138.79,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,AETNA,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,BCBS,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,CIGNA,COM,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,TRICARE,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,UNITED HEALTHCARE,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,UNITED HEALTHCARE,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,VA,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,VA TRICARE,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,WELLMED,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,HUMANA,MGD,1380.52,,,,,,,per diem,1380.52,1380.52,"Per diem rate, code is bundled with other services"
NM PERIT-VEN SHUNT PATEN      ,76085016,CDM,341,RC,,,,,,Inpatient,,,1380.52,1380.52,HUMANA CHOICE PLUS,MGD,1380.52,,,,,,,case rate,1380.52,1380.52,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,AETNA,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,BCBS,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,CIGNA,COM,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,TRICARE,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,UNITED HEALTHCARE,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,UNITED HEALTHCARE,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,VA,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,VA TRICARE,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,WELLMED,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,HUMANA,MGD,5733.06,,,,,,,per diem,5733.06,5733.06,"Per diem rate, code is bundled with other services"
NM PERTECHNETATE PER MCI      ,76085017,CDM,343,RC,,,,,,Inpatient,,,5733.06,5733.06,HUMANA CHOICE PLUS,MGD,5733.06,,,,,,,case rate,5733.06,5733.06,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,AETNA,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,BCBS,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,CIGNA,COM,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,TRICARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,UNITED HEALTHCARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,UNITED HEALTHCARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,VA,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,VA TRICARE,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,WELLMED,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,HUMANA,MGD,2587.54,,,,,,,per diem,2587.54,2587.54,"Per diem rate, code is bundled with other services"
NM PUL PERFUSN QUANT DIFF     ,76085018,CDM,341,RC,,,,,,Inpatient,,,2587.54,2587.54,HUMANA CHOICE PLUS,MGD,2587.54,,,,,,,case rate,2587.54,2587.54,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,AETNA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,CIGNA,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,VA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,VA TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,WELLMED,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,HUMANA,MGD,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IA ADMIN     ,76085019,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,HUMANA CHOICE PLUS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,AETNA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,BCBS,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,CIGNA,COM,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,UNITED HEALTHCARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,VA,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,VA TRICARE,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,WELLMED,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,HUMANA,MGD,1540.1,,,,,,,per diem,1540.1,1540.1,"Per diem rate, code is bundled with other services"
NM RADIO RX THPY IV ADMIN     ,76085020,CDM,342,RC,,,,,,Inpatient,,,1540.1,1540.1,HUMANA CHOICE PLUS,MGD,1540.1,,,,,,,case rate,1540.1,1540.1,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,AETNA,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,BCBS,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,CIGNA,COM,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,TRICARE,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,UNITED HEALTHCARE,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,UNITED HEALTHCARE,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,VA,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,VA TRICARE,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,WELLMED,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,HUMANA,MGD,1.07,,,,,,,per diem,1.07,1.07,"Per diem rate, code is bundled with other services"
NM RADIOPHARM INPT ADMIT      ,76085021,CDM,343,RC,,,,,,Inpatient,,,1.07,1.07,HUMANA CHOICE PLUS,MGD,1.07,,,,,,,case rate,1.07,1.07,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,AETNA,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,BCBS,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,CIGNA,COM,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,TRICARE,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,UNITED HEALTHCARE,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,UNITED HEALTHCARE,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,VA,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,VA TRICARE,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,WELLMED,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,HUMANA,MGD,877.15,,,,,,,per diem,877.15,877.15,"Per diem rate, code is bundled with other services"
NM TESTES W FLOW              ,76085022,CDM,341,RC,,,,,,Inpatient,,,877.15,877.15,HUMANA CHOICE PLUS,MGD,877.15,,,,,,,case rate,877.15,877.15,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,AETNA,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,BCBS,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,CIGNA,COM,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,TRICARE,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,UNITED HEALTHCARE,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,UNITED HEALTHCARE,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,VA,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,VA TRICARE,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,WELLMED,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,HUMANA,MGD,1354.82,,,,,,,per diem,1354.82,1354.82,"Per diem rate, code is bundled with other services"
NM THYROID CA METS LTD        ,76085023,CDM,341,RC,,,,,,Inpatient,,,1354.82,1354.82,HUMANA CHOICE PLUS,MGD,1354.82,,,,,,,case rate,1354.82,1354.82,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,AETNA,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,CIGNA,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,TRICARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,UNITED HEALTHCARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,UNITED HEALTHCARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,VA,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,VA TRICARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,WELLMED,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,HUMANA,MGD,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
NM THYROID CA METS WB         ,76085024,CDM,341,RC,,,,,,Inpatient,,,1964.21,1964.21,HUMANA CHOICE PLUS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,AETNA,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,BCBS,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,CIGNA,COM,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,TRICARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,UNITED HEALTHCARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,UNITED HEALTHCARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,VA,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,VA TRICARE,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,WELLMED,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,HUMANA,MGD,1392.3,,,,,,,per diem,1392.3,1392.3,"Per diem rate, code is bundled with other services"
NM THYROID IMAG W MEASURE     ,76085025,CDM,341,RC,,,,,,Inpatient,,,1392.3,1392.3,HUMANA CHOICE PLUS,MGD,1392.3,,,,,,,case rate,1392.3,1392.3,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,AETNA,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,BCBS,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,CIGNA,COM,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,TRICARE,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,UNITED HEALTHCARE,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,UNITED HEALTHCARE,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,VA,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,VA TRICARE,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,WELLMED,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,HUMANA,MGD,1099.92,,,,,,,per diem,1099.92,1099.92,"Per diem rate, code is bundled with other services"
NM THYROID IMAGING            ,76085026,CDM,341,RC,,,,,,Inpatient,,,1099.92,1099.92,HUMANA CHOICE PLUS,MGD,1099.92,,,,,,,case rate,1099.92,1099.92,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,AETNA,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,BCBS,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,CIGNA,COM,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,TRICARE,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,UNITED HEALTHCARE,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,UNITED HEALTHCARE,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,VA,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,VA TRICARE,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,WELLMED,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,HUMANA,MGD,686.51,,,,,,,per diem,686.51,686.51,"Per diem rate, code is bundled with other services"
NM THYROID UPTAKE MEASURE     ,76085027,CDM,341,RC,,,,,,Inpatient,,,686.51,686.51,HUMANA CHOICE PLUS,MGD,686.51,,,,,,,case rate,686.51,686.51,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,AETNA,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,BCBS,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,CIGNA,COM,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,TRICARE,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,UNITED HEALTHCARE,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,UNITED HEALTHCARE,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,VA,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,VA TRICARE,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,WELLMED,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,HUMANA,MGD,2390.47,,,,,,,per diem,2390.47,2390.47,"Per diem rate, code is bundled with other services"
NM TUMOR LOCALIZE LTD         ,76085028,CDM,341,RC,,,,,,Inpatient,,,2390.47,2390.47,HUMANA CHOICE PLUS,MGD,2390.47,,,,,,,case rate,2390.47,2390.47,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,AETNA,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,BCBS,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,CIGNA,COM,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,TRICARE,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,UNITED HEALTHCARE,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,UNITED HEALTHCARE,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,VA,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,VA TRICARE,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,WELLMED,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,HUMANA,MGD,1495.12,,,,,,,per diem,1495.12,1495.12,"Per diem rate, code is bundled with other services"
NM UREA TEST C-14 ACQ         ,76085029,CDM,310,RC,,,,,,Inpatient,,,1495.12,1495.12,HUMANA CHOICE PLUS,MGD,1495.12,,,,,,,case rate,1495.12,1495.12,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,AETNA,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,BCBS,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,CIGNA,COM,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,TRICARE,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,UNITED HEALTHCARE,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,UNITED HEALTHCARE,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,VA,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,VA TRICARE,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,WELLMED,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,HUMANA,MGD,866.44,,,,,,,per diem,866.44,866.44,"Per diem rate, code is bundled with other services"
PENTETATE DX UP TO 25MCI      ,76085030,CDM,343,RC,,,,,,Inpatient,,,866.44,866.44,HUMANA CHOICE PLUS,MGD,866.44,,,,,,,case rate,866.44,866.44,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,AETNA,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,BCBS,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,CIGNA,COM,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,TRICARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,UNITED HEALTHCARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,UNITED HEALTHCARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,VA,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,VA TRICARE,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,WELLMED,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,HUMANA,MGD,620.11,,,,,,,per diem,620.11,620.11,"Per diem rate, code is bundled with other services"
PYROPHOSPHATE DX TO 25MCI     ,76085031,CDM,343,RC,,,,,,Inpatient,,,620.11,620.11,HUMANA CHOICE PLUS,MGD,620.11,,,,,,,case rate,620.11,620.11,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,AETNA,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,BCBS,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,CIGNA,COM,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,TRICARE,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,UNITED HEALTHCARE,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,UNITED HEALTHCARE,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,VA,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,VA TRICARE,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,WELLMED,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,HUMANA,MGD,513.01,,,,,,,per diem,513.01,513.01,"Per diem rate, code is bundled with other services"
SESTAMBI DX PER DOSE          ,76085032,CDM,343,RC,,,,,,Inpatient,,,513.01,513.01,HUMANA CHOICE PLUS,MGD,513.01,,,,,,,case rate,513.01,513.01,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,AETNA,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,BCBS,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,CIGNA,COM,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,TRICARE,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,UNITED HEALTHCARE,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,UNITED HEALTHCARE,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,VA,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,VA TRICARE,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,WELLMED,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,HUMANA,MGD,2570.4,,,,,,,per diem,2570.4,2570.4,"Per diem rate, code is bundled with other services"
SIMUL AIDED FIELD COMPLEX     ,76085033,CDM,333,RC,,,,,,Inpatient,,,2570.4,2570.4,HUMANA CHOICE PLUS,MGD,2570.4,,,,,,,case rate,2570.4,2570.4,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,AETNA,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,CIGNA,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,TRICARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,UNITED HEALTHCARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,UNITED HEALTHCARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,VA,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,VA TRICARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,WELLMED,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,HUMANA,MGD,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
SINCALIDE 5MCG SDV            ,76085034,CDM,636,RC,,,,,,Inpatient,1,EA,3145.53,3145.53,HUMANA CHOICE PLUS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,AETNA,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,BCBS,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,CIGNA,COM,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,TRICARE,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,UNITED HEALTHCARE,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,UNITED HEALTHCARE,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,VA,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,VA TRICARE,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,WELLMED,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,HUMANA,MGD,41825.76,,,,,,,per diem,41825.76,41825.76,"Per diem rate, code is bundled with other services"
SM153 LEXIDRON TO 150MCI      ,76085035,CDM,344,RC,,,,,,Inpatient,,,41825.76,41825.76,HUMANA CHOICE PLUS,MGD,41825.76,,,,,,,case rate,41825.76,41825.76,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,AETNA,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,BCBS,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,CIGNA,COM,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,TRICARE,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,UNITED HEALTHCARE,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,UNITED HEALTHCARE,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,VA,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,VA TRICARE,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,WELLMED,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,HUMANA,MGD,4429.66,,,,,,,per diem,4429.66,4429.66,"Per diem rate, code is bundled with other services"
SPECIAL TX PROCEDURE          ,76085036,CDM,333,RC,,,,,,Inpatient,,,4429.66,4429.66,HUMANA CHOICE PLUS,MGD,4429.66,,,,,,,case rate,4429.66,4429.66,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,AETNA,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,BCBS,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,CIGNA,COM,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,TRICARE,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,UNITED HEALTHCARE,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,UNITED HEALTHCARE,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,VA,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,VA TRICARE,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,WELLMED,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,HUMANA,MGD,38865.52,,,,,,,per diem,38865.52,38865.52,"Per diem rate, code is bundled with other services"
STRONTIUM SR-89 THERA/MCI     ,76085037,CDM,344,RC,,,,,,Inpatient,,,38865.52,38865.52,HUMANA CHOICE PLUS,MGD,38865.52,,,,,,,case rate,38865.52,38865.52,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,AETNA,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,BCBS,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,CIGNA,COM,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,TRICARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,UNITED HEALTHCARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,UNITED HEALTHCARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,VA,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,VA TRICARE,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,WELLMED,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,HUMANA,MGD,1964.21,,,,,,,per diem,1964.21,1964.21,"Per diem rate, code is bundled with other services"
SUCCIMER DX TO 10MCI          ,76085038,CDM,343,RC,,,,,,Inpatient,,,1964.21,1964.21,HUMANA CHOICE PLUS,MGD,1964.21,,,,,,,case rate,1964.21,1964.21,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,AETNA,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,BCBS,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,CIGNA,COM,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,TRICARE,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,UNITED HEALTHCARE,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,UNITED HEALTHCARE,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,VA,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,VA TRICARE,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,WELLMED,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,HUMANA,MGD,991.75,,,,,,,per diem,991.75,991.75,"Per diem rate, code is bundled with other services"
SULF COLL TC99<=20MCI FLT     ,76085039,CDM,343,RC,,,,,,Inpatient,,,991.75,991.75,HUMANA CHOICE PLUS,MGD,991.75,,,,,,,case rate,991.75,991.75,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,AETNA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,BCBS,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,CIGNA,COM,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,UNITED HEALTHCARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,VA,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,VA TRICARE,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,WELLMED,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA,MGD,269.89,,,,,,,per diem,269.89,269.89,"Per diem rate, code is bundled with other services"
SUPRV HANDL LOAD RADIOELE     ,76085040,CDM,333,RC,,,,,,Inpatient,,,269.89,269.89,HUMANA CHOICE PLUS,MGD,269.89,,,,,,,case rate,269.89,269.89,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,AETNA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,BCBS,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,CIGNA,COM,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,UNITED HEALTHCARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,VA,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,VA TRICARE,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,WELLMED,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA,MGD,139.23,,,,,,,per diem,139.23,139.23,"Per diem rate, code is bundled with other services"
THALLIUM TL201 DX PER MCI     ,76085041,CDM,343,RC,,,,,,Inpatient,,,139.23,139.23,HUMANA CHOICE PLUS,MGD,139.23,,,,,,,case rate,139.23,139.23,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,AETNA,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,BCBS,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,CIGNA,COM,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,TRICARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,UNITED HEALTHCARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,UNITED HEALTHCARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,VA,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,VA TRICARE,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,WELLMED,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,HUMANA,MGD,2285.51,,,,,,,per diem,2285.51,2285.51,"Per diem rate, code is bundled with other services"
US TRANSREC PROSTATE VOL      ,76085042,CDM,402,RC,,,,,,Inpatient,,,2285.51,2285.51,HUMANA CHOICE PLUS,MGD,2285.51,,,,,,,case rate,2285.51,2285.51,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,AETNA,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,BCBS,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,CIGNA,COM,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,TRICARE,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,UNITED HEALTHCARE,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,UNITED HEALTHCARE,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,VA,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,VA TRICARE,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,WELLMED,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,HUMANA,MGD,984.25,,,,,,,per diem,984.25,984.25,"Per diem rate, code is bundled with other services"
XENON XE-133 DX PER 10MCI     ,76085043,CDM,343,RC,,,,,,Inpatient,,,984.25,984.25,HUMANA CHOICE PLUS,MGD,984.25,,,,,,,case rate,984.25,984.25,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,AETNA,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,BCBS,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,CIGNA,COM,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,TRICARE,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,UNITED HEALTHCARE,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,UNITED HEALTHCARE,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,VA,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,VA TRICARE,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,WELLMED,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,HUMANA,MGD,5672.02,,,,,,,per diem,5672.02,5672.02,"Per diem rate, code is bundled with other services"
APCITIDE DX TO 20MCI          ,76085044,CDM,343,RC,,,,,,Inpatient,,,5672.02,5672.02,HUMANA CHOICE PLUS,MGD,5672.02,,,,,,,case rate,5672.02,5672.02,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,AETNA,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,BCBS,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,CIGNA,COM,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,TRICARE,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,UNITED HEALTHCARE,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,UNITED HEALTHCARE,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,VA,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,VA TRICARE,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,WELLMED,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,HUMANA,MGD,15817.6,,,,,,,per diem,15817.6,15817.6,"Per diem rate, code is bundled with other services"
ARCITUMOMAB DX TO 45MCI       ,76085045,CDM,343,RC,,,,,,Inpatient,,,15817.6,15817.6,HUMANA CHOICE PLUS,MGD,15817.6,,,,,,,case rate,15817.6,15817.6,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,AETNA,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,BCBS,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,CIGNA,COM,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,TRICARE,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,UNITED HEALTHCARE,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,UNITED HEALTHCARE,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,VA,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,VA TRICARE,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,WELLMED,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,HUMANA,MGD,4591.38,,,,,,,per diem,4591.38,4591.38,"Per diem rate, code is bundled with other services"
BICISATE DX TO 25MCI          ,76085046,CDM,343,RC,,,,,,Inpatient,,,4591.38,4591.38,HUMANA CHOICE PLUS,MGD,4591.38,,,,,,,case rate,4591.38,4591.38,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,AETNA,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,BCBS,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,CIGNA,COM,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,TRICARE,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,UNITED HEALTHCARE,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,UNITED HEALTHCARE,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,VA,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,VA TRICARE,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,WELLMED,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,HUMANA,MGD,8083.91,,,,,,,per diem,8083.91,8083.91,"Per diem rate, code is bundled with other services"
DEPREOTIDE DX UP TO 35MCI     ,76085047,CDM,343,RC,,,,,,Inpatient,,,8083.91,8083.91,HUMANA CHOICE PLUS,MGD,8083.91,,,,,,,case rate,8083.91,8083.91,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,AETNA,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,BCBS,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,CIGNA,COM,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,TRICARE,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,UNITED HEALTHCARE,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,UNITED HEALTHCARE,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,VA,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,VA TRICARE,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,WELLMED,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,HUMANA,MGD,2591.82,,,,,,,per diem,2591.82,2591.82,"Per diem rate, code is bundled with other services"
EXAMETAZIME DX TO 25MCI       ,76085048,CDM,343,RC,,,,,,Inpatient,,,2591.82,2591.82,HUMANA CHOICE PLUS,MGD,2591.82,,,,,,,case rate,2591.82,2591.82,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,AETNA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,BCBS,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,CIGNA,COM,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,UNITED HEALTHCARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,VA,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,VA TRICARE,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,WELLMED,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA,MGD,59.98,,,,,,,per diem,59.98,59.98,"Per diem rate, code is bundled with other services"
GALLIUM GA-67 DX PER MCI      ,76085049,CDM,343,RC,,,,,,Inpatient,,,59.98,59.98,HUMANA CHOICE PLUS,MGD,59.98,,,,,,,case rate,59.98,59.98,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,AETNA,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,BCBS,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,CIGNA,COM,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,TRICARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,UNITED HEALTHCARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,UNITED HEALTHCARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,VA,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,VA TRICARE,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,WELLMED,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,HUMANA,MGD,741.13,,,,,,,per diem,741.13,741.13,"Per diem rate, code is bundled with other services"
I-123 NA IO DX 100UCI/CAP     ,76085050,CDM,343,RC,,,,,,Inpatient,,,741.13,741.13,HUMANA CHOICE PLUS,MGD,741.13,,,,,,,case rate,741.13,741.13,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,AETNA,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,BCBS,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,CIGNA,COM,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,TRICARE,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,UNITED HEALTHCARE,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,UNITED HEALTHCARE,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,VA,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,VA TRICARE,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,WELLMED,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,HUMANA,MGD,1682.54,,,,,,,per diem,1682.54,1682.54,"Per diem rate, code is bundled with other services"
I-131 NA IOD THER CAP/MCI     ,76085051,CDM,344,RC,,,,,,Inpatient,,,1682.54,1682.54,HUMANA CHOICE PLUS,MGD,1682.54,,,,,,,case rate,1682.54,1682.54,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,AETNA,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,BCBS,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,CIGNA,COM,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,TRICARE,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,UNITED HEALTHCARE,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,UNITED HEALTHCARE,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,VA,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,VA TRICARE,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,WELLMED,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,HUMANA,MGD,847.16,,,,,,,per diem,847.16,847.16,"Per diem rate, code is bundled with other services"
I-131 NA IODID SOL TX/MCI     ,76085052,CDM,344,RC,,,,,,Inpatient,,,847.16,847.16,HUMANA CHOICE PLUS,MGD,847.16,,,,,,,case rate,847.16,847.16,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,AETNA,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,BCBS,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,CIGNA,COM,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,TRICARE,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,UNITED HEALTHCARE,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,UNITED HEALTHCARE,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,VA,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,VA TRICARE,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,WELLMED,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,HUMANA,MGD,22383.9,,,,,,,per diem,22383.9,22383.9,"Per diem rate, code is bundled with other services"
IN-111 CAPROMAB TO 10MCI      ,76085053,CDM,343,RC,,,,,,Inpatient,,,22383.9,22383.9,HUMANA CHOICE PLUS,MGD,22383.9,,,,,,,case rate,22383.9,22383.9,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,AETNA,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,BCBS,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,CIGNA,COM,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,TRICARE,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,UNITED HEALTHCARE,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,UNITED HEALTHCARE,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,VA,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,VA TRICARE,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,WELLMED,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,HUMANA,MGD,2459.02,,,,,,,per diem,2459.02,2459.02,"Per diem rate, code is bundled with other services"
IN111 OXYQUINOL DX/0.5MCI     ,76085054,CDM,343,RC,,,,,,Inpatient,,,2459.02,2459.02,HUMANA CHOICE PLUS,MGD,2459.02,,,,,,,case rate,2459.02,2459.02,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,AETNA,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,BCBS,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,CIGNA,COM,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,TRICARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,UNITED HEALTHCARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,UNITED HEALTHCARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,VA,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,VA TRICARE,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,WELLMED,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,HUMANA,MGD,2314.43,,,,,,,per diem,2314.43,2314.43,"Per diem rate, code is bundled with other services"
IN-111 PENTETAT DX 0.5MCI     ,76085055,CDM,343,RC,,,,,,Inpatient,,,2314.43,2314.43,HUMANA CHOICE PLUS,MGD,2314.43,,,,,,,case rate,2314.43,2314.43,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,AETNA,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,BCBS,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,CIGNA,COM,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,TRICARE,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,UNITED HEALTHCARE,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,UNITED HEALTHCARE,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,VA,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,VA TRICARE,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,WELLMED,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,HUMANA,MGD,23220.35,,,,,,,per diem,23220.35,23220.35,"Per diem rate, code is bundled with other services"
IN-111 PENTETR DX TO 6MCI     ,76085056,CDM,343,RC,,,,,,Inpatient,,,23220.35,23220.35,HUMANA CHOICE PLUS,MGD,23220.35,,,,,,,case rate,23220.35,23220.35,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,AETNA,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,BCBS,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,CIGNA,COM,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,TRICARE,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,UNITED HEALTHCARE,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,UNITED HEALTHCARE,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,VA,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,VA TRICARE,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,WELLMED,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,HUMANA,MGD,24275.29,,,,,,,per diem,24275.29,24275.29,"Per diem rate, code is bundled with other services"
IN111 SATUMOMAB DX TO 6MC     ,76085057,CDM,343,RC,,,,,,Inpatient,,,24275.29,24275.29,HUMANA CHOICE PLUS,MGD,24275.29,,,,,,,case rate,24275.29,24275.29,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,AETNA,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,BCBS,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,CIGNA,COM,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,TRICARE,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,UNITED HEALTHCARE,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,UNITED HEALTHCARE,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,VA,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,VA TRICARE,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,WELLMED,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,HUMANA,MGD,1391.23,,,,,,,per diem,1391.23,1391.23,"Per diem rate, code is bundled with other services"
LABELED RBC DX TO 30MCI       ,76085058,CDM,343,RC,,,,,,Inpatient,,,1391.23,1391.23,HUMANA CHOICE PLUS,MGD,1391.23,,,,,,,case rate,1391.23,1391.23,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,AETNA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,BCBS,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,CIGNA,COM,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,UNITED HEALTHCARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,VA,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,VA TRICARE,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,WELLMED,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA,MGD,64.26,,,,,,,per diem,64.26,64.26,"Per diem rate, code is bundled with other services"
MACROAG ALBUM DX TO 10MCI     ,76085059,CDM,343,RC,,,,,,Inpatient,,,64.26,64.26,HUMANA CHOICE PLUS,MGD,64.26,,,,,,,case rate,64.26,64.26,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,AETNA,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,BCBS,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,CIGNA,COM,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,TRICARE,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,UNITED HEALTHCARE,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,UNITED HEALTHCARE,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,VA,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,VA TRICARE,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,WELLMED,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,HUMANA,MGD,272.03,,,,,,,per diem,272.03,272.03,"Per diem rate, code is bundled with other services"
MEDRONATE DX UP TO 30MCI      ,76085060,CDM,343,RC,,,,,,Inpatient,,,272.03,272.03,HUMANA CHOICE PLUS,MGD,272.03,,,,,,,case rate,272.03,272.03,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,AETNA,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,BCBS,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,CIGNA,COM,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,TRICARE,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,UNITED HEALTHCARE,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,UNITED HEALTHCARE,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,VA,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,VA TRICARE,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,WELLMED,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,HUMANA,MGD,3180.87,,,,,,,per diem,3180.87,3180.87,"Per diem rate, code is bundled with other services"
MERTIATIDE DX TO 15MCI        ,76085061,CDM,343,RC,,,,,,Inpatient,,,3180.87,3180.87,HUMANA CHOICE PLUS,MGD,3180.87,,,,,,,case rate,3180.87,3180.87,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,AETNA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,CIGNA,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,WELLMED,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA,MGD,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,76085062,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA CHOICE PLUS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,AETNA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,CIGNA,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,WELLMED,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA,MGD,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,76085063,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA CHOICE PLUS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,76085064,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,76085065,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,AETNA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,CIGNA,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,WELLMED,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA,MGD,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,76085066,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA CHOICE PLUS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,AETNA,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,BCBS,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,CIGNA,COM,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,TRICARE,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,UNITED HEALTHCARE,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,UNITED HEALTHCARE,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,VA,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,VA TRICARE,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,WELLMED,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,HUMANA,MGD,2728.91,,,,,,,per diem,2728.91,2728.91,"Per diem rate, code is bundled with other services"
PENTETATE DX AERO TO 75MC     ,76085067,CDM,343,RC,,,,,,Inpatient,,,2728.91,2728.91,HUMANA CHOICE PLUS,MGD,2728.91,,,,,,,case rate,2728.91,2728.91,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,AETNA,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,BCBS,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,CIGNA,COM,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,TRICARE,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,UNITED HEALTHCARE,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,UNITED HEALTHCARE,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,VA,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,VA TRICARE,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,WELLMED,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,HUMANA,MGD,5955.83,,,,,,,per diem,5955.83,5955.83,"Per diem rate, code is bundled with other services"
EXAMETAZIME WBC DX/DOSE       ,76085068,CDM,343,RC,,,,,,Inpatient,,,5955.83,5955.83,HUMANA CHOICE PLUS,MGD,5955.83,,,,,,,case rate,5955.83,5955.83,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,AETNA,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,BCBS,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,CIGNA,COM,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,TRICARE,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,UNITED HEALTHCARE,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,UNITED HEALTHCARE,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,VA,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,VA TRICARE,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,WELLMED,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,HUMANA,MGD,14664.13,,,,,,,per diem,14664.13,14664.13,"Per diem rate, code is bundled with other services"
IN-111 WBC DX PER DOSE        ,76085069,CDM,343,RC,,,,,,Inpatient,,,14664.13,14664.13,HUMANA CHOICE PLUS,MGD,14664.13,,,,,,,case rate,14664.13,14664.13,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,AETNA,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,BCBS,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,CIGNA,COM,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,TRICARE,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,UNITED HEALTHCARE,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,UNITED HEALTHCARE,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,VA,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,VA TRICARE,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,WELLMED,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,HUMANA,MGD,664.02,,,,,,,per diem,664.02,664.02,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN SIMPLE        ,76085070,CDM,333,RC,,,,,,Inpatient,,,664.02,664.02,HUMANA CHOICE PLUS,MGD,664.02,,,,,,,case rate,664.02,664.02,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,AETNA,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,CIGNA,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,TRICARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,UNITED HEALTHCARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,UNITED HEALTHCARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,VA,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,VA TRICARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,WELLMED,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,HUMANA,MGD,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN INTERMED      ,76085071,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,HUMANA CHOICE PLUS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,AETNA,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,BCBS,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,CIGNA,COM,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,TRICARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,UNITED HEALTHCARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,UNITED HEALTHCARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,VA,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,VA TRICARE,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,WELLMED,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,HUMANA,MGD,1847.48,,,,,,,per diem,1847.48,1847.48,"Per diem rate, code is bundled with other services"
BRACHY ISO PLAN COMPLEX       ,76085072,CDM,333,RC,,,,,,Inpatient,,,1847.48,1847.48,HUMANA CHOICE PLUS,MGD,1847.48,,,,,,,case rate,1847.48,1847.48,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,AETNA,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,BCBS,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,CIGNA,COM,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,TRICARE,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,UNITED HEALTHCARE,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,UNITED HEALTHCARE,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,VA,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,VA TRICARE,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,WELLMED,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,HUMANA,MGD,1942.79,,,,,,,per diem,1942.79,1942.79,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB TRANS     ,76085073,CDM,341,RC,,,,,,Inpatient,,,1942.79,1942.79,HUMANA CHOICE PLUS,MGD,1942.79,,,,,,,case rate,1942.79,1942.79,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,AETNA,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,BCBS,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,CIGNA,COM,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,TRICARE,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,UNITED HEALTHCARE,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,UNITED HEALTHCARE,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,VA,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,VA TRICARE,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,WELLMED,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,HUMANA,MGD,2577.9,,,,,,,per diem,2577.9,2577.9,"Per diem rate, code is bundled with other services"
NM GASTRIC EMPTY SB&COLON     ,76085074,CDM,341,RC,,,,,,Inpatient,,,2577.9,2577.9,HUMANA CHOICE PLUS,MGD,2577.9,,,,,,,case rate,2577.9,2577.9,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,AETNA,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,BCBS,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,CIGNA,COM,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,TRICARE,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,UNITED HEALTHCARE,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,UNITED HEALTHCARE,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,VA,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,VA TRICARE,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,WELLMED,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,HUMANA,MGD,2661.44,,,,,,,per diem,2661.44,2661.44,"Per diem rate, code is bundled with other services"
TILMANOCEPT DX /50MCG 5VL     ,76085075,CDM,343,RC,,,,,,Inpatient,,,2661.44,2661.44,HUMANA CHOICE PLUS,MGD,2661.44,,,,,,,case rate,2661.44,2661.44,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,AETNA,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,BCBS,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,CIGNA,COM,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,TRICARE,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,UNITED HEALTHCARE,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,UNITED HEALTHCARE,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,VA,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,VA TRICARE,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,WELLMED,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,HUMANA,MGD,12086.24,,,,,,,per diem,12086.24,12086.24,"Per diem rate, code is bundled with other services"
I-123 IOFLUPNE TO5MCI/DSE     ,76085076,CDM,343,RC,,,,,,Inpatient,,,12086.24,12086.24,HUMANA CHOICE PLUS,MGD,12086.24,,,,,,,case rate,12086.24,12086.24,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,AETNA,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,BCBS,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,CIGNA,COM,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,TRICARE,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,UNITED HEALTHCARE,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,UNITED HEALTHCARE,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,VA,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,VA TRICARE,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,WELLMED,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,HUMANA,MGD,3128.39,,,,,,,per diem,3128.39,3128.39,"Per diem rate, code is bundled with other services"
SENTINL NDE RAD TR ID INJ     ,76085078,CDM,360,RC,,,,,,Inpatient,,,3128.39,3128.39,HUMANA CHOICE PLUS,MGD,3128.39,,,,,,,case rate,3128.39,3128.39,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,AETNA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,BCBS,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,CIGNA,COM,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,UNITED HEALTHCARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,VA,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,VA TRICARE,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,WELLMED,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA,MGD,549.42,,,,,,,per diem,549.42,549.42,"Per diem rate, code is bundled with other services"
PERITN-VEN SHUNT EVAL INJ     ,76085079,CDM,361,RC,,,,,,Inpatient,,,549.42,549.42,HUMANA CHOICE PLUS,MGD,549.42,,,,,,,case rate,549.42,549.42,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,AETNA,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,BCBS,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,CIGNA,COM,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,TRICARE,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,UNITED HEALTHCARE,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,UNITED HEALTHCARE,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,VA,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,VA TRICARE,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,WELLMED,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,HUMANA,MGD,2688.21,,,,,,,per diem,2688.21,2688.21,"Per diem rate, code is bundled with other services"
SHUNT TUBE/RESVR ASP/INJ      ,76085080,CDM,361,RC,,,,,,Inpatient,,,2688.21,2688.21,HUMANA CHOICE PLUS,MGD,2688.21,,,,,,,case rate,2688.21,2688.21,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,AETNA,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,BCBS,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,CIGNA,COM,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,TRICARE,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,UNITED HEALTHCARE,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,UNITED HEALTHCARE,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,VA,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,VA TRICARE,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,WELLMED,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,HUMANA,MGD,505.47,,,,,,,per diem,505.47,505.47,"Per diem rate, code is bundled with other services"
PRIMARY IV TPD EACH           ,76085095,CDM,335,RC,96365,CPT,,,,Inpatient,,,505.47,505.47,HUMANA CHOICE PLUS,MGD,505.47,,,,,,,case rate,505.47,505.47,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,AETNA,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,BCBS,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,CIGNA,COM,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,TRICARE,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,UNITED HEALTHCARE,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,UNITED HEALTHCARE,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,VA,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,VA TRICARE,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,WELLMED,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,HUMANA,MGD,189.27,,,,,,,per diem,189.27,189.27,"Per diem rate, code is bundled with other services"
IV INFUSTION TPD EACH         ,76085096,CDM,335,RC,96366,CPT,,,,Inpatient,,,189.27,189.27,HUMANA CHOICE PLUS,MGD,189.27,,,,,,,case rate,189.27,189.27,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,AETNA,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,BCBS,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,CIGNA,COM,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,TRICARE,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,UNITED HEALTHCARE,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,UNITED HEALTHCARE,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,VA,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,VA TRICARE,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,WELLMED,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,HUMANA,MGD,59.17,,,,,,,per diem,59.17,59.17,"Per diem rate, code is bundled with other services"
PRIMARY TPD INJ IV PUSH       ,76086001,CDM,335,RC,96374,CPT,,,,Inpatient,,,59.17,59.17,HUMANA CHOICE PLUS,MGD,59.17,,,,,,,case rate,59.17,59.17,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,AETNA,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,BCBS,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,CIGNA,COM,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,TRICARE,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,UNITED HEALTHCARE,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,UNITED HEALTHCARE,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,VA,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,VA TRICARE,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,WELLMED,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,HUMANA,MGD,2278.35,,,,,,,per diem,2278.35,2278.35,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/CONTRAST         ,77000010,CDM,352,RC,74160,CPT,,,,Inpatient,,,2278.35,2278.35,HUMANA CHOICE PLUS,MGD,2278.35,,,,,,,case rate,2278.35,2278.35,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,AETNA,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,BCBS,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,CIGNA,COM,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,TRICARE,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,UNITED HEALTHCARE,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,UNITED HEALTHCARE,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,VA,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,VA TRICARE,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,WELLMED,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,HUMANA,MGD,158.98,,,,,,,per diem,158.98,158.98,"Per diem rate, code is bundled with other services"
CTA LOWER EXT W/WO CONTRAST   ,77000015,CDM,352,RC,73706,CPT,,,,Inpatient,,,158.98,158.98,HUMANA CHOICE PLUS,MGD,158.98,,,,,,,case rate,158.98,158.98,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,AETNA,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,BCBS,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,CIGNA,COM,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,TRICARE,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,UNITED HEALTHCARE,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,UNITED HEALTHCARE,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,VA,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,VA TRICARE,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,WELLMED,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,HUMANA,MGD,3863.12,,,,,,,per diem,3863.12,3863.12,"Per diem rate, code is bundled with other services"
CTA CHEST (NONCORONARY) WO/W  ,77000019,CDM,352,RC,71275,CPT,,,,Inpatient,,,3863.12,3863.12,HUMANA CHOICE PLUS,MGD,3863.12,,,,,,,case rate,3863.12,3863.12,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,AETNA,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,BCBS,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,CIGNA,COM,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,TRICARE,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,UNITED HEALTHCARE,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,UNITED HEALTHCARE,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,VA,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,VA TRICARE,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,WELLMED,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,HUMANA,MGD,6495.36,,,,,,,per diem,6495.36,6495.36,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/WO CONTRAST      ,77000020,CDM,352,RC,74170,CPT,,,,Inpatient,,,6495.36,6495.36,HUMANA CHOICE PLUS,MGD,6495.36,,,,,,,case rate,6495.36,6495.36,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,AETNA,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,BCBS,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,CIGNA,COM,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,TRICARE,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,UNITED HEALTHCARE,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,UNITED HEALTHCARE,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,VA,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,VA TRICARE,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,WELLMED,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,HUMANA,MGD,3848.52,,,,,,,per diem,3848.52,3848.52,"Per diem rate, code is bundled with other services"
CTA HEAD WO/W CONTRAST        ,77000022,CDM,351,RC,70496,CPT,,,,Inpatient,,,3848.52,3848.52,HUMANA CHOICE PLUS,MGD,3848.52,,,,,,,case rate,3848.52,3848.52,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,AETNA,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,BCBS,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,CIGNA,COM,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,TRICARE,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,UNITED HEALTHCARE,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,UNITED HEALTHCARE,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,VA,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,VA TRICARE,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,WELLMED,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,HUMANA,MGD,5372.79,,,,,,,per diem,5372.79,5372.79,"Per diem rate, code is bundled with other services"
CTA NECK WO/W CONTRAST        ,77000023,CDM,351,RC,70498,CPT,,,,Inpatient,,,5372.79,5372.79,HUMANA CHOICE PLUS,MGD,5372.79,,,,,,,case rate,5372.79,5372.79,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,AETNA,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,BCBS,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,CIGNA,COM,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,TRICARE,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,UNITED HEALTHCARE,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,UNITED HEALTHCARE,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,VA,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,VA TRICARE,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,WELLMED,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,HUMANA,MGD,1134.9,,,,,,,per diem,1134.9,1134.9,"Per diem rate, code is bundled with other services"
CTA PELVIS W/WO CONTRAST      ,77000024,CDM,352,RC,72191,CPT,,,,Inpatient,,,1134.9,1134.9,HUMANA CHOICE PLUS,MGD,1134.9,,,,,,,case rate,1134.9,1134.9,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,AETNA,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,BCBS,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,CIGNA,COM,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,TRICARE,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,UNITED HEALTHCARE,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,UNITED HEALTHCARE,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,VA,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,VA TRICARE,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,WELLMED,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,HUMANA,MGD,2827.44,,,,,,,per diem,2827.44,2827.44,"Per diem rate, code is bundled with other services"
CTA ABD AORTA/FEMORAL W/WO CON,77000025,CDM,352,RC,75635,CPT,,,,Inpatient,,,2827.44,2827.44,HUMANA CHOICE PLUS,MGD,2827.44,,,,,,,case rate,2827.44,2827.44,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,AETNA,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,BCBS,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,CIGNA,COM,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,TRICARE,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,UNITED HEALTHCARE,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,UNITED HEALTHCARE,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,VA,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,VA TRICARE,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,WELLMED,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,HUMANA,MGD,4099.79,,,,,,,per diem,4099.79,4099.79,"Per diem rate, code is bundled with other services"
CTA ABDOMEN W/WO CONTRAST     ,77000028,CDM,352,RC,74175,CPT,,,,Inpatient,,,4099.79,4099.79,HUMANA CHOICE PLUS,MGD,4099.79,,,,,,,case rate,4099.79,4099.79,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,AETNA,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,BCBS,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,CIGNA,COM,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,TRICARE,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,UNITED HEALTHCARE,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,UNITED HEALTHCARE,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,VA,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,VA TRICARE,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,WELLMED,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,HUMANA,MGD,4405.3,,,,,,,per diem,4405.3,4405.3,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77000030,CDM,352,RC,74150,CPT,,,,Inpatient,,,4405.3,4405.3,HUMANA CHOICE PLUS,MGD,4405.3,,,,,,,case rate,4405.3,4405.3,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,AETNA,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,BCBS,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,CIGNA,COM,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,TRICARE,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,UNITED HEALTHCARE,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,UNITED HEALTHCARE,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,VA,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,VA TRICARE,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,WELLMED,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,HUMANA,MGD,3223.46,,,,,,,per diem,3223.46,3223.46,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/WO CONTRAST,77000035,CDM,351,RC,70488,CPT,,,,Inpatient,,,3223.46,3223.46,HUMANA CHOICE PLUS,MGD,3223.46,,,,,,,case rate,3223.46,3223.46,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,AETNA,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,BCBS,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,CIGNA,COM,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,TRICARE,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,UNITED HEALTHCARE,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,UNITED HEALTHCARE,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,VA,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,VA TRICARE,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,WELLMED,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,HUMANA,MGD,4906.2,,,,,,,per diem,4906.2,4906.2,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/O CONTRAST,77000040,CDM,352,RC,72125,CPT,,,,Inpatient,,,4906.2,4906.2,HUMANA CHOICE PLUS,MGD,4906.2,,,,,,,case rate,4906.2,4906.2,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,AETNA,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,BCBS,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,CIGNA,COM,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,TRICARE,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,UNITED HEALTHCARE,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,UNITED HEALTHCARE,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,VA,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,VA TRICARE,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,WELLMED,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,HUMANA,MGD,2876.24,,,,,,,per diem,2876.24,2876.24,"Per diem rate, code is bundled with other services"
CT THORAX W/CONTRAST          ,77000050,CDM,352,RC,71260,CPT,,,,Inpatient,,,2876.24,2876.24,HUMANA CHOICE PLUS,MGD,2876.24,,,,,,,case rate,2876.24,2876.24,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,AETNA,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,BCBS,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,CIGNA,COM,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,TRICARE,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,UNITED HEALTHCARE,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,UNITED HEALTHCARE,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,VA,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,VA TRICARE,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,WELLMED,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,HUMANA,MGD,2973.02,,,,,,,per diem,2973.02,2973.02,"Per diem rate, code is bundled with other services"
CT THORAX W/WO CONTRAST       ,77000060,CDM,352,RC,71270,CPT,,,,Inpatient,,,2973.02,2973.02,HUMANA CHOICE PLUS,MGD,2973.02,,,,,,,case rate,2973.02,2973.02,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,AETNA,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,BCBS,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,CIGNA,COM,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,TRICARE,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,UNITED HEALTHCARE,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,UNITED HEALTHCARE,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,VA,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,VA TRICARE,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,WELLMED,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,HUMANA,MGD,3056.75,,,,,,,per diem,3056.75,3056.75,"Per diem rate, code is bundled with other services"
CT THORAX W/O CONTRAST        ,77000070,CDM,352,RC,71250,CPT,,,,Inpatient,,,3056.75,3056.75,HUMANA CHOICE PLUS,MGD,3056.75,,,,,,,case rate,3056.75,3056.75,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,AETNA,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,BCBS,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,CIGNA,COM,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,TRICARE,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,UNITED HEALTHCARE,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,UNITED HEALTHCARE,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,VA,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,VA TRICARE,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,WELLMED,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,HUMANA,MGD,138.81,,,,,,,per diem,138.81,138.81,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST BIL   ,77000090,CDM,352,RC,73701,CPT,,,50,Inpatient,,,138.81,138.81,HUMANA CHOICE PLUS,MGD,138.81,,,,,,,case rate,138.81,138.81,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,AETNA,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,BCBS,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,CIGNA,COM,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,TRICARE,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,UNITED HEALTHCARE,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,UNITED HEALTHCARE,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,VA,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,VA TRICARE,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,WELLMED,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,HUMANA,MGD,344.64,,,,,,,per diem,344.64,344.64,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST BIL ,77000091,CDM,352,RC,73700,CPT,,,50,Inpatient,,,344.64,344.64,HUMANA CHOICE PLUS,MGD,344.64,,,,,,,case rate,344.64,344.64,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,AETNA,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,BCBS,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,CIGNA,COM,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,TRICARE,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,UNITED HEALTHCARE,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,UNITED HEALTHCARE,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,VA,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,VA TRICARE,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,WELLMED,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,HUMANA,MGD,3593.49,,,,,,,per diem,3593.49,3593.49,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/CONTRAST      ,77000100,CDM,351,RC,70460,CPT,,,,Inpatient,,,3593.49,3593.49,HUMANA CHOICE PLUS,MGD,3593.49,,,,,,,case rate,3593.49,3593.49,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,AETNA,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,BCBS,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,CIGNA,COM,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,TRICARE,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,UNITED HEALTHCARE,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,UNITED HEALTHCARE,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,VA,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,VA TRICARE,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,WELLMED,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,HUMANA,MGD,2684.29,,,,,,,per diem,2684.29,2684.29,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD W/WO CONTRAST   ,77000110,CDM,351,RC,70470,CPT,,,,Inpatient,,,2684.29,2684.29,HUMANA CHOICE PLUS,MGD,2684.29,,,,,,,case rate,2684.29,2684.29,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,AETNA,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,BCBS,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,CIGNA,COM,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,TRICARE,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,UNITED HEALTHCARE,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,UNITED HEALTHCARE,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,VA,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,VA TRICARE,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,WELLMED,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,HUMANA,MGD,413.81,,,,,,,per diem,413.81,413.81,"Per diem rate, code is bundled with other services"
CT BRAIN/HEAD WO CONTRAST     ,77000120,CDM,351,RC,70450,CPT,,,,Inpatient,,,413.81,413.81,HUMANA CHOICE PLUS,MGD,413.81,,,,,,,case rate,413.81,413.81,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,AETNA,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,BCBS,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,CIGNA,COM,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,TRICARE,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,UNITED HEALTHCARE,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,UNITED HEALTHCARE,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,VA,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,VA TRICARE,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,WELLMED,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,HUMANA,MGD,3775.54,,,,,,,per diem,3775.54,3775.54,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTRAST  ,77000130,CDM,352,RC,72131,CPT,,,,Inpatient,,,3775.54,3775.54,HUMANA CHOICE PLUS,MGD,3775.54,,,,,,,case rate,3775.54,3775.54,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,AETNA,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,BCBS,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,CIGNA,COM,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,TRICARE,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,UNITED HEALTHCARE,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,UNITED HEALTHCARE,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,VA,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,VA TRICARE,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,WELLMED,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,HUMANA,MGD,10514.01,,,,,,,per diem,10514.01,10514.01,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/WO CONTRAST ,77000135,CDM,352,RC,72133,CPT,,,,Inpatient,,,10514.01,10514.01,HUMANA CHOICE PLUS,MGD,10514.01,,,,,,,case rate,10514.01,10514.01,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,AETNA,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,BCBS,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,CIGNA,COM,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,TRICARE,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,UNITED HEALTHCARE,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,UNITED HEALTHCARE,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,VA,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,VA TRICARE,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,WELLMED,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,HUMANA,MGD,2770.5,,,,,,,per diem,2770.5,2770.5,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST BIL,77000145,CDM,352,RC,73702,CPT,,,50,Inpatient,,,2770.5,2770.5,HUMANA CHOICE PLUS,MGD,2770.5,,,,,,,case rate,2770.5,2770.5,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,AETNA,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,BCBS,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,CIGNA,COM,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,TRICARE,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,UNITED HEALTHCARE,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,UNITED HEALTHCARE,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,VA,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,VA TRICARE,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,WELLMED,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,HUMANA,MGD,4418.95,,,,,,,per diem,4418.95,4418.95,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC WO CON  ,77000160,CDM,351,RC,70480,CPT,,,,Inpatient,,,4418.95,4418.95,HUMANA CHOICE PLUS,MGD,4418.95,,,,,,,case rate,4418.95,4418.95,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,AETNA,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,BCBS,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,CIGNA,COM,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,TRICARE,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,UNITED HEALTHCARE,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,UNITED HEALTHCARE,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,VA,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,VA TRICARE,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,WELLMED,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,HUMANA,MGD,3680.62,,,,,,,per diem,3680.62,3680.62,"Per diem rate, code is bundled with other services"
CT PELVIS W/CONTRAST          ,77000170,CDM,352,RC,72193,CPT,,,,Inpatient,,,3680.62,3680.62,HUMANA CHOICE PLUS,MGD,3680.62,,,,,,,case rate,3680.62,3680.62,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,AETNA,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,BCBS,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,CIGNA,COM,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,TRICARE,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,UNITED HEALTHCARE,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,UNITED HEALTHCARE,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,VA,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,VA TRICARE,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,WELLMED,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,HUMANA,MGD,1505.45,,,,,,,per diem,1505.45,1505.45,"Per diem rate, code is bundled with other services"
CT PELVIS W/O CONTRAST        ,77000180,CDM,352,RC,72192,CPT,,,,Inpatient,,,1505.45,1505.45,HUMANA CHOICE PLUS,MGD,1505.45,,,,,,,case rate,1505.45,1505.45,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,AETNA,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,BCBS,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,CIGNA,COM,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,TRICARE,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,UNITED HEALTHCARE,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,UNITED HEALTHCARE,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,VA,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,VA TRICARE,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,WELLMED,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,HUMANA,MGD,4336.48,,,,,,,per diem,4336.48,4336.48,"Per diem rate, code is bundled with other services"
CT PELVIS W/WO CONTRAST       ,77000181,CDM,352,RC,72194,CPT,,,,Inpatient,,,4336.48,4336.48,HUMANA CHOICE PLUS,MGD,4336.48,,,,,,,case rate,4336.48,4336.48,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,AETNA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,BCBS,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,CIGNA,COM,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,UNITED HEALTHCARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,VA,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,VA TRICARE,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,WELLMED,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,HUMANA,MGD,1254.14,,,,,,,per diem,1254.14,1254.14,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/O POSTPROCESS  ,77000191,CDM,350,RC,76376,CPT,,,,Inpatient,,,1254.14,1254.14,HUMANA CHOICE PLUS,MGD,1254.14,,,,,,,case rate,1254.14,1254.14,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,AETNA,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,BCBS,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,CIGNA,COM,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,TRICARE,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,UNITED HEALTHCARE,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,UNITED HEALTHCARE,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,VA,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,VA TRICARE,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,WELLMED,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,HUMANA,MGD,2619.39,,,,,,,per diem,2619.39,2619.39,"Per diem rate, code is bundled with other services"
CT 3D RENDER W/POSTPROCESS    ,77000192,CDM,350,RC,76377,CPT,,,,Inpatient,,,2619.39,2619.39,HUMANA CHOICE PLUS,MGD,2619.39,,,,,,,case rate,2619.39,2619.39,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,AETNA,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,BCBS,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,CIGNA,COM,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,TRICARE,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,UNITED HEALTHCARE,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,UNITED HEALTHCARE,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,VA,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,VA TRICARE,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,WELLMED,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,HUMANA,MGD,3276.9,,,,,,,per diem,3276.9,3276.9,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/O CONTRAST ,77000195,CDM,351,RC,70486,CPT,,,,Inpatient,,,3276.9,3276.9,HUMANA CHOICE PLUS,MGD,3276.9,,,,,,,case rate,3276.9,3276.9,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,AETNA,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,BCBS,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,CIGNA,COM,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,TRICARE,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,UNITED HEALTHCARE,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,UNITED HEALTHCARE,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,VA,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,VA TRICARE,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,WELLMED,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,HUMANA,MGD,5941.49,,,,,,,per diem,5941.49,5941.49,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/CONTRAST  ,77000200,CDM,352,RC,72129,CPT,,,,Inpatient,,,5941.49,5941.49,HUMANA CHOICE PLUS,MGD,5941.49,,,,,,,case rate,5941.49,5941.49,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,AETNA,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,BCBS,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,CIGNA,COM,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,TRICARE,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,UNITED HEALTHCARE,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,UNITED HEALTHCARE,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,VA,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,VA TRICARE,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,WELLMED,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,HUMANA,MGD,2179.02,,,,,,,per diem,2179.02,2179.02,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/O CONTRAST,77000201,CDM,352,RC,72128,CPT,,,,Inpatient,,,2179.02,2179.02,HUMANA CHOICE PLUS,MGD,2179.02,,,,,,,case rate,2179.02,2179.02,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,AETNA,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,BCBS,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,CIGNA,COM,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,TRICARE,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,UNITED HEALTHCARE,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,UNITED HEALTHCARE,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,VA,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,VA TRICARE,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,WELLMED,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,HUMANA,MGD,6022.96,,,,,,,per diem,6022.96,6022.96,"Per diem rate, code is bundled with other services"
CT THORACIC SPINE W/WO CONT   ,77000202,CDM,352,RC,72130,CPT,,,,Inpatient,,,6022.96,6022.96,HUMANA CHOICE PLUS,MGD,6022.96,,,,,,,case rate,6022.96,6022.96,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,AETNA,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,BCBS,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,CIGNA,COM,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,TRICARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,UNITED HEALTHCARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,UNITED HEALTHCARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,VA,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,VA TRICARE,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,WELLMED,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,HUMANA,MGD,454.1,,,,,,,per diem,454.1,454.1,"Per diem rate, code is bundled with other services"
CT BONE DENSITY HIP/PELVIS/SP ,77000240,CDM,352,RC,77078,CPT,,,,Inpatient,,,454.1,454.1,HUMANA CHOICE PLUS,MGD,454.1,,,,,,,case rate,454.1,454.1,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,AETNA,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,BCBS,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,CIGNA,COM,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,TRICARE,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,UNITED HEALTHCARE,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,UNITED HEALTHCARE,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,VA,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,VA TRICARE,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,WELLMED,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,HUMANA,MGD,127.68,,,,,,,per diem,127.68,127.68,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST BIL ,77000280,CDM,352,RC,73200,CPT,,,50,Inpatient,,,127.68,127.68,HUMANA CHOICE PLUS,MGD,127.68,,,,,,,case rate,127.68,127.68,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,AETNA,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,BCBS,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,CIGNA,COM,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,TRICARE,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,UNITED HEALTHCARE,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,UNITED HEALTHCARE,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,VA,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,VA TRICARE,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,WELLMED,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,HUMANA,MGD,4141.87,,,,,,,per diem,4141.87,4141.87,"Per diem rate, code is bundled with other services"
CT MAXILLOFACIAL W/ CONTRAST  ,77000300,CDM,351,RC,70487,CPT,,,,Inpatient,,,4141.87,4141.87,HUMANA CHOICE PLUS,MGD,4141.87,,,,,,,case rate,4141.87,4141.87,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,AETNA,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,BCBS,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,CIGNA,COM,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,TRICARE,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,UNITED HEALTHCARE,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,UNITED HEALTHCARE,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,VA,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,VA TRICARE,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,WELLMED,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,HUMANA,MGD,2741.71,,,,,,,per diem,2741.71,2741.71,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/CONTRAST,77000310,CDM,351,RC,70491,CPT,,,,Inpatient,,,2741.71,2741.71,HUMANA CHOICE PLUS,MGD,2741.71,,,,,,,case rate,2741.71,2741.71,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,AETNA,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,BCBS,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,CIGNA,COM,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,TRICARE,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,UNITED HEALTHCARE,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,UNITED HEALTHCARE,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,VA,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,VA TRICARE,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,WELLMED,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,HUMANA,MGD,4069.75,,,,,,,per diem,4069.75,4069.75,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK W/WO CONT ,77000311,CDM,351,RC,70492,CPT,,,,Inpatient,,,4069.75,4069.75,HUMANA CHOICE PLUS,MGD,4069.75,,,,,,,case rate,4069.75,4069.75,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,AETNA,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,BCBS,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,CIGNA,COM,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,TRICARE,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,UNITED HEALTHCARE,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,UNITED HEALTHCARE,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,VA,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,VA TRICARE,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,WELLMED,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,HUMANA,MGD,2181.43,,,,,,,per diem,2181.43,2181.43,"Per diem rate, code is bundled with other services"
CT SOFT TISSUE NECK WO CONT   ,77000320,CDM,351,RC,70490,CPT,,,,Inpatient,,,2181.43,2181.43,HUMANA CHOICE PLUS,MGD,2181.43,,,,,,,case rate,2181.43,2181.43,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,AETNA,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,BCBS,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,CIGNA,COM,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,TRICARE,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,UNITED HEALTHCARE,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,UNITED HEALTHCARE,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,VA,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,VA TRICARE,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,WELLMED,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,HUMANA,MGD,1378.21,,,,,,,per diem,1378.21,1378.21,"Per diem rate, code is bundled with other services"
CT GUIDANCE RAD THERAPY FIELDS,77000360,CDM,350,RC,77014,CPT,,,,Inpatient,,,1378.21,1378.21,HUMANA CHOICE PLUS,MGD,1378.21,,,,,,,case rate,1378.21,1378.21,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,AETNA,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,BCBS,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,CIGNA,COM,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,TRICARE,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,UNITED HEALTHCARE,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,UNITED HEALTHCARE,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,VA,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,VA TRICARE,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,WELLMED,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,HUMANA,MGD,5485.86,,,,,,,per diem,5485.86,5485.86,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W/CONTRAST  ,77000369,CDM,352,RC,72126,CPT,,,,Inpatient,,,5485.86,5485.86,HUMANA CHOICE PLUS,MGD,5485.86,,,,,,,case rate,5485.86,5485.86,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,AETNA,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,BCBS,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,CIGNA,COM,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,TRICARE,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,UNITED HEALTHCARE,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,UNITED HEALTHCARE,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,VA,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,VA TRICARE,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,WELLMED,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,HUMANA,MGD,498.02,,,,,,,per diem,498.02,498.02,"Per diem rate, code is bundled with other services"
CT LIMITED OR FOLLOWUP STUDY  ,77000373,CDM,352,RC,76380,CPT,,,,Inpatient,,,498.02,498.02,HUMANA CHOICE PLUS,MGD,498.02,,,,,,,case rate,498.02,498.02,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,AETNA,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,BCBS,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,CIGNA,COM,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,TRICARE,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,UNITED HEALTHCARE,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,UNITED HEALTHCARE,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,VA,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,VA TRICARE,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,WELLMED,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,HUMANA,MGD,3190.07,,,,,,,per diem,3190.07,3190.07,"Per diem rate, code is bundled with other services"
CT GUIDANCE NEEDLE BIOPSY     ,77000374,CDM,350,RC,77012,CPT,,,,Inpatient,,,3190.07,3190.07,HUMANA CHOICE PLUS,MGD,3190.07,,,,,,,case rate,3190.07,3190.07,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,AETNA,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,BCBS,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,CIGNA,COM,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,TRICARE,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,UNITED HEALTHCARE,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,UNITED HEALTHCARE,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,VA,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,VA TRICARE,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,WELLMED,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,HUMANA,MGD,5214.7,,,,,,,per diem,5214.7,5214.7,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W CONT  ,77000377,CDM,351,RC,70481,CPT,,,,Inpatient,,,5214.7,5214.7,HUMANA CHOICE PLUS,MGD,5214.7,,,,,,,case rate,5214.7,5214.7,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,AETNA,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,BCBS,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,CIGNA,COM,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,TRICARE,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,UNITED HEALTHCARE,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,UNITED HEALTHCARE,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,VA,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,VA TRICARE,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,WELLMED,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,HUMANA,MGD,5700.93,,,,,,,per diem,5700.93,5700.93,"Per diem rate, code is bundled with other services"
CT INTRACRANIAL STRUC W/WO CON,77000378,CDM,351,RC,70482,CPT,,,,Inpatient,,,5700.93,5700.93,HUMANA CHOICE PLUS,MGD,5700.93,,,,,,,case rate,5700.93,5700.93,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,AETNA,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,BCBS,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,CIGNA,COM,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,TRICARE,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,UNITED HEALTHCARE,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,UNITED HEALTHCARE,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,VA,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,VA TRICARE,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,WELLMED,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,HUMANA,MGD,3934.29,,,,,,,per diem,3934.29,3934.29,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/CONTRAST    ,77000384,CDM,352,RC,72132,CPT,,,,Inpatient,,,3934.29,3934.29,HUMANA CHOICE PLUS,MGD,3934.29,,,,,,,case rate,3934.29,3934.29,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,AETNA,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,BCBS,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,CIGNA,COM,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,TRICARE,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,UNITED HEALTHCARE,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,UNITED HEALTHCARE,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,VA,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,VA TRICARE,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,WELLMED,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,HUMANA,MGD,7319.72,,,,,,,per diem,7319.72,7319.72,"Per diem rate, code is bundled with other services"
CT CERVICAL SPINE W&W/O CONT  ,77000386,CDM,352,RC,72127,CPT,,,,Inpatient,,,7319.72,7319.72,HUMANA CHOICE PLUS,MGD,7319.72,,,,,,,case rate,7319.72,7319.72,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,AETNA,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,BCBS,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,CIGNA,COM,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,TRICARE,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,UNITED HEALTHCARE,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,UNITED HEALTHCARE,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,VA,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,VA TRICARE,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,WELLMED,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,HUMANA,MGD,6911.1,,,,,,,per diem,6911.1,6911.1,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST RT    ,77010003,CDM,352,RC,73701,CPT,,,RT,Inpatient,,,6911.1,6911.1,HUMANA CHOICE PLUS,MGD,6911.1,,,,,,,case rate,6911.1,6911.1,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,AETNA,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,BCBS,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,CIGNA,COM,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,TRICARE,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,UNITED HEALTHCARE,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,UNITED HEALTHCARE,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,VA,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,VA TRICARE,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,WELLMED,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,HUMANA,MGD,671.67,,,,,,,per diem,671.67,671.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST RT  ,77010005,CDM,352,RC,73700,CPT,,,RT,Inpatient,,,671.67,671.67,HUMANA CHOICE PLUS,MGD,671.67,,,,,,,case rate,671.67,671.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,AETNA,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,BCBS,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,CIGNA,COM,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,TRICARE,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,UNITED HEALTHCARE,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,UNITED HEALTHCARE,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,VA,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,VA TRICARE,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,WELLMED,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,HUMANA,MGD,2858.38,,,,,,,per diem,2858.38,2858.38,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/O CONTRAST LT  ,77010006,CDM,352,RC,73700,CPT,,,LT,Inpatient,,,2858.38,2858.38,HUMANA CHOICE PLUS,MGD,2858.38,,,,,,,case rate,2858.38,2858.38,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,AETNA,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,BCBS,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,CIGNA,COM,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,TRICARE,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,UNITED HEALTHCARE,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,UNITED HEALTHCARE,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,VA,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,VA TRICARE,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,WELLMED,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,HUMANA,MGD,12931.19,,,,,,,per diem,12931.19,12931.19,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST RT ,77010007,CDM,352,RC,73702,CPT,,,RT,Inpatient,,,12931.19,12931.19,HUMANA CHOICE PLUS,MGD,12931.19,,,,,,,case rate,12931.19,12931.19,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,AETNA,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,BCBS,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,CIGNA,COM,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,TRICARE,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,UNITED HEALTHCARE,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,UNITED HEALTHCARE,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,VA,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,VA TRICARE,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,WELLMED,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,HUMANA,MGD,920.67,,,,,,,per diem,920.67,920.67,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/WO CONTRAST LT ,77010008,CDM,352,RC,73702,CPT,,,LT,Inpatient,,,920.67,920.67,HUMANA CHOICE PLUS,MGD,920.67,,,,,,,case rate,920.67,920.67,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,AETNA,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,BCBS,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,CIGNA,COM,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,TRICARE,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,UNITED HEALTHCARE,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,UNITED HEALTHCARE,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,VA,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,VA TRICARE,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,WELLMED,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,HUMANA,MGD,1058.59,,,,,,,per diem,1058.59,1058.59,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/CONTRAST LT    ,77010012,CDM,352,RC,73201,CPT,,,LT,Inpatient,,,1058.59,1058.59,HUMANA CHOICE PLUS,MGD,1058.59,,,,,,,case rate,1058.59,1058.59,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,AETNA,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,BCBS,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,CIGNA,COM,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,TRICARE,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,UNITED HEALTHCARE,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,UNITED HEALTHCARE,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,VA,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,VA TRICARE,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,WELLMED,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,HUMANA,MGD,359.45,,,,,,,per diem,359.45,359.45,"Per diem rate, code is bundled with other services"
CT UPPER EXT W/O CONTRAST LT  ,77010014,CDM,352,RC,73200,CPT,,,LT,Inpatient,,,359.45,359.45,HUMANA CHOICE PLUS,MGD,359.45,,,,,,,case rate,359.45,359.45,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,AETNA,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,BCBS,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,CIGNA,COM,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,TRICARE,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,UNITED HEALTHCARE,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,UNITED HEALTHCARE,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,VA,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,VA TRICARE,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,WELLMED,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,HUMANA,MGD,4062.05,,,,,,,per diem,4062.05,4062.05,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS WO CONTRAST   ,77010015,CDM,352,RC,74176,CPT,,,,Inpatient,,,4062.05,4062.05,HUMANA CHOICE PLUS,MGD,4062.05,,,,,,,case rate,4062.05,4062.05,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,AETNA,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,BCBS,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,CIGNA,COM,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,TRICARE,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,UNITED HEALTHCARE,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,UNITED HEALTHCARE,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,VA,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,VA TRICARE,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,WELLMED,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,HUMANA,MGD,5581.81,,,,,,,per diem,5581.81,5581.81,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/CONTRAST    ,77010016,CDM,352,RC,74177,CPT,,,,Inpatient,,,5581.81,5581.81,HUMANA CHOICE PLUS,MGD,5581.81,,,,,,,case rate,5581.81,5581.81,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,AETNA,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,BCBS,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,CIGNA,COM,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,TRICARE,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,UNITED HEALTHCARE,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,UNITED HEALTHCARE,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,VA,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,VA TRICARE,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,WELLMED,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,HUMANA,MGD,6017.14,,,,,,,per diem,6017.14,6017.14,"Per diem rate, code is bundled with other services"
CT ABD & PELVIS W/WO CONTRAST ,77010017,CDM,352,RC,74178,CPT,,,,Inpatient,,,6017.14,6017.14,HUMANA CHOICE PLUS,MGD,6017.14,,,,,,,case rate,6017.14,6017.14,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,AETNA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,BCBS,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,CIGNA,COM,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,UNITED HEALTHCARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,VA,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,VA TRICARE,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,WELLMED,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA,MGD,442.32,,,,,,,per diem,442.32,442.32,"Per diem rate, code is bundled with other services"
CO2 EXPIRED GAS INFRARED      ,77020000,CDM,460,RC,,,,,,Inpatient,,,442.32,442.32,HUMANA CHOICE PLUS,MGD,442.32,,,,,,,case rate,442.32,442.32,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,AETNA,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,BCBS,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,CIGNA,COM,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,TRICARE,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,UNITED HEALTHCARE,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,UNITED HEALTHCARE,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,VA,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,VA TRICARE,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,WELLMED,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,HUMANA,MGD,1872.11,,,,,,,per diem,1872.11,1872.11,"Per diem rate, code is bundled with other services"
CT GUIDE CATH DRAIN           ,77020001,CDM,359,RC,,,,,,Inpatient,,,1872.11,1872.11,HUMANA CHOICE PLUS,MGD,1872.11,,,,,,,case rate,1872.11,1872.11,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,AETNA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,BCBS,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,CIGNA,COM,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,UNITED HEALTHCARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,VA,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,VA TRICARE,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,WELLMED,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,HUMANA,MGD,5947.26,,,,,,,per diem,5947.26,5947.26,"Per diem rate, code is bundled with other services"
XR ANGIO EXTREMITY BIL        ,77020002,CDM,323,RC,,,,,,Inpatient,,,5947.26,5947.26,HUMANA CHOICE PLUS,MGD,5947.26,,,,,,,case rate,5947.26,5947.26,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,AETNA,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,BCBS,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,CIGNA,COM,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,TRICARE,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,UNITED HEALTHCARE,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,UNITED HEALTHCARE,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,VA,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,VA TRICARE,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,WELLMED,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,HUMANA,MGD,1711.46,,,,,,,per diem,1711.46,1711.46,"Per diem rate, code is bundled with other services"
XR TUBE/CATH CHANGE W CON     ,77020003,CDM,320,RC,,,,,,Inpatient,,,1711.46,1711.46,HUMANA CHOICE PLUS,MGD,1711.46,,,,,,,case rate,1711.46,1711.46,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,AETNA,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,BCBS,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,CIGNA,COM,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,TRICARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,UNITED HEALTHCARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,UNITED HEALTHCARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,VA,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,VA TRICARE,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,WELLMED,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,HUMANA,MGD,1318.4,,,,,,,per diem,1318.4,1318.4,"Per diem rate, code is bundled with other services"
CT FLUORO NDL LOCAL SPINE     ,77020004,CDM,320,RC,,,,,,Inpatient,,,1318.4,1318.4,HUMANA CHOICE PLUS,MGD,1318.4,,,,,,,case rate,1318.4,1318.4,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,AETNA,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,BCBS,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,CIGNA,COM,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,TRICARE,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,UNITED HEALTHCARE,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,UNITED HEALTHCARE,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,VA,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,VA TRICARE,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,WELLMED,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,HUMANA,MGD,1605.58,,,,,,,per diem,1605.58,1605.58,"Per diem rate, code is bundled with other services"
US GUIDED NEEDL PLACEMENT     ,77020005,CDM,402,RC,,,,,,Inpatient,,,1605.58,1605.58,HUMANA CHOICE PLUS,MGD,1605.58,,,,,,,case rate,1605.58,1605.58,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,AETNA,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,CIGNA,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,TRICARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,UNITED HEALTHCARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,UNITED HEALTHCARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,VA,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,VA TRICARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,WELLMED,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,HUMANA,MGD,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W LT      ,77020006,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,HUMANA CHOICE PLUS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,AETNA,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,BCBS,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,CIGNA,COM,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,TRICARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,UNITED HEALTHCARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,UNITED HEALTHCARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,VA,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,VA TRICARE,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,WELLMED,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,HUMANA,MGD,1956.72,,,,,,,per diem,1956.72,1956.72,"Per diem rate, code is bundled with other services"
CT ANGIO LOW EXTREM W RT      ,77020007,CDM,352,RC,,,,,,Inpatient,,,1956.72,1956.72,HUMANA CHOICE PLUS,MGD,1956.72,,,,,,,case rate,1956.72,1956.72,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,AETNA,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,BCBS,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,CIGNA,COM,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,TRICARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,UNITED HEALTHCARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,UNITED HEALTHCARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,VA,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,VA TRICARE,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,WELLMED,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,HUMANA,MGD,3145.53,,,,,,,per diem,3145.53,3145.53,"Per diem rate, code is bundled with other services"
CT GUIDED NEEDLE PLACEMNT     ,77020008,CDM,359,RC,,,,,,Inpatient,,,3145.53,3145.53,HUMANA CHOICE PLUS,MGD,3145.53,,,,,,,case rate,3145.53,3145.53,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,AETNA,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,BCBS,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,CIGNA,COM,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,TRICARE,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,UNITED HEALTHCARE,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,UNITED HEALTHCARE,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,VA,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,VA TRICARE,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,WELLMED,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,HUMANA,MGD,3591.49,,,,,,,per diem,3591.49,3591.49,"Per diem rate, code is bundled with other services"
CT ANGIO ABD/PELVIS W CON     ,77020009,CDM,352,RC,,,,,,Inpatient,,,3591.49,3591.49,HUMANA CHOICE PLUS,MGD,3591.49,,,,,,,case rate,3591.49,3591.49,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,AETNA,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,BCBS,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,CIGNA,COM,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,TRICARE,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,UNITED HEALTHCARE,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,UNITED HEALTHCARE,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,VA,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,VA TRICARE,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,WELLMED,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,HUMANA,MGD,3576.1,,,,,,,per diem,3576.1,3576.1,"Per diem rate, code is bundled with other services"
CT ANGIO HRT/COR ART 3D W     ,77020010,CDM,352,RC,,,,,,Inpatient,,,3576.1,3576.1,HUMANA CHOICE PLUS,MGD,3576.1,,,,,,,case rate,3576.1,3576.1,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,AETNA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,CIGNA,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,WELLMED,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA,MGD,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W BIL     ,77020011,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA CHOICE PLUS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,AETNA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,CIGNA,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,WELLMED,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA,MGD,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W LT      ,77020012,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA CHOICE PLUS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,AETNA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,BCBS,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,CIGNA,COM,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,UNITED HEALTHCARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,VA TRICARE,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,WELLMED,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA,MGD,2079.88,,,,,,,per diem,2079.88,2079.88,"Per diem rate, code is bundled with other services"
CT ANGIO UPP EXTREM W RT      ,77020013,CDM,352,RC,,,,,,Inpatient,,,2079.88,2079.88,HUMANA CHOICE PLUS,MGD,2079.88,,,,,,,case rate,2079.88,2079.88,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,AETNA,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,BCBS,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,CIGNA,COM,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,TRICARE,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,UNITED HEALTHCARE,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,UNITED HEALTHCARE,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,VA,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,VA TRICARE,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,WELLMED,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,HUMANA,MGD,1819.63,,,,,,,per diem,1819.63,1819.63,"Per diem rate, code is bundled with other services"
CT CEREBRL PERFUSION WCON     ,77020014,CDM,350,RC,,,,,,Inpatient,,,1819.63,1819.63,HUMANA CHOICE PLUS,MGD,1819.63,,,,,,,case rate,1819.63,1819.63,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,AETNA,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,BCBS,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,CIGNA,COM,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,TRICARE,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,UNITED HEALTHCARE,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,UNITED HEALTHCARE,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,VA,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,VA TRICARE,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,WELLMED,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,HUMANA,MGD,3059.85,,,,,,,per diem,3059.85,3059.85,"Per diem rate, code is bundled with other services"
CT HRT EVAL COR CA WO CON     ,77020015,CDM,352,RC,,,,,,Inpatient,,,3059.85,3059.85,HUMANA CHOICE PLUS,MGD,3059.85,,,,,,,case rate,3059.85,3059.85,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,AETNA,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,CIGNA,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,TRICARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,UNITED HEALTHCARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,UNITED HEALTHCARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,VA,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,VA TRICARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,WELLMED,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,HUMANA,MGD,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP CONGENTL     ,77020016,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,HUMANA CHOICE PLUS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,AETNA,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,BCBS,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,CIGNA,COM,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,TRICARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,UNITED HEALTHCARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,UNITED HEALTHCARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,VA,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,VA TRICARE,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,WELLMED,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,HUMANA,MGD,3599.63,,,,,,,per diem,3599.63,3599.63,"Per diem rate, code is bundled with other services"
CT HRT STRC/MORP/3D W CON     ,77020017,CDM,352,RC,,,,,,Inpatient,,,3599.63,3599.63,HUMANA CHOICE PLUS,MGD,3599.63,,,,,,,case rate,3599.63,3599.63,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,AETNA,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,CIGNA,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,TRICARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,UNITED HEALTHCARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,UNITED HEALTHCARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,VA,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,VA TRICARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,WELLMED,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,HUMANA,MGD,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W RT         ,77020018,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,HUMANA CHOICE PLUS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,AETNA,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,BCBS,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,CIGNA,COM,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,TRICARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,UNITED HEALTHCARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,UNITED HEALTHCARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,VA,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,VA TRICARE,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,WELLMED,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,HUMANA,MGD,4171.55,,,,,,,per diem,4171.55,4171.55,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY W LT         ,77020019,CDM,352,RC,,,,,,Inpatient,,,4171.55,4171.55,HUMANA CHOICE PLUS,MGD,4171.55,,,,,,,case rate,4171.55,4171.55,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,AETNA,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,BCBS,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,CIGNA,COM,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,TRICARE,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,UNITED HEALTHCARE,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,UNITED HEALTHCARE,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,VA,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,VA TRICARE,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,WELLMED,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,HUMANA,MGD,1874.08,,,,,,,per diem,1874.08,1874.08,"Per diem rate, code is bundled with other services"
CT LOW EXTREMITY WO UNI       ,77020020,CDM,352,RC,,,,,,Inpatient,,,1874.08,1874.08,HUMANA CHOICE PLUS,MGD,1874.08,,,,,,,case rate,1874.08,1874.08,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,AETNA,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,BCBS,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,CIGNA,COM,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,TRICARE,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,UNITED HEALTHCARE,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,UNITED HEALTHCARE,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,VA,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,VA TRICARE,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,WELLMED,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,HUMANA,MGD,4471.43,,,,,,,per diem,4471.43,4471.43,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON RT        ,77020021,CDM,352,RC,,,,,,Inpatient,,,4471.43,4471.43,HUMANA CHOICE PLUS,MGD,4471.43,,,,,,,case rate,4471.43,4471.43,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,AETNA,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,BCBS,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,CIGNA,COM,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,TRICARE,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,UNITED HEALTHCARE,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,UNITED HEALTHCARE,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,VA,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,VA TRICARE,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,WELLMED,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,HUMANA,MGD,3148.38,,,,,,,per diem,3148.38,3148.38,"Per diem rate, code is bundled with other services"
CT UPP EXTREM W CON LT        ,77020022,CDM,352,RC,,,,,,Inpatient,,,3148.38,3148.38,HUMANA CHOICE PLUS,MGD,3148.38,,,,,,,case rate,3148.38,3148.38,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,AETNA,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,CIGNA,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,TRICARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,UNITED HEALTHCARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,UNITED HEALTHCARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,VA,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,VA TRICARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,WELLMED,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,HUMANA,MGD,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON RT       ,77020023,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,HUMANA CHOICE PLUS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,AETNA,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,BCBS,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,CIGNA,COM,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,TRICARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,UNITED HEALTHCARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,UNITED HEALTHCARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,VA,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,VA TRICARE,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,WELLMED,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,HUMANA,MGD,3606.06,,,,,,,per diem,3606.06,3606.06,"Per diem rate, code is bundled with other services"
CT UPP EXTREM WO CON LT       ,77020024,CDM,352,RC,,,,,,Inpatient,,,3606.06,3606.06,HUMANA CHOICE PLUS,MGD,3606.06,,,,,,,case rate,3606.06,3606.06,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,AETNA,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,BCBS,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,CIGNA,COM,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,TRICARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,UNITED HEALTHCARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,UNITED HEALTHCARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,VA,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,VA TRICARE,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,WELLMED,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,HUMANA,MGD,290.24,,,,,,,per diem,290.24,290.24,"Per diem rate, code is bundled with other services"
CT BONE LENGTH STUDIES        ,77020025,CDM,320,RC,,,,,,Inpatient,,,290.24,290.24,HUMANA CHOICE PLUS,MGD,290.24,,,,,,,case rate,290.24,290.24,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,AETNA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,BCBS,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,CIGNA,COM,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,UNITED HEALTHCARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,VA TRICARE,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,WELLMED,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA,MGD,885.72,,,,,,,per diem,885.72,885.72,"Per diem rate, code is bundled with other services"
MOD SED <5Y 1ST 30 OTH MD     ,77020026,CDM,371,RC,,,,,,Inpatient,,,885.72,885.72,HUMANA CHOICE PLUS,MGD,885.72,,,,,,,case rate,885.72,885.72,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,AETNA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,BCBS,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,CIGNA,COM,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,UNITED HEALTHCARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,VA TRICARE,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,WELLMED,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA,MGD,653.31,,,,,,,per diem,653.31,653.31,"Per diem rate, code is bundled with other services"
MOD SED =>5Y 1ST 30 OTHMD     ,77020027,CDM,371,RC,,,,,,Inpatient,,,653.31,653.31,HUMANA CHOICE PLUS,MGD,653.31,,,,,,,case rate,653.31,653.31,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,AETNA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,BCBS,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,CIGNA,COM,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,UNITED HEALTHCARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,VA TRICARE,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,WELLMED,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA,MGD,702.58,,,,,,,per diem,702.58,702.58,"Per diem rate, code is bundled with other services"
MOD SEDAT =>5YRS 1ST 30M      ,77020028,CDM,371,RC,,,,,,Inpatient,,,702.58,702.58,HUMANA CHOICE PLUS,MGD,702.58,,,,,,,case rate,702.58,702.58,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,AETNA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,BCBS,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,CIGNA,COM,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,UNITED HEALTHCARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,VA TRICARE,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,WELLMED,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA,MGD,386.63,,,,,,,per diem,386.63,386.63,"Per diem rate, code is bundled with other services"
MOD SEDAT ADD 15M OTH MD      ,77020029,CDM,371,RC,,,,,,Inpatient,,,386.63,386.63,HUMANA CHOICE PLUS,MGD,386.63,,,,,,,case rate,386.63,386.63,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,AETNA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,BCBS,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,CIGNA,COM,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,UNITED HEALTHCARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,VA TRICARE,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,WELLMED,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA,MGD,295.6,,,,,,,per diem,295.6,295.6,"Per diem rate, code is bundled with other services"
MODERATE SEDAT ADD 15MIN      ,77020030,CDM,371,RC,,,,,,Inpatient,,,295.6,295.6,HUMANA CHOICE PLUS,MGD,295.6,,,,,,,case rate,295.6,295.6,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,AETNA,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,BCBS,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,CIGNA,COM,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,TRICARE,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,UNITED HEALTHCARE,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,UNITED HEALTHCARE,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,VA,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,VA TRICARE,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,WELLMED,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,HUMANA,MGD,1041.01,,,,,,,per diem,1041.01,1041.01,"Per diem rate, code is bundled with other services"
CT GUIDE TISSUE ABLATION      ,77020031,CDM,359,RC,,,,,,Inpatient,,,1041.01,1041.01,HUMANA CHOICE PLUS,MGD,1041.01,,,,,,,case rate,1041.01,1041.01,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,AETNA,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,BCBS,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,CIGNA,COM,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,TRICARE,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,UNITED HEALTHCARE,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,UNITED HEALTHCARE,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,VA,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,VA TRICARE,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,WELLMED,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,HUMANA,MGD,191.91,,,,,,,per diem,191.91,191.91,"Per diem rate, code is bundled with other services"
CT LUNG SCREEN LOW DOSE       ,77020032,CDM,770,RC,,,,,,Inpatient,,,191.91,191.91,HUMANA CHOICE PLUS,MGD,191.91,,,,,,,case rate,191.91,191.91,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,AETNA,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,BCBS,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,CIGNA,COM,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,TRICARE,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,UNITED HEALTHCARE,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,UNITED HEALTHCARE,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,VA,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,VA TRICARE,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,WELLMED,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,HUMANA,MGD,89.38,,,,,,,per diem,89.38,89.38,"Per diem rate, code is bundled with other services"
DIATRI MEG/NA66-10 120MLQ     ,77020033,CDM,636,RC,,,,,,Inpatient,1,EA,89.38,89.38,HUMANA CHOICE PLUS,MGD,89.38,,,,,,,case rate,89.38,89.38,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,AETNA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,BCBS,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,CIGNA,COM,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,UNITED HEALTHCARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,VA,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,VA TRICARE,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,WELLMED,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA,MGD,32.13,,,,,,,per diem,32.13,32.13,"Per diem rate, code is bundled with other services"
CALCIUM SCORING CB            ,77020034,CDM,352,RC,,,,,,Inpatient,,,32.13,32.13,HUMANA CHOICE PLUS,MGD,32.13,,,,,,,case rate,32.13,32.13,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
ABS/CYST DRN CATH EXCHNGE     ,77020035,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,AETNA,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,BCBS,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,CIGNA,COM,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,TRICARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,UNITED HEALTHCARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,UNITED HEALTHCARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,VA,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,VA TRICARE,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,WELLMED,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,HUMANA,MGD,2220.18,,,,,,,per diem,2220.18,2220.18,"Per diem rate, code is bundled with other services"
ABSCES/CYST EXIST CTH INJ     ,77020036,CDM,361,RC,,,,,,Inpatient,,,2220.18,2220.18,HUMANA CHOICE PLUS,MGD,2220.18,,,,,,,case rate,2220.18,2220.18,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,AETNA,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,BCBS,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,CIGNA,COM,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,TRICARE,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,UNITED HEALTHCARE,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,UNITED HEALTHCARE,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,VA,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,VA TRICARE,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,WELLMED,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,HUMANA,MGD,1007.81,,,,,,,per diem,1007.81,1007.81,"Per diem rate, code is bundled with other services"
ANES CELIAC PLEXUS INJ        ,77020037,CDM,361,RC,,,,,,Inpatient,,,1007.81,1007.81,HUMANA CHOICE PLUS,MGD,1007.81,,,,,,,case rate,1007.81,1007.81,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,AETNA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,BCBS,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,CIGNA,COM,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,UNITED HEALTHCARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,VA,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,VA TRICARE,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,WELLMED,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA,MGD,1198.45,,,,,,,per diem,1198.45,1198.45,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP INTER JT WO     ,77020038,CDM,361,RC,,,,,,Inpatient,,,1198.45,1198.45,HUMANA CHOICE PLUS,MGD,1198.45,,,,,,,case rate,1198.45,1198.45,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,AETNA,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,BCBS,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,CIGNA,COM,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,TRICARE,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,UNITED HEALTHCARE,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,UNITED HEALTHCARE,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,VA,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,VA TRICARE,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,WELLMED,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,HUMANA,MGD,1420.15,,,,,,,per diem,1420.15,1420.15,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP MAJOR JT WO     ,77020039,CDM,361,RC,,,,,,Inpatient,,,1420.15,1420.15,HUMANA CHOICE PLUS,MGD,1420.15,,,,,,,case rate,1420.15,1420.15,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,AETNA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,BCBS,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,CIGNA,COM,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,UNITED HEALTHCARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,VA,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,VA TRICARE,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,WELLMED,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA,MGD,252.76,,,,,,,per diem,252.76,252.76,"Per diem rate, code is bundled with other services"
ARTHROCEN ASP SMALL JT WO     ,77020040,CDM,361,RC,,,,,,Inpatient,,,252.76,252.76,HUMANA CHOICE PLUS,MGD,252.76,,,,,,,case rate,252.76,252.76,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,AETNA,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,BCBS,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,CIGNA,COM,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,TRICARE,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,UNITED HEALTHCARE,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,UNITED HEALTHCARE,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,VA,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,VA TRICARE,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,WELLMED,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,HUMANA,MGD,487.31,,,,,,,per diem,487.31,487.31,"Per diem rate, code is bundled with other services"
ASP ABSC/HEMA/CYST/BULLA      ,77020041,CDM,361,RC,,,,,,Inpatient,,,487.31,487.31,HUMANA CHOICE PLUS,MGD,487.31,,,,,,,case rate,487.31,487.31,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,AETNA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,BCBS,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,CIGNA,COM,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,UNITED HEALTHCARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,VA TRICARE,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,WELLMED,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA,MGD,952.12,,,,,,,per diem,952.12,952.12,"Per diem rate, code is bundled with other services"
ASP FINE NDL W IMAGING        ,77020042,CDM,361,RC,,,,,,Inpatient,,,952.12,952.12,HUMANA CHOICE PLUS,MGD,952.12,,,,,,,case rate,952.12,952.12,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,AETNA,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,BCBS,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,CIGNA,COM,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,TRICARE,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,UNITED HEALTHCARE,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,UNITED HEALTHCARE,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,VA,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,VA TRICARE,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,WELLMED,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,HUMANA,MGD,1560.45,,,,,,,per diem,1560.45,1560.45,"Per diem rate, code is bundled with other services"
FIDUCIAL MARKER PLACEMENT     ,77020043,CDM,361,RC,,,,,,Inpatient,,,1560.45,1560.45,HUMANA CHOICE PLUS,MGD,1560.45,,,,,,,case rate,1560.45,1560.45,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,AETNA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,BCBS,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,CIGNA,COM,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,UNITED HEALTHCARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,VA,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,VA TRICARE,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,WELLMED,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA,MGD,3460.4,,,,,,,per diem,3460.4,3460.4,"Per diem rate, code is bundled with other services"
BIOPSY LUNG/MEDIASTIN NDL     ,77020044,CDM,361,RC,,,,,,Inpatient,,,3460.4,3460.4,HUMANA CHOICE PLUS,MGD,3460.4,,,,,,,case rate,3460.4,3460.4,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BIOPSY PLEURA PERC NEEDLE     ,77020045,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,AETNA,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,BCBS,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,CIGNA,COM,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,TRICARE,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,UNITED HEALTHCARE,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,UNITED HEALTHCARE,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,VA,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,VA TRICARE,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,WELLMED,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,HUMANA,MGD,1752.16,,,,,,,per diem,1752.16,1752.16,"Per diem rate, code is bundled with other services"
BLADDER ABSCESS DRAIN         ,77020046,CDM,361,RC,,,,,,Inpatient,,,1752.16,1752.16,HUMANA CHOICE PLUS,MGD,1752.16,,,,,,,case rate,1752.16,1752.16,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,AETNA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,BCBS,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,CIGNA,COM,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,UNITED HEALTHCARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,VA TRICARE,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,WELLMED,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA,MGD,918.92,,,,,,,per diem,918.92,918.92,"Per diem rate, code is bundled with other services"
BLADDER ASP TROCAR/INTRAC     ,77020047,CDM,361,RC,,,,,,Inpatient,,,918.92,918.92,HUMANA CHOICE PLUS,MGD,918.92,,,,,,,case rate,918.92,918.92,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BLADDER ASP W INS SUPRAP      ,77020048,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,AETNA,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,BCBS,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,CIGNA,COM,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,TRICARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,UNITED HEALTHCARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,UNITED HEALTHCARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,VA,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,VA TRICARE,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,WELLMED,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,HUMANA,MGD,2695.71,,,,,,,per diem,2695.71,2695.71,"Per diem rate, code is bundled with other services"
BX ABD/RETROPERITONL MASS     ,77020049,CDM,361,RC,,,,,,Inpatient,,,2695.71,2695.71,HUMANA CHOICE PLUS,MGD,2695.71,,,,,,,case rate,2695.71,2695.71,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,AETNA,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,BCBS,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,CIGNA,COM,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,TRICARE,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,UNITED HEALTHCARE,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,UNITED HEALTHCARE,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,VA,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,VA TRICARE,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,WELLMED,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,HUMANA,MGD,2068.1,,,,,,,per diem,2068.1,2068.1,"Per diem rate, code is bundled with other services"
BX BONE SUPERFIC TROC/NDL     ,77020050,CDM,361,RC,,,,,,Inpatient,,,2068.1,2068.1,HUMANA CHOICE PLUS,MGD,2068.1,,,,,,,case rate,2068.1,2068.1,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,AETNA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,CIGNA,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,WELLMED,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA,MGD,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
BX BONE TROCAR/NDL DEEP       ,77020051,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA CHOICE PLUS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,AETNA,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,BCBS,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,CIGNA,COM,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,TRICARE,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,UNITED HEALTHCARE,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,UNITED HEALTHCARE,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,VA,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,VA TRICARE,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,WELLMED,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,HUMANA,MGD,9279.14,,,,,,,per diem,9279.14,9279.14,"Per diem rate, code is bundled with other services"
BX GROIN MASS                 ,77020052,CDM,361,RC,,,,,,Inpatient,,,9279.14,9279.14,HUMANA CHOICE PLUS,MGD,9279.14,,,,,,,case rate,9279.14,9279.14,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,AETNA,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,BCBS,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,CIGNA,COM,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,TRICARE,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,UNITED HEALTHCARE,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,UNITED HEALTHCARE,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,VA,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,VA TRICARE,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,WELLMED,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,HUMANA,MGD,1953.5,,,,,,,per diem,1953.5,1953.5,"Per diem rate, code is bundled with other services"
BX LIVER AS 2ND PROC          ,77020053,CDM,361,RC,,,,,,Inpatient,,,1953.5,1953.5,HUMANA CHOICE PLUS,MGD,1953.5,,,,,,,case rate,1953.5,1953.5,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,AETNA,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,BCBS,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,CIGNA,COM,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,TRICARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,UNITED HEALTHCARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,UNITED HEALTHCARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,VA,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,VA TRICARE,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,WELLMED,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,HUMANA,MGD,2018.84,,,,,,,per diem,2018.84,2018.84,"Per diem rate, code is bundled with other services"
BX LIVER NEEDLE PERC          ,77020054,CDM,361,RC,,,,,,Inpatient,,,2018.84,2018.84,HUMANA CHOICE PLUS,MGD,2018.84,,,,,,,case rate,2018.84,2018.84,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,AETNA,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,BCBS,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,CIGNA,COM,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,TRICARE,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,UNITED HEALTHCARE,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,UNITED HEALTHCARE,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,VA,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,VA TRICARE,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,WELLMED,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,HUMANA,MGD,2260.88,,,,,,,per diem,2260.88,2260.88,"Per diem rate, code is bundled with other services"
BX MUSCLE NEEDLE PERC         ,77020055,CDM,361,RC,,,,,,Inpatient,,,2260.88,2260.88,HUMANA CHOICE PLUS,MGD,2260.88,,,,,,,case rate,2260.88,2260.88,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,AETNA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,BCBS,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,CIGNA,COM,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,UNITED HEALTHCARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,VA TRICARE,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,WELLMED,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA,MGD,1663.26,,,,,,,per diem,1663.26,1663.26,"Per diem rate, code is bundled with other services"
BX PANCREAS NEEDLE PERC       ,77020056,CDM,361,RC,,,,,,Inpatient,,,1663.26,1663.26,HUMANA CHOICE PLUS,MGD,1663.26,,,,,,,case rate,1663.26,1663.26,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,AETNA,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,BCBS,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,CIGNA,COM,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,TRICARE,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,UNITED HEALTHCARE,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,UNITED HEALTHCARE,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,VA,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,VA TRICARE,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,WELLMED,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,HUMANA,MGD,1910.66,,,,,,,per diem,1910.66,1910.66,"Per diem rate, code is bundled with other services"
BX RENAL NDL/TROCAR PERC      ,77020057,CDM,361,RC,,,,,,Inpatient,,,1910.66,1910.66,HUMANA CHOICE PLUS,MGD,1910.66,,,,,,,case rate,1910.66,1910.66,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,AETNA,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,BCBS,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,CIGNA,COM,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,TRICARE,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,UNITED HEALTHCARE,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,UNITED HEALTHCARE,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,VA,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,VA TRICARE,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,WELLMED,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,HUMANA,MGD,2927.04,,,,,,,per diem,2927.04,2927.04,"Per diem rate, code is bundled with other services"
BX SPINAL CORD NDL PERC       ,77020058,CDM,361,RC,,,,,,Inpatient,,,2927.04,2927.04,HUMANA CHOICE PLUS,MGD,2927.04,,,,,,,case rate,2927.04,2927.04,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,AETNA,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,BCBS,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,CIGNA,COM,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,TRICARE,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,UNITED HEALTHCARE,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,UNITED HEALTHCARE,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,VA,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,VA TRICARE,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,WELLMED,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,HUMANA,MGD,1165.25,,,,,,,per diem,1165.25,1165.25,"Per diem rate, code is bundled with other services"
BX THYROID NDL CORE PERC      ,77020059,CDM,361,RC,,,,,,Inpatient,,,1165.25,1165.25,HUMANA CHOICE PLUS,MGD,1165.25,,,,,,,case rate,1165.25,1165.25,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,AETNA,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,BCBS,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,CIGNA,COM,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,TRICARE,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,UNITED HEALTHCARE,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,UNITED HEALTHCARE,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,VA,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,VA TRICARE,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,WELLMED,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,HUMANA,MGD,2112.01,,,,,,,per diem,2112.01,2112.01,"Per diem rate, code is bundled with other services"
BX/EXC LYMPH NODE SUPERFI     ,77020060,CDM,361,RC,,,,,,Inpatient,,,2112.01,2112.01,HUMANA CHOICE PLUS,MGD,2112.01,,,,,,,case rate,2112.01,2112.01,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,AETNA,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,BCBS,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,CIGNA,COM,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,TRICARE,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,UNITED HEALTHCARE,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,UNITED HEALTHCARE,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,VA,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,VA TRICARE,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,WELLMED,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,HUMANA,MGD,363.07,,,,,,,per diem,363.07,363.07,"Per diem rate, code is bundled with other services"
CHEMICAL CAUTERIZ TISSUE      ,77020061,CDM,361,RC,,,,,,Inpatient,,,363.07,363.07,HUMANA CHOICE PLUS,MGD,363.07,,,,,,,case rate,363.07,363.07,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,AETNA,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,BCBS,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,CIGNA,COM,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,TRICARE,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,UNITED HEALTHCARE,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,UNITED HEALTHCARE,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,VA,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,VA TRICARE,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,WELLMED,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,HUMANA,MGD,2620.74,,,,,,,per diem,2620.74,2620.74,"Per diem rate, code is bundled with other services"
CHOLECYSTOSTOMY PERC          ,77020062,CDM,361,RC,,,,,,Inpatient,,,2620.74,2620.74,HUMANA CHOICE PLUS,MGD,2620.74,,,,,,,case rate,2620.74,2620.74,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,AETNA,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,BCBS,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,CIGNA,COM,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,TRICARE,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,UNITED HEALTHCARE,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,UNITED HEALTHCARE,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,VA,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,VA TRICARE,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,WELLMED,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,HUMANA,MGD,1814.27,,,,,,,per diem,1814.27,1814.27,"Per diem rate, code is bundled with other services"
DESTR NEUR CELIAC PLXS        ,77020063,CDM,361,RC,,,,,,Inpatient,,,1814.27,1814.27,HUMANA CHOICE PLUS,MGD,1814.27,,,,,,,case rate,1814.27,1814.27,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,AETNA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,BCBS,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,CIGNA,COM,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,UNITED HEALTHCARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,VA TRICARE,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,WELLMED,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA,MGD,628.68,,,,,,,per diem,628.68,628.68,"Per diem rate, code is bundled with other services"
EPI/SUBARACH C/T DRUG INJ     ,77020064,CDM,361,RC,,,,,,Inpatient,,,628.68,628.68,HUMANA CHOICE PLUS,MGD,628.68,,,,,,,case rate,628.68,628.68,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,AETNA,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,BCBS,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,CIGNA,COM,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,TRICARE,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,UNITED HEALTHCARE,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,UNITED HEALTHCARE,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,VA,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,VA TRICARE,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,WELLMED,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,HUMANA,MGD,614.75,,,,,,,per diem,614.75,614.75,"Per diem rate, code is bundled with other services"
I&D ABSCESS SIMPLE            ,77020065,CDM,361,RC,,,,,,Inpatient,,,614.75,614.75,HUMANA CHOICE PLUS,MGD,614.75,,,,,,,case rate,614.75,614.75,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,AETNA,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,BCBS,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,CIGNA,COM,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,TRICARE,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,UNITED HEALTHCARE,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,UNITED HEALTHCARE,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,VA,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,VA TRICARE,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,WELLMED,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,HUMANA,MGD,1395.51,,,,,,,per diem,1395.51,1395.51,"Per diem rate, code is bundled with other services"
I&D HEMATOMA/SEROMA/FLUID     ,77020066,CDM,361,RC,,,,,,Inpatient,,,1395.51,1395.51,HUMANA CHOICE PLUS,MGD,1395.51,,,,,,,case rate,1395.51,1395.51,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,AETNA,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,BCBS,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,CIGNA,COM,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,TRICARE,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,UNITED HEALTHCARE,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,UNITED HEALTHCARE,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,VA,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,VA TRICARE,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,WELLMED,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,HUMANA,MGD,1241.29,,,,,,,per diem,1241.29,1241.29,"Per diem rate, code is bundled with other services"
PARACENTESIS ABD WO IMAG      ,77020067,CDM,361,RC,,,,,,Inpatient,,,1241.29,1241.29,HUMANA CHOICE PLUS,MGD,1241.29,,,,,,,case rate,1241.29,1241.29,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,AETNA,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,BCBS,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,CIGNA,COM,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,TRICARE,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,UNITED HEALTHCARE,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,UNITED HEALTHCARE,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,VA,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,VA TRICARE,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,WELLMED,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,HUMANA,MGD,1438.35,,,,,,,per diem,1438.35,1438.35,"Per diem rate, code is bundled with other services"
PARACENTSIS ABD W IMAGING     ,77020068,CDM,361,RC,,,,,,Inpatient,,,1438.35,1438.35,HUMANA CHOICE PLUS,MGD,1438.35,,,,,,,case rate,1438.35,1438.35,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,AETNA,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,BCBS,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,CIGNA,COM,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,TRICARE,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,UNITED HEALTHCARE,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,UNITED HEALTHCARE,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,VA,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,VA TRICARE,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,WELLMED,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,HUMANA,MGD,825.74,,,,,,,per diem,825.74,825.74,"Per diem rate, code is bundled with other services"
PERICARDIOCENTES INITIAL      ,77020069,CDM,361,RC,,,,,,Inpatient,,,825.74,825.74,HUMANA CHOICE PLUS,MGD,825.74,,,,,,,case rate,825.74,825.74,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,AETNA,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,BCBS,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,CIGNA,COM,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,TRICARE,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,UNITED HEALTHCARE,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,UNITED HEALTHCARE,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,VA,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,VA TRICARE,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,WELLMED,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,HUMANA,MGD,1506.9,,,,,,,per diem,1506.9,1506.9,"Per diem rate, code is bundled with other services"
PERITONEAL LAVAGE             ,77020070,CDM,361,RC,,,,,,Inpatient,,,1506.9,1506.9,HUMANA CHOICE PLUS,MGD,1506.9,,,,,,,case rate,1506.9,1506.9,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,AETNA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,BCBS,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,CIGNA,COM,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,UNITED HEALTHCARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,VA TRICARE,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,WELLMED,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA,MGD,518.36,,,,,,,per diem,518.36,518.36,"Per diem rate, code is bundled with other services"
PLEURODESIS INSTIL AGENT      ,77020071,CDM,361,RC,,,,,,Inpatient,,,518.36,518.36,HUMANA CHOICE PLUS,MGD,518.36,,,,,,,case rate,518.36,518.36,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,AETNA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,BCBS,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,CIGNA,COM,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,UNITED HEALTHCARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,VA TRICARE,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,WELLMED,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA,MGD,4970.51,,,,,,,per diem,4970.51,4970.51,"Per diem rate, code is bundled with other services"
PNEUMOTHORAX THERAPEUTIC      ,77020072,CDM,361,RC,,,,,,Inpatient,,,4970.51,4970.51,HUMANA CHOICE PLUS,MGD,4970.51,,,,,,,case rate,4970.51,4970.51,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,AETNA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,BCBS,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,CIGNA,COM,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,UNITED HEALTHCARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,VA TRICARE,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,WELLMED,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA,MGD,2227.68,,,,,,,per diem,2227.68,2227.68,"Per diem rate, code is bundled with other services"
RECTAL DEEP ABSCESS DRAIN     ,77020073,CDM,361,RC,,,,,,Inpatient,,,2227.68,2227.68,HUMANA CHOICE PLUS,MGD,2227.68,,,,,,,case rate,2227.68,2227.68,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,AETNA,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,BCBS,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,CIGNA,COM,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,TRICARE,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,UNITED HEALTHCARE,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,UNITED HEALTHCARE,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,VA,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,VA TRICARE,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,WELLMED,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,HUMANA,MGD,3265.48,,,,,,,per diem,3265.48,3265.48,"Per diem rate, code is bundled with other services"
RENAL CYST ASP/INJ PERC       ,77020074,CDM,361,RC,,,,,,Inpatient,,,3265.48,3265.48,HUMANA CHOICE PLUS,MGD,3265.48,,,,,,,case rate,3265.48,3265.48,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,AETNA,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,BCBS,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,CIGNA,COM,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,TRICARE,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,UNITED HEALTHCARE,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,UNITED HEALTHCARE,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,VA,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,VA TRICARE,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,WELLMED,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,HUMANA,MGD,514.08,,,,,,,per diem,514.08,514.08,"Per diem rate, code is bundled with other services"
RENAL TISSUE ABLAT PERC       ,77020075,CDM,361,RC,,,,,,Inpatient,,,514.08,514.08,HUMANA CHOICE PLUS,MGD,514.08,,,,,,,case rate,514.08,514.08,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,AETNA,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,BCBS,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,CIGNA,COM,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,TRICARE,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,UNITED HEALTHCARE,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,UNITED HEALTHCARE,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,VA,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,VA TRICARE,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,WELLMED,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,HUMANA,MGD,1621.49,,,,,,,per diem,1621.49,1621.49,"Per diem rate, code is bundled with other services"
SPINAL CORD CYST ASP PERC     ,77020076,CDM,361,RC,,,,,,Inpatient,,,1621.49,1621.49,HUMANA CHOICE PLUS,MGD,1621.49,,,,,,,case rate,1621.49,1621.49,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,AETNA,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,BCBS,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,CIGNA,COM,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,TRICARE,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,UNITED HEALTHCARE,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,UNITED HEALTHCARE,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,VA,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,VA TRICARE,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,WELLMED,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,HUMANA,MGD,2573.61,,,,,,,per diem,2573.61,2573.61,"Per diem rate, code is bundled with other services"
THORACENTESIS W IMAGING       ,77020077,CDM,361,RC,,,,,,Inpatient,,,2573.61,2573.61,HUMANA CHOICE PLUS,MGD,2573.61,,,,,,,case rate,2573.61,2573.61,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,AETNA,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,BCBS,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,CIGNA,COM,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,TRICARE,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,UNITED HEALTHCARE,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,UNITED HEALTHCARE,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,VA,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,VA TRICARE,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,WELLMED,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,HUMANA,MGD,2724.62,,,,,,,per diem,2724.62,2724.62,"Per diem rate, code is bundled with other services"
THORACENTESIS WO IMAGING      ,77020078,CDM,361,RC,,,,,,Inpatient,,,2724.62,2724.62,HUMANA CHOICE PLUS,MGD,2724.62,,,,,,,case rate,2724.62,2724.62,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,AETNA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,BCBS,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,CIGNA,COM,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,UNITED HEALTHCARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,VA,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,VA TRICARE,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,WELLMED,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA,MGD,1362.31,,,,,,,per diem,1362.31,1362.31,"Per diem rate, code is bundled with other services"
THORACOSTOMY TUBE             ,77020079,CDM,361,RC,,,,,,Inpatient,,,1362.31,1362.31,HUMANA CHOICE PLUS,MGD,1362.31,,,,,,,case rate,1362.31,1362.31,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,AETNA,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,BCBS,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,CIGNA,COM,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,TRICARE,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,UNITED HEALTHCARE,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,UNITED HEALTHCARE,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,VA,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,VA TRICARE,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,WELLMED,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,HUMANA,MGD,2717.13,,,,,,,per diem,2717.13,2717.13,"Per diem rate, code is bundled with other services"
TRANSVAG/REC PELV DRN         ,77020080,CDM,361,RC,,,,,,Inpatient,,,2717.13,2717.13,HUMANA CHOICE PLUS,MGD,2717.13,,,,,,,case rate,2717.13,2717.13,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID VISCERAL     ,77020081,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,AETNA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,BCBS,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,CIGNA,COM,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,UNITED HEALTHCARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,VA TRICARE,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,WELLMED,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA,MGD,7802.24,,,,,,,per diem,7802.24,7802.24,"Per diem rate, code is bundled with other services"
IMAGE CATH FLUID PERITO       ,77020082,CDM,361,RC,,,,,,Inpatient,,,7802.24,7802.24,HUMANA CHOICE PLUS,MGD,7802.24,,,,,,,case rate,7802.24,7802.24,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,AETNA,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,BCBS,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,CIGNA,COM,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,TRICARE,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,UNITED HEALTHCARE,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,UNITED HEALTHCARE,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,VA,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,VA TRICARE,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,WELLMED,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,HUMANA,MGD,25297.02,,,,,,,per diem,25297.02,25297.02,"Per diem rate, code is bundled with other services"
LIVER TUMOR ABLAT RF PERC     ,77020083,CDM,361,RC,,,,,,Inpatient,,,25297.02,25297.02,HUMANA CHOICE PLUS,MGD,25297.02,,,,,,,case rate,25297.02,25297.02,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,AETNA,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,BCBS,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,CIGNA,COM,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,TRICARE,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,UNITED HEALTHCARE,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,UNITED HEALTHCARE,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,VA,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,VA TRICARE,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,WELLMED,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,HUMANA,MGD,4624.58,,,,,,,per diem,4624.58,4624.58,"Per diem rate, code is bundled with other services"
BX ADRENAL GLAND NDL PERC     ,77020084,CDM,361,RC,,,,,,Inpatient,,,4624.58,4624.58,HUMANA CHOICE PLUS,MGD,4624.58,,,,,,,case rate,4624.58,4624.58,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP SMALL JT     ,77020085,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP INTER JT     ,77020086,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,AETNA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,BCBS,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,CIGNA,COM,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,UNITED HEALTHCARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,VA TRICARE,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,WELLMED,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA,MGD,1451.21,,,,,,,per diem,1451.21,1451.21,"Per diem rate, code is bundled with other services"
US ARTHROCEN ASP MAJOR JT     ,77020087,CDM,361,RC,,,,,,Inpatient,,,1451.21,1451.21,HUMANA CHOICE PLUS,MGD,1451.21,,,,,,,case rate,1451.21,1451.21,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,AETNA,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,BCBS,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,CIGNA,COM,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,TRICARE,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,UNITED HEALTHCARE,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,UNITED HEALTHCARE,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,VA,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,VA TRICARE,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,WELLMED,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,HUMANA,MGD,1833.55,,,,,,,per diem,1833.55,1833.55,"Per diem rate, code is bundled with other services"
BX SPLEEN NDL                 ,77020088,CDM,361,RC,,,,,,Inpatient,,,1833.55,1833.55,HUMANA CHOICE PLUS,MGD,1833.55,,,,,,,case rate,1833.55,1833.55,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,AETNA,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,BCBS,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,CIGNA,COM,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,TRICARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,UNITED HEALTHCARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,UNITED HEALTHCARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,VA,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,VA TRICARE,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,WELLMED,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,HUMANA,MGD,3285.83,,,,,,,per diem,3285.83,3285.83,"Per diem rate, code is bundled with other services"
GTUBE CHANGE TO GJ PERC       ,77020089,CDM,361,RC,,,,,,Inpatient,,,3285.83,3285.83,HUMANA CHOICE PLUS,MGD,3285.83,,,,,,,case rate,3285.83,3285.83,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,AETNA,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,BCBS,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,CIGNA,COM,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,TRICARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,UNITED HEALTHCARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,UNITED HEALTHCARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,VA,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,VA TRICARE,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,WELLMED,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,HUMANA,MGD,4828.07,,,,,,,per diem,4828.07,4828.07,"Per diem rate, code is bundled with other services"
BIOPSY SFT TISS LEG/ANKLE     ,77020090,CDM,361,RC,,,,,,Inpatient,,,4828.07,4828.07,HUMANA CHOICE PLUS,MGD,4828.07,,,,,,,case rate,4828.07,4828.07,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROSTOM CTH W IMAG     ,77020091,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROUR CTH IMAG NEW     ,77020092,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,AETNA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,BCBS,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,CIGNA,COM,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,UNITED HEALTHCARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,VA TRICARE,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,WELLMED,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA,MGD,8798.27,,,,,,,per diem,8798.27,8798.27,"Per diem rate, code is bundled with other services"
PLC NEPHROU CTH IMA NW BI     ,77020093,CDM,361,RC,,,,,,Inpatient,,,8798.27,8798.27,HUMANA CHOICE PLUS,MGD,8798.27,,,,,,,case rate,8798.27,8798.27,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CONV NEPHRS TO NEPHRU CTH     ,77020094,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
CON NPHRS TO NPHRU CTH BI     ,77020095,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHROS CTH W IMAG     ,77020096,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,AETNA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,BCBS,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,CIGNA,COM,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,UNITED HEALTHCARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,VA TRICARE,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,WELLMED,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA,MGD,2899.2,,,,,,,per diem,2899.2,2899.2,"Per diem rate, code is bundled with other services"
EXCHNG NEPHRO CTH IMAG BI     ,77020097,CDM,361,RC,,,,,,Inpatient,,,2899.2,2899.2,HUMANA CHOICE PLUS,MGD,2899.2,,,,,,,case rate,2899.2,2899.2,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EXIST     ,77020098,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT PRE EX BI     ,77020099,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACCESS     ,77020100,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NW ACC BI     ,77020101,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URETER STNT NEW W CTH     ,77020102,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,AETNA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,BCBS,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,CIGNA,COM,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,UNITED HEALTHCARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,VA TRICARE,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,WELLMED,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA,MGD,13103.69,,,,,,,per diem,13103.69,13103.69,"Per diem rate, code is bundled with other services"
PLC URET STNT NW W CTH BI     ,77020103,CDM,361,RC,,,,,,Inpatient,,,13103.69,13103.69,HUMANA CHOICE PLUS,MGD,13103.69,,,,,,,case rate,13103.69,13103.69,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,AETNA,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,BCBS,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,CIGNA,COM,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,TRICARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,UNITED HEALTHCARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,UNITED HEALTHCARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,VA,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,VA TRICARE,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,WELLMED,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,HUMANA,MGD,11230.51,,,,,,,per diem,11230.51,11230.51,"Per diem rate, code is bundled with other services"
BX LEG/ANKL SFT TISS DEEP     ,77020104,CDM,361,RC,,,,,,Inpatient,,,11230.51,11230.51,HUMANA CHOICE PLUS,MGD,11230.51,,,,,,,case rate,11230.51,11230.51,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,AETNA,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,BCBS,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,CIGNA,COM,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,TRICARE,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,UNITED HEALTHCARE,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,UNITED HEALTHCARE,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,VA,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,VA TRICARE,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,WELLMED,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,HUMANA,MGD,479.81,,,,,,,per diem,479.81,479.81,"Per diem rate, code is bundled with other services"
URETHROCYSTOGRM CHAIN INJ     ,77020105,CDM,361,RC,,,,,,Inpatient,,,479.81,479.81,HUMANA CHOICE PLUS,MGD,479.81,,,,,,,case rate,479.81,479.81,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,AETNA,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,BCBS,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,CIGNA,COM,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,TRICARE,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,UNITED HEALTHCARE,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,UNITED HEALTHCARE,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,VA,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,VA TRICARE,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,WELLMED,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,HUMANA,MGD,5563.85,,,,,,,per diem,5563.85,5563.85,"Per diem rate, code is bundled with other services"
SCLERO FLUID COLLECT PERC     ,77020106,CDM,361,RC,,,,,,Inpatient,,,5563.85,5563.85,HUMANA CHOICE PLUS,MGD,5563.85,,,,,,,case rate,5563.85,5563.85,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,AETNA,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,BCBS,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,CIGNA,COM,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,TRICARE,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,UNITED HEALTHCARE,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,UNITED HEALTHCARE,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,VA,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,VA TRICARE,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,WELLMED,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,HUMANA,MGD,625.02,,,,,,,per diem,625.02,625.02,"Per diem rate, code is bundled with other services"
HIP COMPLETE LT MIN 2 VIEW    ,77020107,CDM,350,RC,,,,,,Inpatient,,,625.02,625.02,HUMANA CHOICE PLUS,MGD,625.02,,,,,,,case rate,625.02,625.02,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,AETNA,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,BCBS,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,CIGNA,COM,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,TRICARE,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,UNITED HEALTHCARE,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,UNITED HEALTHCARE,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,VA,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,VA TRICARE,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,WELLMED,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,HUMANA,MGD,3028.9,,,,,,,per diem,3028.9,3028.9,"Per diem rate, code is bundled with other services"
CT LUMBAR SPINE W/O CONTR     ,77020108,CDM,350,RC,,,,,,Inpatient,,,3028.9,3028.9,HUMANA CHOICE PLUS,MGD,3028.9,,,,,,,case rate,3028.9,3028.9,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,AETNA,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,BCBS,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,CIGNA,COM,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,TRICARE,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,UNITED HEALTHCARE,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,UNITED HEALTHCARE,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,VA,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,VA TRICARE,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,WELLMED,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,HUMANA,MGD,1765.55,,,,,,,per diem,1765.55,1765.55,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W/O CO     ,77020109,CDM,350,RC,,,,,,Inpatient,,,1765.55,1765.55,HUMANA CHOICE PLUS,MGD,1765.55,,,,,,,case rate,1765.55,1765.55,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,AETNA,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,BCBS,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,CIGNA,COM,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,TRICARE,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,UNITED HEALTHCARE,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,UNITED HEALTHCARE,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,VA,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,VA TRICARE,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,WELLMED,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,HUMANA,MGD,2051.61,,,,,,,per diem,2051.61,2051.61,"Per diem rate, code is bundled with other services"
CT ABDOMEN W/O CONTRAST       ,77020110,CDM,352,RC,,,,,,Inpatient,,,2051.61,2051.61,HUMANA CHOICE PLUS,MGD,2051.61,,,,,,,case rate,2051.61,2051.61,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,AETNA,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,BCBS,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,CIGNA,COM,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,TRICARE,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,UNITED HEALTHCARE,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,UNITED HEALTHCARE,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,VA,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,VA TRICARE,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,WELLMED,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,HUMANA,MGD,2190.14,,,,,,,per diem,2190.14,2190.14,"Per diem rate, code is bundled with other services"
PULM W/WOUT SINGLE BREATH     ,77020111,CDM,460,RC,78585,CPT,,,,Inpatient,,,2190.14,2190.14,HUMANA CHOICE PLUS,MGD,2190.14,,,,,,,case rate,2190.14,2190.14,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,AETNA,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,BCBS,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,CIGNA,COM,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,TRICARE,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,UNITED HEALTHCARE,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,UNITED HEALTHCARE,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,VA,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,VA TRICARE,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,WELLMED,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,HUMANA,MGD,745.24,,,,,,,per diem,745.24,745.24,"Per diem rate, code is bundled with other services"
INJ/CHECK DRAINAGE CATHETER   ,77020112,CDM,361,RC,49424,CPT,,,,Inpatient,,,745.24,745.24,HUMANA CHOICE PLUS,MGD,745.24,,,,,,,case rate,745.24,745.24,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,AETNA,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,BCBS,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,CIGNA,COM,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,TRICARE,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,UNITED HEALTHCARE,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,UNITED HEALTHCARE,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,VA,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,VA TRICARE,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,WELLMED,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,HUMANA,MGD,3381.53,,,,,,,per diem,3381.53,3381.53,"Per diem rate, code is bundled with other services"
CT EXTREMITY LOWER W          ,77020113,CDM,352,RC,,,,,,Inpatient,,,3381.53,3381.53,HUMANA CHOICE PLUS,MGD,3381.53,,,,,,,case rate,3381.53,3381.53,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,AETNA,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,BCBS,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,CIGNA,COM,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,TRICARE,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,UNITED HEALTHCARE,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,UNITED HEALTHCARE,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,VA,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,VA TRICARE,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,WELLMED,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,HUMANA,MGD,1196.67,,,,,,,per diem,1196.67,1196.67,"Per diem rate, code is bundled with other services"
CT HEAD W/WO CONTRAST         ,77020117,CDM,351,RC,,,,,,Inpatient,,,1196.67,1196.67,HUMANA CHOICE PLUS,MGD,1196.67,,,,,,,case rate,1196.67,1196.67,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,AETNA,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,BCBS,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,CIGNA,COM,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,TRICARE,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,UNITED HEALTHCARE,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,UNITED HEALTHCARE,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,VA,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,VA TRICARE,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,WELLMED,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,HUMANA,MGD,1426.57,,,,,,,per diem,1426.57,1426.57,"Per diem rate, code is bundled with other services"
CT LOWER EXT W/CONTRAST       ,77020118,CDM,352,RC,73701,CPT,,,,Inpatient,,,1426.57,1426.57,HUMANA CHOICE PLUS,MGD,1426.57,,,,,,,case rate,1426.57,1426.57,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,AETNA,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,BCBS,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,CIGNA,COM,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,TRICARE,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,UNITED HEALTHCARE,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,UNITED HEALTHCARE,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,VA,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,VA TRICARE,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,WELLMED,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,HUMANA,MGD,513.32,,,,,,,per diem,513.32,513.32,"Per diem rate, code is bundled with other services"
CT UNLISTED PROC OUTSIDE SERV ,77099999,CDM,350,RC,76497,CPT,,,,Inpatient,,,513.32,513.32,HUMANA CHOICE PLUS,MGD,513.32,,,,,,,case rate,513.32,513.32,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,AETNA,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,BCBS,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,CIGNA,COM,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,TRICARE,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,UNITED HEALTHCARE,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,UNITED HEALTHCARE,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,VA,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,VA TRICARE,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,WELLMED,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,HUMANA,MGD,191.18,,,,,,,per diem,191.18,191.18,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL I       ,79500160,CDM,510,RC,99211,CPT,,,,Inpatient,,,191.18,191.18,HUMANA CHOICE PLUS,MGD,191.18,,,,,,,case rate,191.18,191.18,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,AETNA,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,BCBS,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,CIGNA,COM,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,TRICARE,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,UNITED HEALTHCARE,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,UNITED HEALTHCARE,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,VA,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,VA TRICARE,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,WELLMED,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,HUMANA,MGD,175.46,,,,,,,per diem,175.46,175.46,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL III     ,79500162,CDM,510,RC,99213,CPT,,,,Inpatient,,,175.46,175.46,HUMANA CHOICE PLUS,MGD,175.46,,,,,,,case rate,175.46,175.46,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,AETNA,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,BCBS,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,CIGNA,COM,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,TRICARE,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,UNITED HEALTHCARE,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,UNITED HEALTHCARE,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,VA,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,VA TRICARE,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,WELLMED,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,HUMANA,MGD,767.19,,,,,,,per diem,767.19,767.19,"Per diem rate, code is bundled with other services"
OP VISIT EST PT LEVEL IV      ,79500163,CDM,510,RC,99214,CPT,,,,Inpatient,,,767.19,767.19,HUMANA CHOICE PLUS,MGD,767.19,,,,,,,case rate,767.19,767.19,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,AETNA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,BCBS,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,CIGNA,COM,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,UNITED HEALTHCARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,VA,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,VA TRICARE,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,WELLMED,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA,MGD,157.5,,,,,,,per diem,157.5,157.5,"Per diem rate, code is bundled with other services"
PHYSICIAN OFFICE VIS          ,79500165,CDM,510,RC,,,,,,Inpatient,,,157.5,157.5,HUMANA CHOICE PLUS,MGD,157.5,,,,,,,case rate,157.5,157.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,AETNA,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,BCBS,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,CIGNA,COM,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,TRICARE,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,UNITED HEALTHCARE,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,UNITED HEALTHCARE,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,VA,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,VA TRICARE,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,WELLMED,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,HUMANA,MGD,165.11,,,,,,,per diem,165.11,165.11,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL I       ,79500170,CDM,510,RC,99201,CPT,,,,Inpatient,,,165.11,165.11,HUMANA CHOICE PLUS,MGD,165.11,,,,,,,case rate,165.11,165.11,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,AETNA,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,BCBS,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,CIGNA,COM,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,TRICARE,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,UNITED HEALTHCARE,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,UNITED HEALTHCARE,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,VA,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,VA TRICARE,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,WELLMED,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,HUMANA,MGD,1941.5,,,,,,,per diem,1941.5,1941.5,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL IV      ,79500173,CDM,510,RC,99204,CPT,,,,Inpatient,,,1941.5,1941.5,HUMANA CHOICE PLUS,MGD,1941.5,,,,,,,case rate,1941.5,1941.5,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,AETNA,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,BCBS,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,CIGNA,COM,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,TRICARE,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,UNITED HEALTHCARE,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,UNITED HEALTHCARE,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,VA,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,VA TRICARE,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,WELLMED,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,HUMANA,MGD,1904.71,,,,,,,per diem,1904.71,1904.71,"Per diem rate, code is bundled with other services"
OP VISIT NEW PT LEVEL V       ,79500174,CDM,510,RC,99205,CPT,,,,Inpatient,,,1904.71,1904.71,HUMANA CHOICE PLUS,MGD,1904.71,,,,,,,case rate,1904.71,1904.71,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,AETNA,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,BCBS,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,CIGNA,COM,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,TRICARE,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,UNITED HEALTHCARE,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,UNITED HEALTHCARE,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,VA,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,VA TRICARE,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,WELLMED,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,HUMANA,MGD,1138.41,,,,,,,per diem,1138.41,1138.41,"Per diem rate, code is bundled with other services"
AMBULANCE SERVICE             ,85001000,CDM,540,RC,,,,,,Inpatient,,,1138.41,1138.41,HUMANA CHOICE PLUS,MGD,1138.41,,,,,,,case rate,1138.41,1138.41,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,AETNA,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,BCBS,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,CIGNA,COM,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,TRICARE,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,UNITED HEALTHCARE,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,UNITED HEALTHCARE,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,VA,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,VA TRICARE,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,WELLMED,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,HUMANA,MGD,488.12,,,,,,,per diem,488.12,488.12,"Per diem rate, code is bundled with other services"
TAXI SERVICE                  ,85002000,CDM,542,RC,,,,,,Inpatient,,,488.12,488.12,HUMANA CHOICE PLUS,MGD,488.12,,,,,,,case rate,488.12,488.12,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,AETNA,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,BCBS,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,CIGNA,COM,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,TRICARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,UNITED HEALTHCARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,UNITED HEALTHCARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,VA,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,VA TRICARE,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,WELLMED,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,HUMANA,MGD,16.54,,,,,,,per diem,16.54,16.54,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SOL   ,92000371,CDM,250,RC,,,,,,Inpatient,1,EA,16.54,16.54,HUMANA CHOICE PLUS,MGD,16.54,,,,,,,case rate,16.54,16.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92000386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92000601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
ACULAR 0.5% EYE DROPS         ,92000900,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92000936,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,AETNA,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,BCBS,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,CIGNA,COM,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,TRICARE,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,UNITED HEALTHCARE,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,UNITED HEALTHCARE,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,VA,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,VA TRICARE,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,WELLMED,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,HUMANA,MGD,286.65,,,,,,,per diem,286.65,286.65,"Per diem rate, code is bundled with other services"
ADVAIR 250-50 DISKUS          ,92001021,CDM,250,RC,,,,,,Inpatient,1,EA,286.65,286.65,HUMANA CHOICE PLUS,MGD,286.65,,,,,,,case rate,286.65,286.65,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALDACTONE 100MG TAB           ,92001276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ALDACTONE 50MG TAB            ,92001282,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92001552,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMBIEN 5MG TAB                ,92001674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
ANUSOL OINT                   ,92002585,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARAVA 20MG TAB                ,92002708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,AETNA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,CIGNA,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,VA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,VA TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,WELLMED,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,HUMANA,MGD,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
ARIMIDEX 1MG TAB              ,92002714,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,HUMANA CHOICE PLUS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARMOUR THYROID 30MG TAB       ,92002743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB EC          ,92002990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92003280,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,AETNA,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,BCBS,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,CIGNA,COM,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,TRICARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UNITED HEALTHCARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,UNITED HEALTHCARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,VA,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,VA TRICARE,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,WELLMED,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,HUMANA,MGD,53.13,,,,,,,per diem,53.13,53.13,"Per diem rate, code is bundled with other services"
ATROPINE 1% EYE DROPS         ,92003399,CDM,250,RC,,,,,,Inpatient,1,EA,53.13,53.13,HUMANA CHOICE PLUS,MGD,53.13,,,,,,,case rate,53.13,53.13,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZATHIOPRINE 50MG TAB         ,92003564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,AETNA,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,BCBS,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,CIGNA,COM,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,TRICARE,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,UNITED HEALTHCARE,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,UNITED HEALTHCARE,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,VA,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,VA TRICARE,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,WELLMED,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,HUMANA,MGD,25.62,,,,,,,per diem,25.62,25.62,"Per diem rate, code is bundled with other services"
BACIT/POLYMYXIN EYE OINT      ,92003627,CDM,250,RC,,,,,,Inpatient,1,EA,25.62,25.62,HUMANA CHOICE PLUS,MGD,25.62,,,,,,,case rate,25.62,25.62,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,AETNA,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,BCBS,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,CIGNA,COM,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,TRICARE,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,UNITED HEALTHCARE,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,UNITED HEALTHCARE,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,VA,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,VA TRICARE,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,WELLMED,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,HUMANA,MGD,7.78,,,,,,,per diem,7.78,7.78,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92003702,CDM,250,RC,,,,,,Inpatient,1,EA,7.78,7.78,HUMANA CHOICE PLUS,MGD,7.78,,,,,,,case rate,7.78,7.78,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MES 1MG TAB       ,92004051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG TAB             ,92004125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92004347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,AETNA,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,BCBS,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,CIGNA,COM,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,TRICARE,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,UNITED HEALTHCARE,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,UNITED HEALTHCARE,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,VA,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,VA TRICARE,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,WELLMED,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,HUMANA,MGD,23.29,,,,,,,per diem,23.29,23.29,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92004680,CDM,250,RC,,,,,,Inpatient,1,EA,23.29,23.29,HUMANA CHOICE PLUS,MGD,23.29,,,,,,,case rate,23.29,23.29,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,AETNA,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,BCBS,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,CIGNA,COM,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,TRICARE,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,UNITED HEALTHCARE,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,UNITED HEALTHCARE,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,VA,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,VA TRICARE,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,WELLMED,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,HUMANA,MGD,5.81,,,,,,,per diem,5.81,5.81,"Per diem rate, code is bundled with other services"
BUPROPION HCL 75MG TAB        ,92004684,CDM,250,RC,,,,,,Inpatient,1,EA,5.81,5.81,HUMANA CHOICE PLUS,MGD,5.81,,,,,,,case rate,5.81,5.81,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,AETNA,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,BCBS,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,CIGNA,COM,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,TRICARE,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UNITED HEALTHCARE,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,UNITED HEALTHCARE,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,VA TRICARE,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,WELLMED,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,HUMANA,MGD,6.06,,,,,,,per diem,6.06,6.06,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92005422,CDM,250,RC,,,,,,Inpatient,1,EA,6.06,6.06,HUMANA CHOICE PLUS,MGD,6.06,,,,,,,case rate,6.06,6.06,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92005433,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92005462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 4MG TAB               ,92005530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,AETNA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,BCBS,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,CIGNA,COM,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,UNITED HEALTHCARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,VA,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,VA TRICARE,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,WELLMED,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,HUMANA,MGD,29.4,,,,,,,per diem,29.4,29.4,"Per diem rate, code is bundled with other services"
CATAPRES-TTS 2 PATCH          ,92005676,CDM,250,RC,,,,,,Inpatient,1,EA,29.4,29.4,HUMANA CHOICE PLUS,MGD,29.4,,,,,,,case rate,29.4,29.4,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
CELEBREX 100MG CAP            ,92005872,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITRATE OF MAGNESIA SOL       ,92006747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92007148,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92007165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,AETNA,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,BCBS,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,CIGNA,COM,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,TRICARE,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,UNITED HEALTHCARE,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,UNITED HEALTHCARE,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,VA,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,VA TRICARE,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,WELLMED,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,HUMANA,MGD,9.93,,,,,,,per diem,9.93,9.93,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92007188,CDM,250,RC,,,,,,Inpatient,1,EA,9.93,9.93,HUMANA CHOICE PLUS,MGD,9.93,,,,,,,case rate,9.93,9.93,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CODEINE SULFATE 15MG TAB      ,92007292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,AETNA,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,BCBS,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,CIGNA,COM,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,TRICARE,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,UNITED HEALTHCARE,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,UNITED HEALTHCARE,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,VA,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,VA TRICARE,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,WELLMED,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,HUMANA,MGD,265.91,,,,,,,per diem,265.91,265.91,"Per diem rate, code is bundled with other services"
COSOPT EYE DROPS              ,92007467,CDM,250,RC,,,,,,Inpatient,1,EA,265.91,265.91,HUMANA CHOICE PLUS,MGD,265.91,,,,,,,case rate,265.91,265.91,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,AETNA,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,CIGNA,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,TRICARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,UNITED HEALTHCARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,UNITED HEALTHCARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,VA,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,VA TRICARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,WELLMED,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,HUMANA,MGD,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN 10MG TAB             ,92007476,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,HUMANA CHOICE PLUS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 3MG TAB              ,92007487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 4MG TAB              ,92007490,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 5MG TAB              ,92007493,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COZAAR 25MG TAB               ,92007509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 10MG TAB      ,92007591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 1MG TAB         ,92008241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,AETNA,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,BCBS,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,CIGNA,COM,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,TRICARE,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,UNITED HEALTHCARE,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,UNITED HEALTHCARE,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,VA,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,VA TRICARE,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,WELLMED,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,HUMANA,MGD,7.1,,,,,,,per diem,7.1,7.1,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE 5MG TAB     ,92008291,CDM,250,RC,,,,,,Inpatient,1,EA,7.1,7.1,HUMANA CHOICE PLUS,MGD,7.1,,,,,,,case rate,7.1,7.1,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92008526,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,AETNA,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,BCBS,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,CIGNA,COM,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,TRICARE,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,UNITED HEALTHCARE,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,UNITED HEALTHCARE,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,VA,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,VA TRICARE,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,WELLMED,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,HUMANA,MGD,6.65,,,,,,,per diem,6.65,6.65,"Per diem rate, code is bundled with other services"
DICYCLOMINE 10MG CAP          ,92008721,CDM,250,RC,,,,,,Inpatient,1,EA,6.65,6.65,HUMANA CHOICE PLUS,MGD,6.65,,,,,,,case rate,6.65,6.65,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
DIFLUCAN 50MG TAB             ,92008803,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,AETNA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,CIGNA,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,WELLMED,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA,MGD,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92008847,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA CHOICE PLUS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 30MG TAB            ,92008940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM 60MG TAB            ,92008968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,AETNA,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,BCBS,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,CIGNA,COM,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,TRICARE,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,UNITED HEALTHCARE,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,UNITED HEALTHCARE,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,VA,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,VA TRICARE,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,WELLMED,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,HUMANA,MGD,12.97,,,,,,,per diem,12.97,12.97,"Per diem rate, code is bundled with other services"
DILTIAZEM ER 90MG CAP SA      ,92009006,CDM,250,RC,,,,,,Inpatient,1,EA,12.97,12.97,HUMANA CHOICE PLUS,MGD,12.97,,,,,,,case rate,12.97,12.97,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 120MG CAP     ,92009009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DILTIAZEM CD ER 180MG CAP     ,92009017,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,AETNA,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,BCBS,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,CIGNA,COM,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,TRICARE,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,UNITED HEALTHCARE,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,UNITED HEALTHCARE,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,VA,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,VA TRICARE,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,WELLMED,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,HUMANA,MGD,20.41,,,,,,,per diem,20.41,20.41,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 50MG/ML VL    ,92009313,CDM,250,RC,,,,,,Inpatient,1,EA,20.41,20.41,HUMANA CHOICE PLUS,MGD,20.41,,,,,,,case rate,20.41,20.41,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92009432,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,AETNA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,CIGNA,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,WELLMED,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA,MGD,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
DOXYCYCLINE 100MG TAB         ,92009943,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA CHOICE PLUS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,AETNA,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,BCBS,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,CIGNA,COM,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,TRICARE,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,UNITED HEALTHCARE,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,UNITED HEALTHCARE,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,VA,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,VA TRICARE,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,WELLMED,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,HUMANA,MGD,21.9,,,,,,,per diem,21.9,21.9,"Per diem rate, code is bundled with other services"
EFFEXOR XR 37.5MG CAP SA      ,92010231,CDM,250,RC,,,,,,Inpatient,1,EA,21.9,21.9,HUMANA CHOICE PLUS,MGD,21.9,,,,,,,case rate,21.9,21.9,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,AETNA,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,BCBS,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,CIGNA,COM,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,TRICARE,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,UNITED HEALTHCARE,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,UNITED HEALTHCARE,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,VA,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,VA TRICARE,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,WELLMED,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,HUMANA,MGD,51.79,,,,,,,per diem,51.79,51.79,"Per diem rate, code is bundled with other services"
EFFEXOR XR 75MG CAP SA        ,92010233,CDM,250,RC,,,,,,Inpatient,1,EA,51.79,51.79,HUMANA CHOICE PLUS,MGD,51.79,,,,,,,case rate,51.79,51.79,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
EMLA CREAM                    ,92010332,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92010670,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92010807,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92011011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA                   ,92011445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLOMAX 0.4MG CAP SA           ,92011479,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,AETNA,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,BCBS,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,CIGNA,COM,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,TRICARE,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,UNITED HEALTHCARE,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,UNITED HEALTHCARE,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,VA,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,VA TRICARE,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,WELLMED,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,HUMANA,MGD,132.83,,,,,,,per diem,132.83,132.83,"Per diem rate, code is bundled with other services"
FLONASE 0.05PCT NASAL SPRAY   ,92011480,CDM,250,RC,,,,,,Inpatient,1,EA,132.83,132.83,HUMANA CHOICE PLUS,MGD,132.83,,,,,,,case rate,132.83,132.83,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUDROCORTISONE 0.1MG TAB     ,92011535,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 10MG CAP           ,92011681,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUOXETINE 20MG CAP           ,92011684,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 1MG TAB            ,92011971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92012113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92012145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,AETNA,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,BCBS,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,CIGNA,COM,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,TRICARE,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,UNITED HEALTHCARE,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,UNITED HEALTHCARE,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,VA,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,VA TRICARE,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,WELLMED,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,HUMANA,MGD,209.81,,,,,,,per diem,209.81,209.81,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.1% OINT          ,92012288,CDM,250,RC,,,,,,Inpatient,1,EA,209.81,209.81,HUMANA CHOICE PLUS,MGD,209.81,,,,,,,case rate,209.81,209.81,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOPHAGE 500 MG TABLET      ,92012419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM SYRUP          ,92012685,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LABETALOL 100MG TAB           ,92012834,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92012878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,AETNA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,CIGNA,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,WELLMED,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA,MGD,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92012900,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA CHOICE PLUS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG 100 UNITS/ML VL       ,92013240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMULIN R 500 U/ML VL         ,92013270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,AETNA,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,BCBS,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,CIGNA,COM,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,TRICARE,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,UNITED HEALTHCARE,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,UNITED HEALTHCARE,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,VA,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,VA TRICARE,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,WELLMED,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,HUMANA,MGD,80.12,,,,,,,per diem,80.12,80.12,"Per diem rate, code is bundled with other services"
HYDRALAZINE 20MG/ML VL        ,92013323,CDM,250,RC,,,,,,Inpatient,1,EA,80.12,80.12,HUMANA CHOICE PLUS,MGD,80.12,,,,,,,case rate,80.12,80.12,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 25MG TAB          ,92013332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CREAM     ,92013857,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92013994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,AETNA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,BCBS,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,CIGNA,COM,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,UNITED HEALTHCARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,VA,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,VA TRICARE,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,WELLMED,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,HUMANA,MGD,74.62,,,,,,,per diem,74.62,74.62,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92014011,CDM,250,RC,,,,,,Inpatient,1,EA,74.62,74.62,HUMANA CHOICE PLUS,MGD,74.62,,,,,,,case rate,74.62,74.62,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,AETNA,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,BCBS,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,CIGNA,COM,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,TRICARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,UNITED HEALTHCARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,UNITED HEALTHCARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,VA,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,VA TRICARE,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,WELLMED,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,HUMANA,MGD,5.72,,,,,,,per diem,5.72,5.72,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92014065,CDM,250,RC,,,,,,Inpatient,1,EA,5.72,5.72,HUMANA CHOICE PLUS,MGD,5.72,,,,,,,case rate,5.72,5.72,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92014640,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92014761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92015388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,AETNA,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,BCBS,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,CIGNA,COM,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,TRICARE,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,UNITED HEALTHCARE,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,UNITED HEALTHCARE,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,VA,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,VA TRICARE,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,WELLMED,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,HUMANA,MGD,113.93,,,,,,,per diem,113.93,113.93,"Per diem rate, code is bundled with other services"
LAC-HYDRIN 12% LOTION         ,92015867,CDM,250,RC,,,,,,Inpatient,1,EA,113.93,113.93,HUMANA CHOICE PLUS,MGD,113.93,,,,,,,case rate,113.93,113.93,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,AETNA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,CIGNA,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,WELLMED,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA,MGD,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
LACLOTION 12% LOTION          ,92015874,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA CHOICE PLUS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LAMICTAL 100MG TAB            ,92015963,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
LANOXIN 125MCG TAB            ,92015987,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,AETNA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,CIGNA,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,WELLMED,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA,MGD,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
LANTUS 100 UNITS/ML VL        ,92016008,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA CHOICE PLUS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,AETNA,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,BCBS,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,CIGNA,COM,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,TRICARE,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,UNITED HEALTHCARE,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,UNITED HEALTHCARE,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,VA,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,VA TRICARE,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,WELLMED,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,HUMANA,MGD,70.61,,,,,,,per diem,70.61,70.61,"Per diem rate, code is bundled with other services"
LEVAQUIN 250MG TAB            ,92016097,CDM,250,RC,,,,,,Inpatient,1,EA,70.61,70.61,HUMANA CHOICE PLUS,MGD,70.61,,,,,,,case rate,70.61,70.61,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXAPRO 10MG TAB              ,92016356,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,AETNA,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,BCBS,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,CIGNA,COM,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,TRICARE,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,UNITED HEALTHCARE,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,UNITED HEALTHCARE,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,VA,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,VA TRICARE,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,WELLMED,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,HUMANA,MGD,9.25,,,,,,,per diem,9.25,9.25,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016468,CDM,250,RC,,,,,,Inpatient,1,EA,9.25,9.25,HUMANA CHOICE PLUS,MGD,9.25,,,,,,,case rate,9.25,9.25,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,AETNA,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,BCBS,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,CIGNA,COM,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,TRICARE,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,UNITED HEALTHCARE,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,UNITED HEALTHCARE,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,VA,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,VA TRICARE,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,WELLMED,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,HUMANA,MGD,36.9,,,,,,,per diem,36.9,36.9,"Per diem rate, code is bundled with other services"
LIDOCAINE 2% VISCOUS SOL      ,92016469,CDM,250,RC,,,,,,Inpatient,1,EA,36.9,36.9,HUMANA CHOICE PLUS,MGD,36.9,,,,,,,case rate,36.9,36.9,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,AETNA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,CIGNA,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,WELLMED,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA,MGD,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LIPITOR 10MG TAB              ,92016620,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA CHOICE PLUS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 20MG TAB              ,92016623,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIPITOR 40MG TAB              ,92016625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92016654,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 5MG TAB            ,92016723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92016987,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92017019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,AETNA,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,BCBS,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,CIGNA,COM,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,TRICARE,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,UNITED HEALTHCARE,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,UNITED HEALTHCARE,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,VA,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,VA TRICARE,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,WELLMED,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,HUMANA,MGD,53.81,,,,,,,per diem,53.81,53.81,"Per diem rate, code is bundled with other services"
LOTRISONE CREAM               ,92017145,CDM,250,RC,,,,,,Inpatient,1,EA,53.81,53.81,HUMANA CHOICE PLUS,MGD,53.81,,,,,,,case rate,53.81,53.81,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
LOVENOX 100MG PREFILLED SYRING,92017181,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,AETNA,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,BCBS,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,CIGNA,COM,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,TRICARE,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,UNITED HEALTHCARE,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,UNITED HEALTHCARE,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,VA,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,VA TRICARE,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,WELLMED,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,HUMANA,MGD,90.78,,,,,,,per diem,90.78,90.78,"Per diem rate, code is bundled with other services"
LOVENOX 120MG PREFILLED SYRING,92017182,CDM,250,RC,,,,,,Inpatient,1,EA,90.78,90.78,HUMANA CHOICE PLUS,MGD,90.78,,,,,,,case rate,90.78,90.78,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,AETNA,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,BCBS,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,CIGNA,COM,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,TRICARE,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,UNITED HEALTHCARE,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,UNITED HEALTHCARE,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,VA,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,VA TRICARE,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,WELLMED,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,HUMANA,MGD,34.87,,,,,,,per diem,34.87,34.87,"Per diem rate, code is bundled with other services"
LOVENOX 150MG PREFILLED SYR   ,92017183,CDM,250,RC,,,,,,Inpatient,1,EA,34.87,34.87,HUMANA CHOICE PLUS,MGD,34.87,,,,,,,case rate,34.87,34.87,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,AETNA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,CIGNA,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,WELLMED,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA,MGD,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
LOVENOX 30MG PREFILLED SYRINGE,92017186,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA CHOICE PLUS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,AETNA,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,BCBS,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,CIGNA,COM,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,TRICARE,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,UNITED HEALTHCARE,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,UNITED HEALTHCARE,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,VA,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,VA TRICARE,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,WELLMED,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,HUMANA,MGD,26.81,,,,,,,per diem,26.81,26.81,"Per diem rate, code is bundled with other services"
LOVENOX 40MG PREFILLED SYRINGE,92017187,CDM,250,RC,,,,,,Inpatient,1,EA,26.81,26.81,HUMANA CHOICE PLUS,MGD,26.81,,,,,,,case rate,26.81,26.81,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,AETNA,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,CIGNA,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,TRICARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,UNITED HEALTHCARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,UNITED HEALTHCARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,VA,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,VA TRICARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,WELLMED,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,HUMANA,MGD,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
LOVENOX 60MG PREFILLED SYRINGE,92017188,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,HUMANA CHOICE PLUS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,AETNA,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,CIGNA,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,TRICARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UNITED HEALTHCARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UNITED HEALTHCARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA TRICARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,WELLMED,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,HUMANA,MGD,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
LOVENOX 80MG PREFILLED SYRINGE,92017189,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,HUMANA CHOICE PLUS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAG-OX 400 TAB                ,92017408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MANNITOL 25% VL               ,92017437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MECLIZINE 12.5MG TAB          ,92017563,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG     ,92017669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL 40MG TAB            ,92017700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MERREM 1GM VL                 ,92017860,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHIMAZOLE 5MG TAB           ,92018051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 500MG TAB       ,92018059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,AETNA,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,BCBS,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,CIGNA,COM,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,TRICARE,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,UNITED HEALTHCARE,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,UNITED HEALTHCARE,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,VA,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,VA TRICARE,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,WELLMED,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,HUMANA,MGD,11.21,,,,,,,per diem,11.21,11.21,"Per diem rate, code is bundled with other services"
METHOTREXATE 2.5MG TAB        ,92018150,CDM,250,RC,,,,,,Inpatient,1,EA,11.21,11.21,HUMANA CHOICE PLUS,MGD,11.21,,,,,,,case rate,11.21,11.21,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE 5MG TAB       ,92018248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92018290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 50MG TAB           ,92018377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92018445,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,AETNA,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,CIGNA,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,TRICARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,UNITED HEALTHCARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,UNITED HEALTHCARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,VA,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,VA TRICARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,WELLMED,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,HUMANA,MGD,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
MEXILETINE 150MG CAP          ,92018494,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,HUMANA CHOICE PLUS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MILK OF MAGNESIA SUSP         ,92018699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
MIRTAZAPINE 15MG TAB          ,92018907,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92018921,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,AETNA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,CIGNA,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,VA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,VA TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,WELLMED,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,HUMANA,MGD,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
MOBIC 7.5 MG TABLET           ,92018943,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,HUMANA CHOICE PLUS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,AETNA,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,BCBS,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,CIGNA,COM,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,TRICARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,UNITED HEALTHCARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,UNITED HEALTHCARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,VA,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,VA TRICARE,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,WELLMED,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,HUMANA,MGD,41.21,,,,,,,per diem,41.21,41.21,"Per diem rate, code is bundled with other services"
"MYCOSTATIN 100,000 UNITS/GM PW",92019450,CDM,250,RC,,,,,,Inpatient,1,EA,41.21,41.21,HUMANA CHOICE PLUS,MGD,41.21,,,,,,,case rate,41.21,41.21,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYLANTA LIQUID                ,92019509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,AETNA,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,BCBS,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,CIGNA,COM,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,TRICARE,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,UNITED HEALTHCARE,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,UNITED HEALTHCARE,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,VA,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,VA TRICARE,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,WELLMED,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,HUMANA,MGD,65.95,,,,,,,per diem,65.95,65.95,"Per diem rate, code is bundled with other services"
NEO/BACIT/POLY EYE OINT       ,92020045,CDM,250,RC,,,,,,Inpatient,1,EA,65.95,65.95,HUMANA CHOICE PLUS,MGD,65.95,,,,,,,case rate,65.95,65.95,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NEOSPORIN OINT                ,92020096,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,AETNA,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,CIGNA,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,TRICARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,UNITED HEALTHCARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,UNITED HEALTHCARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,VA,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,VA TRICARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,WELLMED,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,HUMANA,MGD,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92020426,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,HUMANA CHOICE PLUS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NORVASC 5MG TAB               ,92020781,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,AETNA,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,BCBS,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,CIGNA,COM,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,TRICARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,UNITED HEALTHCARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,UNITED HEALTHCARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,VA,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,VA TRICARE,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,WELLMED,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,HUMANA,MGD,332.01,,,,,,,per diem,332.01,332.01,"Per diem rate, code is bundled with other services"
NOVOLOG 100U/ML VL            ,92020840,CDM,250,RC,,,,,,Inpatient,1,EA,332.01,332.01,HUMANA CHOICE PLUS,MGD,332.01,,,,,,,case rate,332.01,332.01,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,AETNA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,CIGNA,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,WELLMED,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA,MGD,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020883,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA CHOICE PLUS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM CREAM   ",92020884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,AETNA,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,BCBS,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,CIGNA,COM,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,TRICARE,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UNITED HEALTHCARE,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,UNITED HEALTHCARE,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,VA,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,VA TRICARE,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,WELLMED,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,HUMANA,MGD,6.18,,,,,,,per diem,6.18,6.18,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000 U/GM OINT    ",92020899,CDM,250,RC,,,,,,Inpatient,1,EA,6.18,6.18,HUMANA CHOICE PLUS,MGD,6.18,,,,,,,case rate,6.18,6.18,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,AETNA,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,BCBS,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,CIGNA,COM,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,TRICARE,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,UNITED HEALTHCARE,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,UNITED HEALTHCARE,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,VA,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,VA TRICARE,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,WELLMED,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,HUMANA,MGD,251.48,,,,,,,per diem,251.48,251.48,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020963,CDM,250,RC,,,,,,Inpatient,1,EA,251.48,251.48,HUMANA CHOICE PLUS,MGD,251.48,,,,,,,case rate,251.48,251.48,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CREAM  ,92020964,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,AETNA,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,BCBS,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,CIGNA,COM,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,TRICARE,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,UNITED HEALTHCARE,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,UNITED HEALTHCARE,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,VA,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,VA TRICARE,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,WELLMED,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,HUMANA,MGD,22.23,,,,,,,per diem,22.23,22.23,"Per diem rate, code is bundled with other services"
OMNICEF 300MG OMNI-PAC CAP    ,92021016,CDM,250,RC,,,,,,Inpatient,1,EA,22.23,22.23,HUMANA CHOICE PLUS,MGD,22.23,,,,,,,case rate,22.23,22.23,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,AETNA,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,BCBS,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,CIGNA,COM,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,TRICARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,UNITED HEALTHCARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,UNITED HEALTHCARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,VA,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,VA TRICARE,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,WELLMED,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,HUMANA,MGD,5.69,,,,,,,per diem,5.69,5.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN 5MG TAB            ,92021211,CDM,250,RC,,,,,,Inpatient,1,EA,5.69,5.69,HUMANA CHOICE PLUS,MGD,5.69,,,,,,,case rate,5.69,5.69,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,AETNA,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,BCBS,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,CIGNA,COM,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,TRICARE,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,UNITED HEALTHCARE,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,UNITED HEALTHCARE,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,VA,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,VA TRICARE,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,WELLMED,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,HUMANA,MGD,446.99,,,,,,,per diem,446.99,446.99,"Per diem rate, code is bundled with other services"
PERMETHRIN 5% CREAM           ,92021824,CDM,250,RC,,,,,,Inpatient,1,EA,446.99,446.99,HUMANA CHOICE PLUS,MGD,446.99,,,,,,,case rate,446.99,446.99,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,AETNA,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,CIGNA,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,TRICARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UNITED HEALTHCARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UNITED HEALTHCARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,VA,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,VA TRICARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,WELLMED,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,HUMANA,MGD,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92022646,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,HUMANA CHOICE PLUS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,AETNA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,CIGNA,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,WELLMED,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA,MGD,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ S  ,92022656,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA CHOICE PLUS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92022968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92023021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92023063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREPARATION H OINT            ,92023158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PREPARATION H SUPPOS          ,92023160,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 5MG TAB              ,92023270,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,AETNA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,CIGNA,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,WELLMED,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA,MGD,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92023294,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA CHOICE PLUS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCARDIA 10MG CAP            ,92023331,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,AETNA,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,BCBS,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,CIGNA,COM,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,TRICARE,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,UNITED HEALTHCARE,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,UNITED HEALTHCARE,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,VA,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,VA TRICARE,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,WELLMED,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,HUMANA,MGD,19.96,,,,,,,per diem,19.96,19.96,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE 25MG SUPP    ,92023364,CDM,250,RC,,,,,,Inpatient,1,EA,19.96,19.96,HUMANA CHOICE PLUS,MGD,19.96,,,,,,,case rate,19.96,19.96,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023431,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,AETNA,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,CIGNA,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,TRICARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,UNITED HEALTHCARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,UNITED HEALTHCARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,VA,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,VA TRICARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,WELLMED,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,HUMANA,MGD,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
PROMETHAZINE 25MG TAB         ,92023433,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,HUMANA CHOICE PLUS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPAFENONE HCL 150MG TAB     ,92023523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PROPRANOLOL 10MG TAB          ,92023685,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROZAC 10MG PULVULE           ,92023868,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,AETNA,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,BCBS,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,CIGNA,COM,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,TRICARE,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,UNITED HEALTHCARE,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,UNITED HEALTHCARE,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,VA,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,VA TRICARE,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,WELLMED,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,HUMANA,MGD,25.73,,,,,,,per diem,25.73,25.73,"Per diem rate, code is bundled with other services"
PULMICORT 0.5MG/2ML RESPULE   ,92024000,CDM,250,RC,,,,,,Inpatient,1,EA,25.73,25.73,HUMANA CHOICE PLUS,MGD,25.73,,,,,,,case rate,25.73,25.73,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,AETNA,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,BCBS,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,CIGNA,COM,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,TRICARE,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,UNITED HEALTHCARE,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,UNITED HEALTHCARE,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,VA,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,VA TRICARE,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,WELLMED,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,HUMANA,MGD,8.66,,,,,,,per diem,8.66,8.66,"Per diem rate, code is bundled with other services"
REMERON 15MG SOLTAB           ,92024338,CDM,250,RC,,,,,,Inpatient,1,EA,8.66,8.66,HUMANA CHOICE PLUS,MGD,8.66,,,,,,,case rate,8.66,8.66,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,AETNA,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,BCBS,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,CIGNA,COM,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,TRICARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,UNITED HEALTHCARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,UNITED HEALTHCARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,VA,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,VA TRICARE,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,WELLMED,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,HUMANA,MGD,27.22,,,,,,,per diem,27.22,27.22,"Per diem rate, code is bundled with other services"
RESTASIS 0.05% EYE EMULSION   ,92024382,CDM,250,RC,,,,,,Inpatient,1,EA,27.22,27.22,HUMANA CHOICE PLUS,MGD,27.22,,,,,,,case rate,27.22,27.22,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RESTORIL 15MG CAP             ,92024386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,AETNA,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,BCBS,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,CIGNA,COM,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,TRICARE,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,UNITED HEALTHCARE,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,UNITED HEALTHCARE,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,VA,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,VA TRICARE,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,WELLMED,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,HUMANA,MGD,6.14,,,,,,,per diem,6.14,6.14,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92024447,CDM,250,RC,,,,,,Inpatient,1,EA,6.14,6.14,HUMANA CHOICE PLUS,MGD,6.14,,,,,,,case rate,6.14,6.14,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBITUSSIN DM S/F COUGH  SYRUP,92024524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA PLUS TAB                ,92024801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNA SYRUP                   ,92024808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,AETNA,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,BCBS,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,CIGNA,COM,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,TRICARE,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UNITED HEALTHCARE,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,UNITED HEALTHCARE,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,VA,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,VA TRICARE,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,WELLMED,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,HUMANA,MGD,17.85,,,,,,,per diem,17.85,17.85,"Per diem rate, code is bundled with other services"
SEROQUEL 100MG TAB            ,92024912,CDM,250,RC,,,,,,Inpatient,1,EA,17.85,17.85,HUMANA CHOICE PLUS,MGD,17.85,,,,,,,case rate,17.85,17.85,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,AETNA,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,BCBS,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,CIGNA,COM,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,TRICARE,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,UNITED HEALTHCARE,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,UNITED HEALTHCARE,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,VA,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,VA TRICARE,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,WELLMED,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,HUMANA,MGD,30.33,,,,,,,per diem,30.33,30.33,"Per diem rate, code is bundled with other services"
SILVER NITRATE APPLICATOR     ,92024951,CDM,250,RC,,,,,,Inpatient,1,EA,30.33,30.33,HUMANA CHOICE PLUS,MGD,30.33,,,,,,,case rate,30.33,30.33,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,AETNA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,CIGNA,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,WELLMED,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA,MGD,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
SINGULAIR 10MG TAB            ,92025005,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA CHOICE PLUS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92025093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,AETNA,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,BCBS,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,CIGNA,COM,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,TRICARE,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,UNITED HEALTHCARE,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,UNITED HEALTHCARE,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,VA,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,VA TRICARE,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,WELLMED,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,HUMANA,MGD,14.61,,,,,,,per diem,14.61,14.61,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92025105,CDM,250,RC,,,,,,Inpatient,1,EA,14.61,14.61,HUMANA CHOICE PLUS,MGD,14.61,,,,,,,case rate,14.61,14.61,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,AETNA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,CIGNA,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,WELLMED,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA,MGD,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE DROPS  ,92025241,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA CHOICE PLUS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,AETNA,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,CIGNA,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,TRICARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,UNITED HEALTHCARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,UNITED HEALTHCARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,VA,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,VA TRICARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,WELLMED,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,HUMANA,MGD,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 5% EYE OINT   ,92025245,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,HUMANA CHOICE PLUS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SOMA 350MG TAB                ,92025310,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SOTALOL 80MG TAB              ,92025388,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92025449,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID 25MCG TAB           ,92025928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,AETNA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,CIGNA,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,VA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,VA TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,WELLMED,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,HUMANA,MGD,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
TAMOXIFEN 20MG TAB            ,92026011,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,HUMANA CHOICE PLUS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92026127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,AETNA,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,CIGNA,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,TRICARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UNITED HEALTHCARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UNITED HEALTHCARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,VA,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,VA TRICARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,WELLMED,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,HUMANA,MGD,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92026563,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,HUMANA CHOICE PLUS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,AETNA,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,BCBS,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,CIGNA,COM,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,TRICARE,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,UNITED HEALTHCARE,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,UNITED HEALTHCARE,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,VA,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,VA TRICARE,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,WELLMED,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,HUMANA,MGD,75.25,,,,,,,per diem,75.25,75.25,"Per diem rate, code is bundled with other services"
TIMOLOL 0.5% EYE DROPS        ,92026857,CDM,250,RC,,,,,,Inpatient,1,EA,75.25,75.25,HUMANA CHOICE PLUS,MGD,75.25,,,,,,,case rate,75.25,75.25,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,AETNA,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,BCBS,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,CIGNA,COM,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,TRICARE,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,UNITED HEALTHCARE,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,UNITED HEALTHCARE,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,VA,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,VA TRICARE,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,WELLMED,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,HUMANA,MGD,18.11,,,,,,,per diem,18.11,18.11,"Per diem rate, code is bundled with other services"
TOPAMAX 100MG TAB             ,92027054,CDM,250,RC,,,,,,Inpatient,1,EA,18.11,18.11,HUMANA CHOICE PLUS,MGD,18.11,,,,,,,case rate,18.11,18.11,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 25MG TAB SA         ,92027068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPROL XL 50MG TAB SA         ,92027071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,AETNA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,BCBS,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,CIGNA,COM,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,UNITED HEALTHCARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,VA,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,VA TRICARE,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,WELLMED,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,HUMANA,MGD,82.16,,,,,,,per diem,82.16,82.16,"Per diem rate, code is bundled with other services"
TORADOL IV/IM 30MG/ML TUBEX   ,92027100,CDM,250,RC,,,,,,Inpatient,1,EA,82.16,82.16,HUMANA CHOICE PLUS,MGD,82.16,,,,,,,case rate,82.16,82.16,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE 50MG TAB            ,92027245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CREAM      ,92027401,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HCTZ 37.5/25 TB   ,92027418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,AETNA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,BCBS,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,CIGNA,COM,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,UNITED HEALTHCARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,VA,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,VA TRICARE,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,WELLMED,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,HUMANA,MGD,105,,,,,,,per diem,105,105,"Per diem rate, code is bundled with other services"
TRUSOPT 2% EYE DROPS          ,92027728,CDM,250,RC,,,,,,Inpatient,1,EA,105,105,HUMANA CHOICE PLUS,MGD,105,,,,,,,case rate,105,105,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,AETNA,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,BCBS,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,CIGNA,COM,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,TRICARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,UNITED HEALTHCARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,UNITED HEALTHCARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,VA,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,VA TRICARE,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,WELLMED,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,HUMANA,MGD,15.29,,,,,,,per diem,15.29,15.29,"Per diem rate, code is bundled with other services"
URSODIOL 300MG CAP            ,92027919,CDM,250,RC,,,,,,Inpatient,1,EA,15.29,15.29,HUMANA CHOICE PLUS,MGD,15.29,,,,,,,case rate,15.29,15.29,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,AETNA,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,BCBS,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,CIGNA,COM,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,TRICARE,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,UNITED HEALTHCARE,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,UNITED HEALTHCARE,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,VA,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,VA TRICARE,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,WELLMED,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,HUMANA,MGD,24.65,,,,,,,per diem,24.65,24.65,"Per diem rate, code is bundled with other services"
VALTREX 500MG CAP             ,92027965,CDM,250,RC,,,,,,Inpatient,1,EA,24.65,24.65,HUMANA CHOICE PLUS,MGD,24.65,,,,,,,case rate,24.65,24.65,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL 40MG TAB            ,92028213,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,AETNA,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,BCBS,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,CIGNA,COM,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,TRICARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,UNITED HEALTHCARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,UNITED HEALTHCARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,VA,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,VA TRICARE,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,WELLMED,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,HUMANA,MGD,10.61,,,,,,,per diem,10.61,10.61,"Per diem rate, code is bundled with other services"
VITAMIN A & D OINT            ,92028434,CDM,250,RC,,,,,,Inpatient,1,EA,10.61,10.61,HUMANA CHOICE PLUS,MGD,10.61,,,,,,,case rate,10.61,10.61,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN B-12 1,000MCG TAB     ",92028549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400 UNIT CAP        ,92029005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER FOR INJECTION VL        ,92029252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN 100MG TABLET       ,92029257,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELLBUTRIN SR 150MG TAB SA    ,92029268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,AETNA,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,CIGNA,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,TRICARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,UNITED HEALTHCARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,UNITED HEALTHCARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,VA,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,VA TRICARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,WELLMED,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,HUMANA,MGD,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
XALATAN 0.005% DROPS          ,92029282,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,HUMANA CHOICE PLUS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,AETNA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,CIGNA,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,WELLMED,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA,MGD,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
ZINC SULFATE 220MG CAP        ,92029574,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA CHOICE PLUS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,AETNA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,BCBS,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,CIGNA,COM,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,UNITED HEALTHCARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,VA,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,VA TRICARE,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,WELLMED,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,HUMANA,MGD,19.43,,,,,,,per diem,19.43,19.43,"Per diem rate, code is bundled with other services"
ZITHROMAX IV 500MG VL         ,92029609,CDM,250,RC,,,,,,Inpatient,1,EA,19.43,19.43,HUMANA CHOICE PLUS,MGD,19.43,,,,,,,case rate,19.43,19.43,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,AETNA,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,BCBS,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,CIGNA,COM,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,TRICARE,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,UNITED HEALTHCARE,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,UNITED HEALTHCARE,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,VA,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,VA TRICARE,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,WELLMED,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,HUMANA,MGD,27.83,,,,,,,per diem,27.83,27.83,"Per diem rate, code is bundled with other services"
ZYPREXA 5MG TAB               ,92029769,CDM,250,RC,,,,,,Inpatient,1,EA,27.83,27.83,HUMANA CHOICE PLUS,MGD,27.83,,,,,,,case rate,27.83,27.83,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYRTEC 10MG TAB               ,92029782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,AETNA,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,CIGNA,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,TRICARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,UNITED HEALTHCARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,UNITED HEALTHCARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,VA,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,VA TRICARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,WELLMED,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,HUMANA,MGD,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ACTOS 15MG TAB                ,92030513,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,HUMANA CHOICE PLUS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,AETNA,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,BCBS,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,CIGNA,COM,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,TRICARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,UNITED HEALTHCARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,UNITED HEALTHCARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,VA,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,VA TRICARE,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,WELLMED,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,HUMANA,MGD,6.13,,,,,,,per diem,6.13,6.13,"Per diem rate, code is bundled with other services"
AMILORIDE HCL 5MG TAB         ,92031470,CDM,250,RC,,,,,,Inpatient,1,EA,6.13,6.13,HUMANA CHOICE PLUS,MGD,6.13,,,,,,,case rate,6.13,6.13,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 10 MG TAB       ,92031590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 875MG TAB         ,92032151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARICEPT 10MG TAB              ,92032515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,AETNA,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,BCBS,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,CIGNA,COM,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,TRICARE,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,UNITED HEALTHCARE,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,UNITED HEALTHCARE,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,VA,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,VA TRICARE,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,WELLMED,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,HUMANA,MGD,11.81,,,,,,,per diem,11.81,11.81,"Per diem rate, code is bundled with other services"
AUGMENTIN 500-125 TAB         ,92033172,CDM,250,RC,,,,,,Inpatient,1,EA,11.81,11.81,HUMANA CHOICE PLUS,MGD,11.81,,,,,,,case rate,11.81,11.81,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,AETNA,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,CIGNA,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,TRICARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,UNITED HEALTHCARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,UNITED HEALTHCARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,VA,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,VA TRICARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,WELLMED,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,HUMANA,MGD,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN OINT               ,92033373,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,HUMANA CHOICE PLUS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,AETNA,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,BCBS,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,CIGNA,COM,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,TRICARE,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UNITED HEALTHCARE,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,UNITED HEALTHCARE,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,VA TRICARE,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,WELLMED,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,HUMANA,MGD,5.43,,,,,,,per diem,5.43,5.43,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE 5MG CAP      ,92036033,CDM,250,RC,,,,,,Inpatient,1,EA,5.43,5.43,HUMANA CHOICE PLUS,MGD,5.43,,,,,,,case rate,5.43,5.43,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,AETNA,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,BCBS,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,CIGNA,COM,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,TRICARE,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,UNITED HEALTHCARE,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,UNITED HEALTHCARE,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,VA,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,VA TRICARE,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,WELLMED,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,HUMANA,MGD,6.67,,,,,,,per diem,6.67,6.67,"Per diem rate, code is bundled with other services"
DAPSONE 25MG TAB              ,92037963,CDM,250,RC,,,,,,Inpatient,1,EA,6.67,6.67,HUMANA CHOICE PLUS,MGD,6.67,,,,,,,case rate,6.67,6.67,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE 25MG TAB      ,92039451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,AETNA,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,BCBS,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,CIGNA,COM,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,TRICARE,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,UNITED HEALTHCARE,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,UNITED HEALTHCARE,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,VA,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,VA TRICARE,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,WELLMED,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,HUMANA,MGD,5.5,,,,,,,per diem,5.5,5.5,"Per diem rate, code is bundled with other services"
DOXEPIN 50MG CAP              ,92040048,CDM,250,RC,,,,,,Inpatient,1,EA,5.5,5.5,HUMANA CHOICE PLUS,MGD,5.5,,,,,,,case rate,5.5,5.5,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,AETNA,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,BCBS,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,CIGNA,COM,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,TRICARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,UNITED HEALTHCARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,UNITED HEALTHCARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,VA,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,VA TRICARE,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,WELLMED,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,HUMANA,MGD,97.13,,,,,,,per diem,97.13,97.13,"Per diem rate, code is bundled with other services"
FOSAMAX 70MG TAB              ,92042390,CDM,250,RC,,,,,,Inpatient,1,EA,97.13,97.13,HUMANA CHOICE PLUS,MGD,97.13,,,,,,,case rate,97.13,97.13,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,AETNA,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,BCBS,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,CIGNA,COM,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,TRICARE,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,UNITED HEALTHCARE,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,UNITED HEALTHCARE,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,VA,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,VA TRICARE,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,WELLMED,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,HUMANA,MGD,44.36,,,,,,,per diem,44.36,44.36,"Per diem rate, code is bundled with other services"
IMITREX 25MG TAB              ,92045689,CDM,250,RC,,,,,,Inpatient,1,EA,44.36,44.36,HUMANA CHOICE PLUS,MGD,44.36,,,,,,,case rate,44.36,44.36,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
IMURAN 50MG TAB               ,92045744,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MAXIPIME 2G VL                ,92047956,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG CAP DR        ,92051374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,AETNA,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,BCBS,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,CIGNA,COM,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,TRICARE,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,UNITED HEALTHCARE,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,UNITED HEALTHCARE,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,VA,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,VA TRICARE,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,WELLMED,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,HUMANA,MGD,7.93,,,,,,,per diem,7.93,7.93,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE 0.05% SPRAY     ,92051667,CDM,250,RC,,,,,,Inpatient,1,EA,7.93,7.93,HUMANA CHOICE PLUS,MGD,7.93,,,,,,,case rate,7.93,7.93,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PHENYTOIN SOD EXT 100MG CAP   ,92052796,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAVIX 75MG TAB               ,92053058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PRAZOSIN 1MG CAP              ,92053265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,AETNA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,CIGNA,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,WELLMED,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA,MGD,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
PROAMATINE 2.5MG TAB          ,92053860,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA CHOICE PLUS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALAGEN 5MG TAB               ,92055302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL EX-STR 500MG CAP      ,92058409,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,AETNA,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,BCBS,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,CIGNA,COM,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,TRICARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,UNITED HEALTHCARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,UNITED HEALTHCARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,VA,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,VA TRICARE,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,WELLMED,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,HUMANA,MGD,21.17,,,,,,,per diem,21.17,21.17,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1GM VL             ,92058666,CDM,250,RC,,,,,,Inpatient,1,EA,21.17,21.17,HUMANA CHOICE PLUS,MGD,21.17,,,,,,,case rate,21.17,21.17,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,AETNA,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,BCBS,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,CIGNA,COM,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,TRICARE,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,UNITED HEALTHCARE,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,UNITED HEALTHCARE,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,VA,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,VA TRICARE,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,WELLMED,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,HUMANA,MGD,8.86,,,,,,,per diem,8.86,8.86,"Per diem rate, code is bundled with other services"
VANCOMYCIN 500MG VL           ,92058667,CDM,250,RC,,,,,,Inpatient,1,EA,8.86,8.86,HUMANA CHOICE PLUS,MGD,8.86,,,,,,,case rate,8.86,8.86,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WELCHOL 625MG TAB             ,92059689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
XOPENEX 1.25MG/3ML SOL        ,92059814,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,AETNA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,CIGNA,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,WELLMED,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA,MGD,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
ZADITOR 0.025% EYE DROPS      ,92059868,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA CHOICE PLUS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,AETNA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,BCBS,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,CIGNA,COM,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,UNITED HEALTHCARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,VA,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,VA TRICARE,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,WELLMED,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,HUMANA,MGD,28.88,,,,,,,per diem,28.88,28.88,"Per diem rate, code is bundled with other services"
ZETIA 10MG TAB                ,92060017,CDM,250,RC,,,,,,Inpatient,1,EA,28.88,28.88,HUMANA CHOICE PLUS,MGD,28.88,,,,,,,case rate,28.88,28.88,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TUSSIONEX PENNKINETIC SUSP    ,92060313,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,AETNA,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,BCBS,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,CIGNA,COM,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,TRICARE,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,UNITED HEALTHCARE,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,UNITED HEALTHCARE,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,VA,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,VA TRICARE,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,WELLMED,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,HUMANA,MGD,242.04,,,,,,,per diem,242.04,242.04,"Per diem rate, code is bundled with other services"
CATHFLO ACTIVASE 2MG VL       ,92060328,CDM,250,RC,,,,,,Inpatient,1,EA,242.04,242.04,HUMANA CHOICE PLUS,MGD,242.04,,,,,,,case rate,242.04,242.04,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE POWDER     ,92060351,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
REQUIP 1MG TAB                ,92060361,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHILD ASPIRIN 81MG TAB CHEW   ,92060376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,AETNA,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,BCBS,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,CIGNA,COM,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,TRICARE,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,UNITED HEALTHCARE,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,UNITED HEALTHCARE,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,VA,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,VA TRICARE,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,WELLMED,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,HUMANA,MGD,50.66,,,,,,,per diem,50.66,50.66,"Per diem rate, code is bundled with other services"
ABILIFY 5MG TAB               ,92060389,CDM,250,RC,,,,,,Inpatient,1,EA,50.66,50.66,HUMANA CHOICE PLUS,MGD,50.66,,,,,,,case rate,50.66,50.66,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OMEGA-3 1000MG SOFTGEL        ,92061453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE DROPS       ,92061455,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,AETNA,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,CIGNA,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,TRICARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,UNITED HEALTHCARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,UNITED HEALTHCARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,VA,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,VA TRICARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,WELLMED,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,HUMANA,MGD,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
ABILIFY 10MG TAB              ,92061505,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,HUMANA CHOICE PLUS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,AETNA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,CIGNA,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,WELLMED,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA,MGD,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG TAB         ,92061561,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA CHOICE PLUS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,AETNA,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,BCBS,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,CIGNA,COM,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,TRICARE,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,UNITED HEALTHCARE,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,UNITED HEALTHCARE,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,VA,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,VA TRICARE,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,WELLMED,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,HUMANA,MGD,8.96,,,,,,,per diem,8.96,8.96,"Per diem rate, code is bundled with other services"
METOLAZONE 2.5MG TAB          ,92061578,CDM,250,RC,,,,,,Inpatient,1,EA,8.96,8.96,HUMANA CHOICE PLUS,MGD,8.96,,,,,,,case rate,8.96,8.96,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,AETNA,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,CIGNA,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,TRICARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UNITED HEALTHCARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UNITED HEALTHCARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,VA,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,VA TRICARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,WELLMED,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,HUMANA,MGD,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
RISPERDAL 0.25MG TAB          ,92062270,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,HUMANA CHOICE PLUS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL 5MG TAB           ,92062488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TUMS TAB CHEWABLE             ,92063292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORINEF ACETATE 0.1MG TAB    ,92063875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,AETNA,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,BCBS,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,CIGNA,COM,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,TRICARE,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,UNITED HEALTHCARE,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,UNITED HEALTHCARE,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,VA,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,VA TRICARE,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,WELLMED,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,HUMANA,MGD,23.59,,,,,,,per diem,23.59,23.59,"Per diem rate, code is bundled with other services"
NAMENDA 5MG TAB               ,92064019,CDM,250,RC,,,,,,Inpatient,1,EA,23.59,23.59,HUMANA CHOICE PLUS,MGD,23.59,,,,,,,case rate,23.59,23.59,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24HR PATCH      ,92064026,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,AETNA,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,CIGNA,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,TRICARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,UNITED HEALTHCARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,UNITED HEALTHCARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,VA,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,VA TRICARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,WELLMED,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,HUMANA,MGD,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
SKELAXIN 800MG TAB            ,92064101,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,HUMANA CHOICE PLUS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL 25MG TAB           ,92064476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,AETNA,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,BCBS,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,CIGNA,COM,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,TRICARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,UNITED HEALTHCARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,UNITED HEALTHCARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,VA,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,VA TRICARE,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,WELLMED,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,HUMANA,MGD,50.14,,,,,,,per diem,50.14,50.14,"Per diem rate, code is bundled with other services"
DEMECLOCYCLINE 150MG TAB      ,92065581,CDM,250,RC,,,,,,Inpatient,1,EA,50.14,50.14,HUMANA CHOICE PLUS,MGD,50.14,,,,,,,case rate,50.14,50.14,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,AETNA,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,CIGNA,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,TRICARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,UNITED HEALTHCARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,UNITED HEALTHCARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,VA,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,VA TRICARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,WELLMED,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,HUMANA,MGD,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
SENSIPAR 30MG TAB             ,92066085,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,HUMANA CHOICE PLUS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DULCOLAX 5MG TAB EC           ,92066153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENOKOT TAB                   ,92066224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,AETNA,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,BCBS,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,CIGNA,COM,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,TRICARE,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,UNITED HEALTHCARE,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,UNITED HEALTHCARE,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,VA,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,VA TRICARE,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,WELLMED,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,HUMANA,MGD,24.6,,,,,,,per diem,24.6,24.6,"Per diem rate, code is bundled with other services"
SPIRIVA 18MCG CP-HANDIHALER   ,92066233,CDM,250,RC,,,,,,Inpatient,1,EA,24.6,24.6,HUMANA CHOICE PLUS,MGD,24.6,,,,,,,case rate,24.6,24.6,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
JANTOVEN 4MG TAB              ,92066465,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,AETNA,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,BCBS,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,CIGNA,COM,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,TRICARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UNITED HEALTHCARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,UNITED HEALTHCARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,VA,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,VA TRICARE,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,WELLMED,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,HUMANA,MGD,5.85,,,,,,,per diem,5.85,5.85,"Per diem rate, code is bundled with other services"
JANTOVEN 5MG TAB              ,92066466,CDM,250,RC,,,,,,Inpatient,1,EA,5.85,5.85,HUMANA CHOICE PLUS,MGD,5.85,,,,,,,case rate,5.85,5.85,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
FLUCONAZOLE 100MG TAB         ,92066693,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,AETNA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,CIGNA,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,WELLMED,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA,MGD,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
CYMBALTA 20MG CAP             ,92066895,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA CHOICE PLUS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,AETNA,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,BCBS,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,CIGNA,COM,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,TRICARE,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,UNITED HEALTHCARE,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,UNITED HEALTHCARE,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,VA,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,VA TRICARE,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,WELLMED,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,HUMANA,MGD,164.06,,,,,,,per diem,164.06,164.06,"Per diem rate, code is bundled with other services"
OXACILLIN 10GM VL             ,92067190,CDM,250,RC,,,,,,Inpatient,1,EA,164.06,164.06,HUMANA CHOICE PLUS,MGD,164.06,,,,,,,case rate,164.06,164.06,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,AETNA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,BCBS,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,CIGNA,COM,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,UNITED HEALTHCARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,VA,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,VA TRICARE,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,WELLMED,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,HUMANA,MGD,94.5,,,,,,,per diem,94.5,94.5,"Per diem rate, code is bundled with other services"
NOREPINEPHRINE 4MG/4ML AMP    ,92067289,CDM,250,RC,,,,,,Inpatient,1,EA,94.5,94.5,HUMANA CHOICE PLUS,MGD,94.5,,,,,,,case rate,94.5,94.5,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE PRESERVISION TAB      ,92067312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE TAB                   ,92067325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 100MG CAP          ,92067352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,AETNA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,CIGNA,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,WELLMED,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA,MGD,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 20% LIQ    ,92067836,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA CHOICE PLUS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
FENTANYL 50MCG/HR PATCH       ,92067994,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,AETNA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,CIGNA,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,WELLMED,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA,MGD,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
FENTANYL 25MCG/HR PATCH       ,92067995,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA CHOICE PLUS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,AETNA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,BCBS,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,CIGNA,COM,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,UNITED HEALTHCARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,VA,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,VA TRICARE,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,WELLMED,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,HUMANA,MGD,106.94,,,,,,,per diem,106.94,106.94,"Per diem rate, code is bundled with other services"
FENTANYL 100MCG/HR PATCH      ,92068000,CDM,250,RC,,,,,,Inpatient,1,EA,106.94,106.94,HUMANA CHOICE PLUS,MGD,106.94,,,,,,,case rate,106.94,106.94,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 2MG/ML VL              ,92068031,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,AETNA,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,BCBS,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,CIGNA,COM,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,TRICARE,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,UNITED HEALTHCARE,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,UNITED HEALTHCARE,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,VA,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,VA TRICARE,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,WELLMED,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,HUMANA,MGD,14.04,,,,,,,per diem,14.04,14.04,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE 2.5MG TAB       ,92068230,CDM,250,RC,,,,,,Inpatient,1,EA,14.04,14.04,HUMANA CHOICE PLUS,MGD,14.04,,,,,,,case rate,14.04,14.04,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,AETNA,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,BCBS,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,CIGNA,COM,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,TRICARE,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,UNITED HEALTHCARE,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,UNITED HEALTHCARE,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,VA,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,VA TRICARE,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,WELLMED,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,HUMANA,MGD,38.29,,,,,,,per diem,38.29,38.29,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML VL ,92068321,CDM,250,RC,,,,,,Inpatient,1,EA,38.29,38.29,HUMANA CHOICE PLUS,MGD,38.29,,,,,,,case rate,38.29,38.29,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ATROVENT HFA INHALER          ,92068662,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL SORE THROAT LOZENGE   ,92069389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,AETNA,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,BCBS,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,CIGNA,COM,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,TRICARE,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,UNITED HEALTHCARE,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,UNITED HEALTHCARE,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,VA,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,VA TRICARE,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,WELLMED,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,HUMANA,MGD,11.5,,,,,,,per diem,11.5,11.5,"Per diem rate, code is bundled with other services"
CEFTRIAXONE 1GM VL            ,92069579,CDM,250,RC,,,,,,Inpatient,1,EA,11.5,11.5,HUMANA CHOICE PLUS,MGD,11.5,,,,,,,case rate,11.5,11.5,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 7.5/325 TAB             ,92070183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYTOMEL 5MCG TAB              ,92070633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,AETNA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,CIGNA,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,VA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,VA TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,WELLMED,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,HUMANA,MGD,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FORTICAL 200 UNITS NASAL SPRAY,92070727,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,HUMANA CHOICE PLUS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,AETNA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,CIGNA,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,WELLMED,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA,MGD,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 50MG CAP               ,92070884,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA CHOICE PLUS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,AETNA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,CIGNA,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,WELLMED,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA,MGD,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
LYRICA 75MG CAP               ,92070885,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA CHOICE PLUS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,AETNA,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,BCBS,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,CIGNA,COM,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,TRICARE,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,UNITED HEALTHCARE,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,UNITED HEALTHCARE,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,VA,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,VA TRICARE,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,WELLMED,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,HUMANA,MGD,6.98,,,,,,,per diem,6.98,6.98,"Per diem rate, code is bundled with other services"
LEVOCARNITINE 330MG TAB       ,92071207,CDM,250,RC,,,,,,Inpatient,1,EA,6.98,6.98,HUMANA CHOICE PLUS,MGD,6.98,,,,,,,case rate,6.98,6.98,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL 325MG CAP             ,92071875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,AETNA,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,CIGNA,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,TRICARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UNITED HEALTHCARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UNITED HEALTHCARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,VA,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,VA TRICARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,WELLMED,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,HUMANA,MGD,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
ZONISAMIDE 100MG CAP          ,92073819,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,HUMANA CHOICE PLUS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,AETNA,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,BCBS,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,CIGNA,COM,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,TRICARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,UNITED HEALTHCARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,UNITED HEALTHCARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,VA,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,VA TRICARE,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,WELLMED,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,HUMANA,MGD,49.88,,,,,,,per diem,49.88,49.88,"Per diem rate, code is bundled with other services"
ABILIFY 2MG TAB               ,92073838,CDM,250,RC,,,,,,Inpatient,1,EA,49.88,49.88,HUMANA CHOICE PLUS,MGD,49.88,,,,,,,case rate,49.88,49.88,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,AETNA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,BCBS,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,CIGNA,COM,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,UNITED HEALTHCARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,VA,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,VA TRICARE,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,WELLMED,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,HUMANA,MGD,51.45,,,,,,,per diem,51.45,51.45,"Per diem rate, code is bundled with other services"
ALPHAGAN P 0.1% DROPS         ,92074653,CDM,250,RC,,,,,,Inpatient,1,EA,51.45,51.45,HUMANA CHOICE PLUS,MGD,51.45,,,,,,,case rate,51.45,51.45,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE 5MG TAB       ,92074810,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
MS CONTIN 30MG TAB SA         ,92075073,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,AETNA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,CIGNA,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,WELLMED,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA,MGD,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
AMITIZA 24MCG CAP             ,92075356,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA CHOICE PLUS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORCO 10-325 TAB              ,92075874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,AETNA,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,BCBS,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,CIGNA,COM,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,TRICARE,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,UNITED HEALTHCARE,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,UNITED HEALTHCARE,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,VA,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,VA TRICARE,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,WELLMED,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,HUMANA,MGD,735,,,,,,,per diem,735,735,"Per diem rate, code is bundled with other services"
PROCAINAMIDE 100MG/ML VL      ,92075955,CDM,250,RC,,,,,,Inpatient,1,EA,735,735,HUMANA CHOICE PLUS,MGD,735,,,,,,,case rate,735,735,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,AETNA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,BCBS,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,CIGNA,COM,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,UNITED HEALTHCARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,VA,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,VA TRICARE,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,WELLMED,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,HUMANA,MGD,21.53,,,,,,,per diem,21.53,21.53,"Per diem rate, code is bundled with other services"
RANEXA 500MG TAB              ,92075994,CDM,250,RC,,,,,,Inpatient,1,EA,21.53,21.53,HUMANA CHOICE PLUS,MGD,21.53,,,,,,,case rate,21.53,21.53,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLORANEX TAB CHEWABLE         ,92076217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,AETNA,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,BCBS,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,CIGNA,COM,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,TRICARE,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,UNITED HEALTHCARE,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,UNITED HEALTHCARE,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,VA,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,VA TRICARE,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,WELLMED,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,HUMANA,MGD,9.19,,,,,,,per diem,9.19,9.19,"Per diem rate, code is bundled with other services"
MIRAPEX 0.25MG TAB            ,92077677,CDM,250,RC,,,,,,Inpatient,1,EA,9.19,9.19,HUMANA CHOICE PLUS,MGD,9.19,,,,,,,case rate,9.19,9.19,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FINASTERIDE 5MG TAB           ,92077852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,AETNA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,BCBS,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,CIGNA,COM,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,UNITED HEALTHCARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,VA TRICARE,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,WELLMED,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,HUMANA,MGD,23.1,,,,,,,per diem,23.1,23.1,"Per diem rate, code is bundled with other services"
MIRAPEX 1MG TAB               ,92077995,CDM,250,RC,,,,,,Inpatient,1,EA,23.1,23.1,HUMANA CHOICE PLUS,MGD,23.1,,,,,,,case rate,23.1,23.1,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,AETNA,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,BCBS,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,CIGNA,COM,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,TRICARE,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,UNITED HEALTHCARE,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,UNITED HEALTHCARE,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,VA,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,VA TRICARE,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,WELLMED,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,HUMANA,MGD,830.2,,,,,,,per diem,830.2,830.2,"Per diem rate, code is bundled with other services"
ARANESP 100MCG/0.5ML SYRINGE  ,92078010,CDM,250,RC,,,,,,Inpatient,1,EA,830.2,830.2,HUMANA CHOICE PLUS,MGD,830.2,,,,,,,case rate,830.2,830.2,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL 4MG/2ML VL    ,92078254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92078363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG VL         ,92078527,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORASEPTIC SORE THROAT SPRAY,92078614,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,AETNA,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,BCBS,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,CIGNA,COM,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,TRICARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,UNITED HEALTHCARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,UNITED HEALTHCARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,VA,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,VA TRICARE,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,WELLMED,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,HUMANA,MGD,24.07,,,,,,,per diem,24.07,24.07,"Per diem rate, code is bundled with other services"
ZOSYN 3/0.375GM PRE MIX-BAG   ,92078891,CDM,250,RC,,,,,,Inpatient,1,EA,24.07,24.07,HUMANA CHOICE PLUS,MGD,24.07,,,,,,,case rate,24.07,24.07,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,AETNA,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,BCBS,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,CIGNA,COM,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,TRICARE,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,UNITED HEALTHCARE,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,UNITED HEALTHCARE,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,VA,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,VA TRICARE,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,WELLMED,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,HUMANA,MGD,56.51,,,,,,,per diem,56.51,56.51,"Per diem rate, code is bundled with other services"
BROVANA 15MCG/2ML SOL         ,92078905,CDM,250,RC,,,,,,Inpatient,1,EA,56.51,56.51,HUMANA CHOICE PLUS,MGD,56.51,,,,,,,case rate,56.51,56.51,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,AETNA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,BCBS,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,CIGNA,COM,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,UNITED HEALTHCARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,VA,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,VA TRICARE,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,WELLMED,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,HUMANA,MGD,66.15,,,,,,,per diem,66.15,66.15,"Per diem rate, code is bundled with other services"
IODOSORB GEL                  ,92079381,CDM,250,RC,,,,,,Inpatient,1,EA,66.15,66.15,HUMANA CHOICE PLUS,MGD,66.15,,,,,,,case rate,66.15,66.15,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,AETNA,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,BCBS,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,CIGNA,COM,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,TRICARE,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,UNITED HEALTHCARE,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,UNITED HEALTHCARE,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,VA,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,VA TRICARE,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,WELLMED,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,HUMANA,MGD,475.18,,,,,,,per diem,475.18,475.18,"Per diem rate, code is bundled with other services"
SYMBICORT 80/4.5MCG INHALER   ,92079382,CDM,250,RC,,,,,,Inpatient,1,EA,475.18,475.18,HUMANA CHOICE PLUS,MGD,475.18,,,,,,,case rate,475.18,475.18,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OS-CAL 500+D CAP              ,92079391,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81 MG TAB EC          ,92079487,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,AETNA,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,BCBS,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,CIGNA,COM,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,TRICARE,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,UNITED HEALTHCARE,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,UNITED HEALTHCARE,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,VA,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,VA TRICARE,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,WELLMED,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,HUMANA,MGD,0.5,,,,,,,per diem,0.5,0.5,"Per diem rate, code is bundled with other services"
LANTUS SOLOSTAR U100 PEN      ,92080041,CDM,250,RC,J1815,HCPCS,,,,Inpatient,1,EA,0.5,0.5,HUMANA CHOICE PLUS,MGD,0.5,,,,,,,case rate,0.5,0.5,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,AETNA,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,CIGNA,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,TRICARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UNITED HEALTHCARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UNITED HEALTHCARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,VA,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,VA TRICARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,WELLMED,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,HUMANA,MGD,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 10MG TAB     ,92080717,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,HUMANA CHOICE PLUS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CHEW TAB         ,92081055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,AETNA,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,BCBS,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,CIGNA,COM,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,TRICARE,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UNITED HEALTHCARE,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,UNITED HEALTHCARE,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,VA TRICARE,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,WELLMED,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,HUMANA,MGD,5.91,,,,,,,per diem,5.91,5.91,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92081169,CDM,250,RC,,,,,,Inpatient,1,EA,5.91,5.91,HUMANA CHOICE PLUS,MGD,5.91,,,,,,,case rate,5.91,5.91,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THERAGRAN-M 9-0.4MG TAB       ,92082992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 1,000 UNIT TAB     ",92083147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 30MG TAB ER     ,92083212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,AETNA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,CIGNA,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,WELLMED,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA,MGD,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG/10ML SOL  ,92084085,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA CHOICE PLUS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 150MG TAB       ,92084249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,AETNA,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,BCBS,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,CIGNA,COM,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,TRICARE,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,UNITED HEALTHCARE,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,UNITED HEALTHCARE,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,VA,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,VA TRICARE,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,WELLMED,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,HUMANA,MGD,16.16,,,,,,,per diem,16.16,16.16,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL ER 5MG TAB      ,92084521,CDM,250,RC,,,,,,Inpatient,1,EA,16.16,16.16,HUMANA CHOICE PLUS,MGD,16.16,,,,,,,case rate,16.16,16.16,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPACOL DUAL RELIEF SPRAY     ,92084727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,AETNA,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,BCBS,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,CIGNA,COM,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,TRICARE,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,UNITED HEALTHCARE,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,UNITED HEALTHCARE,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,VA,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,VA TRICARE,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,WELLMED,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,HUMANA,MGD,189.53,,,,,,,per diem,189.53,189.53,"Per diem rate, code is bundled with other services"
COMBIGAN EYE DROPS            ,92084776,CDM,250,RC,,,,,,Inpatient,1,EA,189.53,189.53,HUMANA CHOICE PLUS,MGD,189.53,,,,,,,case rate,189.53,189.53,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OCUVITE LUTEIN CAP            ,92086241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,AETNA,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,BCBS,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,CIGNA,COM,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,TRICARE,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UNITED HEALTHCARE,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,UNITED HEALTHCARE,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,VA,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,VA TRICARE,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,WELLMED,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,HUMANA,MGD,9.78,,,,,,,per diem,9.78,9.78,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92088279,CDM,250,RC,,,,,,Inpatient,1,EA,9.78,9.78,HUMANA CHOICE PLUS,MGD,9.78,,,,,,,case rate,9.78,9.78,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 500,000 UNITS/5ML    ",92088861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PULMICORT 90MCG FLEXHALER     ,92089123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24 HR PATCH     ,92089699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,AETNA,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,BCBS,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,CIGNA,COM,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,TRICARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,UNITED HEALTHCARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,UNITED HEALTHCARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,VA,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,VA TRICARE,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,WELLMED,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,HUMANA,MGD,35.65,,,,,,,per diem,35.65,35.65,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92090739,CDM,250,RC,,,,,,Inpatient,1,EA,35.65,35.65,HUMANA CHOICE PLUS,MGD,35.65,,,,,,,case rate,35.65,35.65,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,AETNA,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,BCBS,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,CIGNA,COM,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,TRICARE,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,UNITED HEALTHCARE,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,UNITED HEALTHCARE,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,VA,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,VA TRICARE,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,WELLMED,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,HUMANA,MGD,16.75,,,,,,,per diem,16.75,16.75,"Per diem rate, code is bundled with other services"
AMITIZA 8MCG CAP              ,92091205,CDM,250,RC,,,,,,Inpatient,1,EA,16.75,16.75,HUMANA CHOICE PLUS,MGD,16.75,,,,,,,case rate,16.75,16.75,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,AETNA,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,BCBS,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,CIGNA,COM,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,TRICARE,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,UNITED HEALTHCARE,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,UNITED HEALTHCARE,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,VA,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,VA TRICARE,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,WELLMED,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,HUMANA,MGD,5.96,,,,,,,per diem,5.96,5.96,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92091580,CDM,250,RC,,,,,,Inpatient,1,EA,5.96,5.96,HUMANA CHOICE PLUS,MGD,5.96,,,,,,,case rate,5.96,5.96,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DRONABINOL 2.5MG CAP          ,92092853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 100MG TAB         ,92093045,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92093048,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,AETNA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,CIGNA,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,WELLMED,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA,MGD,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 40MG CAP DR        ,92093172,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA CHOICE PLUS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,AETNA,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,BCBS,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,CIGNA,COM,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,TRICARE,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,UNITED HEALTHCARE,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,UNITED HEALTHCARE,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,VA,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,VA TRICARE,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,WELLMED,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,HUMANA,MGD,43.84,,,,,,,per diem,43.84,43.84,"Per diem rate, code is bundled with other services"
ALENDRONATE DODIUM 35MG TAB   ,92093490,CDM,250,RC,,,,,,Inpatient,1,EA,43.84,43.84,HUMANA CHOICE PLUS,MGD,43.84,,,,,,,case rate,43.84,43.84,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,AETNA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,CIGNA,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,WELLMED,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA,MGD,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
BIOTENE MOISTURIZING MOUTH SPR,92093570,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA CHOICE PLUS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GALANTAMINE 4MG TAB           ,92093779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,AETNA,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,BCBS,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,CIGNA,COM,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,TRICARE,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,UNITED HEALTHCARE,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,UNITED HEALTHCARE,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,VA,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,VA TRICARE,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,WELLMED,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,HUMANA,MGD,37.51,,,,,,,per diem,37.51,37.51,"Per diem rate, code is bundled with other services"
CEFEPIME 1GM INJECTION        ,92094336,CDM,250,RC,,,,,,Inpatient,1,EA,37.51,37.51,HUMANA CHOICE PLUS,MGD,37.51,,,,,,,case rate,37.51,37.51,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,AETNA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,CIGNA,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,WELLMED,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA,MGD,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
CEFEPIME 2GM INJECTION        ,92094337,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA CHOICE PLUS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE 100 MG CAPSULE     ,92094852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
BENGAY ARTHRITIS FORMULA CREAM,92095371,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 250MG TAB       ,92095475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 500MG TAB       ,92095478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
LEVETIRACETAM 750MG TAB       ,92095484,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,AETNA,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,BCBS,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,CIGNA,COM,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,TRICARE,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,UNITED HEALTHCARE,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,UNITED HEALTHCARE,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,VA,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,VA TRICARE,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,WELLMED,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,HUMANA,MGD,3.41,,,,,,,per diem,3.41,3.41,"Per diem rate, code is bundled with other services"
TEARS RENEWED EYE OINT        ,92097719,CDM,250,RC,,,,,,Inpatient,1,EA,3.41,3.41,HUMANA CHOICE PLUS,MGD,3.41,,,,,,,case rate,3.41,3.41,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92098618,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,AETNA,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,BCBS,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,CIGNA,COM,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,TRICARE,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,UNITED HEALTHCARE,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,UNITED HEALTHCARE,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,VA,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,VA TRICARE,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,WELLMED,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,HUMANA,MGD,14.66,,,,,,,per diem,14.66,14.66,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92099397,CDM,250,RC,,,,,,Inpatient,1,EA,14.66,14.66,HUMANA CHOICE PLUS,MGD,14.66,,,,,,,case rate,14.66,14.66,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 250MG CAP       ,92099926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE 15 GEL                ,92100128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92100292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE 0.125MG ODT       ,92100685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,AETNA,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,BCBS,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,CIGNA,COM,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,TRICARE,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,UNITED HEALTHCARE,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,UNITED HEALTHCARE,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,VA,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,VA TRICARE,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,WELLMED,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,HUMANA,MGD,23.57,,,,,,,per diem,23.57,23.57,"Per diem rate, code is bundled with other services"
MULTAQ 400MG TAB              ,92100925,CDM,250,RC,,,,,,Inpatient,1,EA,23.57,23.57,HUMANA CHOICE PLUS,MGD,23.57,,,,,,,case rate,23.57,23.57,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
POTASSIUM GLUC 595MG TAB      ,92101033,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VIMPAT 50MG TAB               ,92101324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,AETNA,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,BCBS,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,CIGNA,COM,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,TRICARE,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,UNITED HEALTHCARE,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,UNITED HEALTHCARE,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,VA,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,VA TRICARE,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,WELLMED,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,HUMANA,MGD,211.74,,,,,,,per diem,211.74,211.74,"Per diem rate, code is bundled with other services"
CLONIDINE 0.2MG/DAY PATCH     ,92101471,CDM,250,RC,,,,,,Inpatient,1,EA,211.74,211.74,HUMANA CHOICE PLUS,MGD,211.74,,,,,,,case rate,211.74,211.74,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,AETNA,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,BCBS,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,CIGNA,COM,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,TRICARE,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,UNITED HEALTHCARE,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,UNITED HEALTHCARE,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,VA,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,VA TRICARE,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,WELLMED,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,HUMANA,MGD,215.24,,,,,,,per diem,215.24,215.24,"Per diem rate, code is bundled with other services"
MILRINONE-D5W 20MG/100ML      ,92102981,CDM,250,RC,,,,,,Inpatient,1,EA,215.24,215.24,HUMANA CHOICE PLUS,MGD,215.24,,,,,,,case rate,215.24,215.24,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANCRELIPASE 5,000 DR CAP     ",92103577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"HEPARIN SOD 1,000 U/ML VL     ",92103878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,AETNA,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,BCBS,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,CIGNA,COM,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,TRICARE,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,UNITED HEALTHCARE,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,UNITED HEALTHCARE,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,VA,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,VA TRICARE,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,WELLMED,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,HUMANA,MGD,70.8,,,,,,,per diem,70.8,70.8,"Per diem rate, code is bundled with other services"
AZTREONAM 1GM VL              ,92104668,CDM,250,RC,,,,,,Inpatient,1,EA,70.8,70.8,HUMANA CHOICE PLUS,MGD,70.8,,,,,,,case rate,70.8,70.8,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN D3 5,000 UNIT CAP     ",92104708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,AETNA,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,BCBS,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,CIGNA,COM,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,TRICARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,UNITED HEALTHCARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,UNITED HEALTHCARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,VA,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,VA TRICARE,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,WELLMED,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,HUMANA,MGD,27.3,,,,,,,per diem,27.3,27.3,"Per diem rate, code is bundled with other services"
OXYCONTIN 10MG TAB            ,92104754,CDM,250,RC,,,,,,Inpatient,1,EA,27.3,27.3,HUMANA CHOICE PLUS,MGD,27.3,,,,,,,case rate,27.3,27.3,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,AETNA,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,BCBS,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,CIGNA,COM,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,TRICARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,UNITED HEALTHCARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,UNITED HEALTHCARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,VA,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,VA TRICARE,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,WELLMED,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,HUMANA,MGD,50.93,,,,,,,per diem,50.93,50.93,"Per diem rate, code is bundled with other services"
OXYCONTIN 20MG TAB            ,92104755,CDM,250,RC,,,,,,Inpatient,1,EA,50.93,50.93,HUMANA CHOICE PLUS,MGD,50.93,,,,,,,case rate,50.93,50.93,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,AETNA,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,BCBS,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,CIGNA,COM,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,TRICARE,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UNITED HEALTHCARE,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,UNITED HEALTHCARE,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,VA TRICARE,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,WELLMED,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,HUMANA,MGD,5.31,,,,,,,per diem,5.31,5.31,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.125MG           ,92104757,CDM,250,RC,,,,,,Inpatient,1,EA,5.31,5.31,HUMANA CHOICE PLUS,MGD,5.31,,,,,,,case rate,5.31,5.31,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
TACROLIMUS 0.5MG CAP          ,92104781,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,AETNA,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,BCBS,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,CIGNA,COM,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,TRICARE,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,UNITED HEALTHCARE,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,UNITED HEALTHCARE,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,VA,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,VA TRICARE,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,WELLMED,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,HUMANA,MGD,5.57,,,,,,,per diem,5.57,5.57,"Per diem rate, code is bundled with other services"
EUCERIN CREAM                 ,92104811,CDM,250,RC,,,,,,Inpatient,1,EA,5.57,5.57,HUMANA CHOICE PLUS,MGD,5.57,,,,,,,case rate,5.57,5.57,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,AETNA,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,BCBS,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,CIGNA,COM,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,TRICARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UNITED HEALTHCARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,UNITED HEALTHCARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,VA,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,VA TRICARE,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,WELLMED,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,HUMANA,MGD,11.04,,,,,,,per diem,11.04,11.04,"Per diem rate, code is bundled with other services"
RIVASTIGMINE 1.5MG CAP        ,92104819,CDM,250,RC,,,,,,Inpatient,1,EA,11.04,11.04,HUMANA CHOICE PLUS,MGD,11.04,,,,,,,case rate,11.04,11.04,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,AETNA,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,BCBS,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,CIGNA,COM,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,TRICARE,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,UNITED HEALTHCARE,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,UNITED HEALTHCARE,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,VA,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,VA TRICARE,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,WELLMED,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,HUMANA,MGD,83.49,,,,,,,per diem,83.49,83.49,"Per diem rate, code is bundled with other services"
CLONIDINE 0.1MG/DAY PATCH     ,92104833,CDM,250,RC,,,,,,Inpatient,1,EA,83.49,83.49,HUMANA CHOICE PLUS,MGD,83.49,,,,,,,case rate,83.49,83.49,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,AETNA,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,BCBS,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,CIGNA,COM,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,TRICARE,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,UNITED HEALTHCARE,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,UNITED HEALTHCARE,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,VA,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,VA TRICARE,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,WELLMED,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,HUMANA,MGD,30.15,,,,,,,per diem,30.15,30.15,"Per diem rate, code is bundled with other services"
PRADAXA 75MG CAP              ,92104856,CDM,250,RC,,,,,,Inpatient,1,EA,30.15,30.15,HUMANA CHOICE PLUS,MGD,30.15,,,,,,,case rate,30.15,30.15,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,AETNA,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,BCBS,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,CIGNA,COM,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,TRICARE,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,UNITED HEALTHCARE,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,UNITED HEALTHCARE,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,VA,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,VA TRICARE,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,WELLMED,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,HUMANA,MGD,50.73,,,,,,,per diem,50.73,50.73,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% EYE DROPS  ,92105097,CDM,250,RC,,,,,,Inpatient,1,EA,50.73,50.73,HUMANA CHOICE PLUS,MGD,50.73,,,,,,,case rate,50.73,50.73,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,AETNA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,CIGNA,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,VA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,VA TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,WELLMED,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,HUMANA,MGD,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG CR 10MG CAP             ,92105203,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,HUMANA CHOICE PLUS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,AETNA,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,BCBS,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,CIGNA,COM,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,TRICARE,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,UNITED HEALTHCARE,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,UNITED HEALTHCARE,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,VA,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,VA TRICARE,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,WELLMED,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,HUMANA,MGD,13.91,,,,,,,per diem,13.91,13.91,"Per diem rate, code is bundled with other services"
TACROLIMUS 1 MG CAPSULE       ,92105477,CDM,250,RC,,,,,,Inpatient,1,EA,13.91,13.91,HUMANA CHOICE PLUS,MGD,13.91,,,,,,,case rate,13.91,13.91,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,AETNA,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,BCBS,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,CIGNA,COM,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,TRICARE,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,UNITED HEALTHCARE,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,UNITED HEALTHCARE,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,VA,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,VA TRICARE,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,WELLMED,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,HUMANA,MGD,51.75,,,,,,,per diem,51.75,51.75,"Per diem rate, code is bundled with other services"
VORICONAZOLE 200MG TAB        ,92105491,CDM,250,RC,,,,,,Inpatient,1,EA,51.75,51.75,HUMANA CHOICE PLUS,MGD,51.75,,,,,,,case rate,51.75,51.75,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 300 MG CAPSULE     ,92105511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
METHENAMIN HIPP 1GM TAB       ,92105559,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92106761,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,AETNA,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,BCBS,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,CIGNA,COM,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,TRICARE,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,UNITED HEALTHCARE,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,UNITED HEALTHCARE,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,VA,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,VA TRICARE,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,WELLMED,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,HUMANA,MGD,9.98,,,,,,,per diem,9.98,9.98,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600 MG TAB        ,92106909,CDM,250,RC,,,,,,Inpatient,1,EA,9.98,9.98,HUMANA CHOICE PLUS,MGD,9.98,,,,,,,case rate,9.98,9.98,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCHLOROTHIAZIDE 25 MG TAB ,92106948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,AETNA,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,BCBS,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,CIGNA,COM,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,TRICARE,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,UNITED HEALTHCARE,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,UNITED HEALTHCARE,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,VA,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,VA TRICARE,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,WELLMED,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,HUMANA,MGD,50.46,,,,,,,per diem,50.46,50.46,"Per diem rate, code is bundled with other services"
XARELTO 10MG TAB              ,92106952,CDM,250,RC,,,,,,Inpatient,1,EA,50.46,50.46,HUMANA CHOICE PLUS,MGD,50.46,,,,,,,case rate,50.46,50.46,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
OLANZAPINE 2.5MG TAB          ,92107085,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,AETNA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,CIGNA,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,WELLMED,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA,MGD,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
TRADJENTA 5MG TAB             ,92107160,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA CHOICE PLUS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,AETNA,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,BCBS,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,CIGNA,COM,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,TRICARE,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,UNITED HEALTHCARE,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,UNITED HEALTHCARE,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,VA,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,VA TRICARE,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,WELLMED,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,HUMANA,MGD,301.18,,,,,,,per diem,301.18,301.18,"Per diem rate, code is bundled with other services"
BUTRANS 10MCG/HR PATCH        ,92107193,CDM,250,RC,,,,,,Inpatient,1,EA,301.18,301.18,HUMANA CHOICE PLUS,MGD,301.18,,,,,,,case rate,301.18,301.18,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,AETNA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,CIGNA,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,WELLMED,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA,MGD,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
BRILINTA 90MG TAB             ,92107196,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA CHOICE PLUS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL 5MG TAB            ,92107234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,AETNA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,BCBS,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,CIGNA,COM,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,UNITED HEALTHCARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,VA,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,VA TRICARE,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,WELLMED,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,HUMANA,MGD,39.38,,,,,,,per diem,39.38,39.38,"Per diem rate, code is bundled with other services"
XARELTO 15MG TAB              ,92107570,CDM,250,RC,,,,,,Inpatient,1,EA,39.38,39.38,HUMANA CHOICE PLUS,MGD,39.38,,,,,,,case rate,39.38,39.38,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,AETNA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,CIGNA,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,VA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,VA TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,WELLMED,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,HUMANA,MGD,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM VIAL            ,92107716,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,HUMANA CHOICE PLUS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOPIDOGREL 75MG TAB          ,92107794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1000MG INJ         ,92107963,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
ELIQUIS 2.5MG TAB             ,92108352,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,AETNA,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,BCBS,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,CIGNA,COM,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,TRICARE,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,UNITED HEALTHCARE,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,UNITED HEALTHCARE,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,VA,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,VA TRICARE,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,WELLMED,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,HUMANA,MGD,5.6,,,,,,,per diem,5.6,5.6,"Per diem rate, code is bundled with other services"
CALCIUM ACE 667MG CAP         ,92108611,CDM,250,RC,,,,,,Inpatient,1,EA,5.6,5.6,HUMANA CHOICE PLUS,MGD,5.6,,,,,,,case rate,5.6,5.6,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROPINIROLE 1MG TAB            ,92108731,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,AETNA,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,CIGNA,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,TRICARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UNITED HEALTHCARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UNITED HEALTHCARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA TRICARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,WELLMED,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,HUMANA,MGD,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
ROPINIROLE 0.25MG TAB         ,92108938,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,HUMANA CHOICE PLUS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON-FORMULARY                 ,92110002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,AETNA,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,BCBS,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,CIGNA,COM,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,TRICARE,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,UNITED HEALTHCARE,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,UNITED HEALTHCARE,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,VA,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,VA TRICARE,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,WELLMED,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,HUMANA,MGD,234.15,,,,,,,per diem,234.15,234.15,"Per diem rate, code is bundled with other services"
HEPAT B VAC 5MCG ADOL IM      ,92120049,CDM,636,RC,90743,HCPCS,,,,Inpatient,1,EA,234.15,234.15,HUMANA CHOICE PLUS,MGD,234.15,,,,,,,case rate,234.15,234.15,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,AETNA,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,BCBS,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,CIGNA,COM,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,TRICARE,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,UNITED HEALTHCARE,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,UNITED HEALTHCARE,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,VA,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,VA TRICARE,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,WELLMED,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,HUMANA,MGD,20.54,,,,,,,per diem,20.54,20.54,"Per diem rate, code is bundled with other services"
ACETYLCYSTNE 6GM/30ML INJ     ,92120098,CDM,636,RC,J0132,HCPCS,,,,Inpatient,1,EA,20.54,20.54,HUMANA CHOICE PLUS,MGD,20.54,,,,,,,case rate,20.54,20.54,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPINEPH PF 1MG/10ML INJ       ,92120111,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,AETNA,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,BCBS,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,CIGNA,COM,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,TRICARE,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,UNITED HEALTHCARE,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,UNITED HEALTHCARE,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,VA,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,VA TRICARE,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,WELLMED,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,HUMANA,MGD,228.38,,,,,,,per diem,228.38,228.38,"Per diem rate, code is bundled with other services"
EPINEPHRINE 0.3MG/3ML INJ     ,92120119,CDM,636,RC,J0171,HCPCS,,,,Inpatient,1,EA,228.38,228.38,HUMANA CHOICE PLUS,MGD,228.38,,,,,,,case rate,228.38,228.38,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,AETNA,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,BCBS,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,CIGNA,COM,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,TRICARE,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,UNITED HEALTHCARE,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,UNITED HEALTHCARE,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,VA,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,VA TRICARE,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,WELLMED,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,HUMANA,MGD,38.44,,,,,,,per diem,38.44,38.44,"Per diem rate, code is bundled with other services"
AMPICILLIN 1GM INJ            ,92120158,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,38.44,38.44,HUMANA CHOICE PLUS,MGD,38.44,,,,,,,case rate,38.44,38.44,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,AETNA,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,BCBS,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,CIGNA,COM,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,TRICARE,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,UNITED HEALTHCARE,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,UNITED HEALTHCARE,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,VA,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,VA TRICARE,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,WELLMED,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,HUMANA,MGD,29.02,,,,,,,per diem,29.02,29.02,"Per diem rate, code is bundled with other services"
AMPICILLIN 2GM INJ            ,92120159,CDM,636,RC,J0290,HCPCS,,,,Inpatient,1,EA,29.02,29.02,HUMANA CHOICE PLUS,MGD,29.02,,,,,,,case rate,29.02,29.02,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,AETNA,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,BCBS,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,CIGNA,COM,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,TRICARE,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,UNITED HEALTHCARE,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,UNITED HEALTHCARE,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,VA,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,VA TRICARE,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,WELLMED,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,HUMANA,MGD,677.25,,,,,,,per diem,677.25,677.25,"Per diem rate, code is bundled with other services"
BACLOFEN 50MCG/1ML INTH       ,92120204,CDM,636,RC,J0476,HCPCS,,,,Inpatient,1,EA,677.25,677.25,HUMANA CHOICE PLUS,MGD,677.25,,,,,,,case rate,677.25,677.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,AETNA,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,BCBS,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,CIGNA,COM,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,TRICARE,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,UNITED HEALTHCARE,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,UNITED HEALTHCARE,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,VA,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,VA TRICARE,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,WELLMED,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,HUMANA,MGD,43.55,,,,,,,per diem,43.55,43.55,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM/50ML PB         ,92120256,CDM,636,RC,J0690,HCPCS,,,,Inpatient,1,EA,43.55,43.55,HUMANA CHOICE PLUS,MGD,43.55,,,,,,,case rate,43.55,43.55,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,AETNA,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,BCBS,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,CIGNA,COM,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,TRICARE,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,UNITED HEALTHCARE,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,UNITED HEALTHCARE,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,VA,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,VA TRICARE,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,WELLMED,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,HUMANA,MGD,10.66,,,,,,,per diem,10.66,10.66,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM 50ML PB       ,92120321,CDM,636,RC,J0713,HCPCS,,,,Inpatient,1,EA,10.66,10.66,HUMANA CHOICE PLUS,MGD,10.66,,,,,,,case rate,10.66,10.66,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,AETNA,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,BCBS,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,CIGNA,COM,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,TRICARE,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,UNITED HEALTHCARE,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,UNITED HEALTHCARE,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,VA,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,VA TRICARE,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,WELLMED,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,HUMANA,MGD,387.19,,,,,,,per diem,387.19,387.19,"Per diem rate, code is bundled with other services"
COLLAGENASEXIAFLEX0.9MG       ,92120350,CDM,636,RC,J0775,HCPCS,,,,Inpatient,1,EA,387.19,387.19,HUMANA CHOICE PLUS,MGD,387.19,,,,,,,case rate,387.19,387.19,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH P 4MG/1ML PEDIV      ,92120408,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXAMETH /1MG 120MG MDV       ,92120409,CDM,636,RC,J1100,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,AETNA,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,BCBS,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,CIGNA,COM,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,TRICARE,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,UNITED HEALTHCARE,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,UNITED HEALTHCARE,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,VA,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,VA TRICARE,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,WELLMED,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,HUMANA,MGD,658.05,,,,,,,per diem,658.05,658.05,"Per diem rate, code is bundled with other services"
FILGRASTIM 300MCG/1ML INJ     ,92120524,CDM,636,RC,J1442,HCPCS,,,,Inpatient,1,EA,658.05,658.05,HUMANA CHOICE PLUS,MGD,658.05,,,,,,,case rate,658.05,658.05,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,AETNA,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,BCBS,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,CIGNA,COM,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,TRICARE,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,UNITED HEALTHCARE,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,UNITED HEALTHCARE,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,VA,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,VA TRICARE,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,WELLMED,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,HUMANA,MGD,11.98,,,,,,,per diem,11.98,11.98,"Per diem rate, code is bundled with other services"
GENTAMICIN 80MG INJ           ,92120585,CDM,636,RC,J1580,HCPCS,,,,Inpatient,1,EA,11.98,11.98,HUMANA CHOICE PLUS,MGD,11.98,,,,,,,case rate,11.98,11.98,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,AETNA,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,BCBS,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,CIGNA,COM,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,TRICARE,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,UNITED HEALTHCARE,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,UNITED HEALTHCARE,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,VA,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,VA TRICARE,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,WELLMED,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,HUMANA,MGD,572.23,,,,,,,per diem,572.23,572.23,"Per diem rate, code is bundled with other services"
GLUCAGON 1MG1U 1ML INJ        ,92120604,CDM,636,RC,J1610,HCPCS,,,,Inpatient,1,EA,572.23,572.23,HUMANA CHOICE PLUS,MGD,572.23,,,,,,,case rate,572.23,572.23,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,AETNA,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,BCBS,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,CIGNA,COM,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,TRICARE,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,UNITED HEALTHCARE,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,UNITED HEALTHCARE,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,VA,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,VA TRICARE,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,WELLMED,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,HUMANA,MGD,31.89,,,,,,,per diem,31.89,31.89,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG/ML 1ML IN     ,92120609,CDM,636,RC,J1630,HCPCS,,,,Inpatient,1,EA,31.89,31.89,HUMANA CHOICE PLUS,MGD,31.89,,,,,,,case rate,31.89,31.89,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,AETNA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,BCBS,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,CIGNA,COM,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,UNITED HEALTHCARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,VA,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,VA TRICARE,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,WELLMED,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,HUMANA,MGD,63,,,,,,,per diem,63,63,"Per diem rate, code is bundled with other services"
HYDROCORT NA 100MG/2MLINJ     ,92120675,CDM,636,RC,J1720,HCPCS,,,,Inpatient,1,EA,63,63,HUMANA CHOICE PLUS,MGD,63,,,,,,,case rate,63,63,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,AETNA,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,BCBS,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,CIGNA,COM,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,TRICARE,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,UNITED HEALTHCARE,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,UNITED HEALTHCARE,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,VA,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,VA TRICARE,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,WELLMED,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,HUMANA,MGD,44.16,,,,,,,per diem,44.16,44.16,"Per diem rate, code is bundled with other services"
IRON SUCROSE 100MG/5MLSDV     ,92120688,CDM,250,RC,J1756,HCPCS,,,,Inpatient,1,EA,44.16,44.16,HUMANA CHOICE PLUS,MGD,44.16,,,,,,,case rate,44.16,44.16,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,AETNA,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,BCBS,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,CIGNA,COM,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,TRICARE,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,UNITED HEALTHCARE,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,UNITED HEALTHCARE,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,VA,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,VA TRICARE,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,WELLMED,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,HUMANA,MGD,8.75,,,,,,,per diem,8.75,8.75,"Per diem rate, code is bundled with other services"
FUROSEMIDE 100MG/10ML INJ     ,92120741,CDM,636,RC,J1940,HCPCS,,,,Inpatient,1,EA,8.75,8.75,HUMANA CHOICE PLUS,MGD,8.75,,,,,,,case rate,8.75,8.75,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,AETNA,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,BCBS,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,CIGNA,COM,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,TRICARE,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,UNITED HEALTHCARE,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,UNITED HEALTHCARE,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,VA,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,VA TRICARE,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,WELLMED,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,HUMANA,MGD,22.32,,,,,,,per diem,22.32,22.32,"Per diem rate, code is bundled with other services"
LEVETIRACET 500MG/100MLPB     ,92120752,CDM,636,RC,J1953,HCPCS,,,,Inpatient,1,EA,22.32,22.32,HUMANA CHOICE PLUS,MGD,22.32,,,,,,,case rate,22.32,22.32,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
LIDO 0.4PCT 1GM/250ML PB      ,92120766,CDM,636,RC,J2001,HCPCS,,,,Inpatient,1,EA,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,AETNA,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,BCBS,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,CIGNA,COM,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,TRICARE,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,UNITED HEALTHCARE,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,UNITED HEALTHCARE,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,VA,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,VA TRICARE,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,WELLMED,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,HUMANA,MGD,7.3,,,,,,,per diem,7.3,7.3,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/1ML INJ         ,92120774,CDM,636,RC,J2060,HCPCS,,,,Inpatient,1,EA,7.3,7.3,HUMANA CHOICE PLUS,MGD,7.3,,,,,,,case rate,7.3,7.3,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,AETNA,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,BCBS,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,CIGNA,COM,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,TRICARE,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,UNITED HEALTHCARE,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,UNITED HEALTHCARE,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,VA,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,VA TRICARE,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,WELLMED,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,HUMANA,MGD,13.22,,,,,,,per diem,13.22,13.22,"Per diem rate, code is bundled with other services"
MICAFUNGIN 100MG INJ          ,92120805,CDM,636,RC,J2248,HCPCS,,,,Inpatient,1,EA,13.22,13.22,HUMANA CHOICE PLUS,MGD,13.22,,,,,,,case rate,13.22,13.22,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,AETNA,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,BCBS,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,CIGNA,COM,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,TRICARE,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,UNITED HEALTHCARE,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,UNITED HEALTHCARE,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,VA,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,VA TRICARE,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,WELLMED,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,HUMANA,MGD,44.81,,,,,,,per diem,44.81,44.81,"Per diem rate, code is bundled with other services"
NALOXONE 0.4MG/ML 10ML IN     ,92120874,CDM,636,RC,J2310,HCPCS,,,,Inpatient,1,EA,44.81,44.81,HUMANA CHOICE PLUS,MGD,44.81,,,,,,,case rate,44.81,44.81,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,AETNA,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,BCBS,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,CIGNA,COM,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,TRICARE,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,UNITED HEALTHCARE,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,UNITED HEALTHCARE,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,VA,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,VA TRICARE,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,WELLMED,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,HUMANA,MGD,31.17,,,,,,,per diem,31.17,31.17,"Per diem rate, code is bundled with other services"
PARICALCITOL 2MCG/ML 1ML      ,92120929,CDM,636,RC,J2501,HCPCS,,,,Inpatient,1,EA,31.17,31.17,HUMANA CHOICE PLUS,MGD,31.17,,,,,,,case rate,31.17,31.17,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,AETNA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,CIGNA,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,VA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,VA TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,WELLMED,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,HUMANA,MGD,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
PIPERA/TAZO 2.25GM/50MLPB     ,92120954,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,8.13,8.13,HUMANA CHOICE PLUS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,AETNA,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,BCBS,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,CIGNA,COM,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,TRICARE,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,UNITED HEALTHCARE,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,UNITED HEALTHCARE,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,VA,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,VA TRICARE,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,WELLMED,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,HUMANA,MGD,14.47,,,,,,,per diem,14.47,14.47,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 4.5GM/1DL PB     ,92120956,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,14.47,14.47,HUMANA CHOICE PLUS,MGD,14.47,,,,,,,case rate,14.47,14.47,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,AETNA,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,BCBS,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,CIGNA,COM,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,TRICARE,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,UNITED HEALTHCARE,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,UNITED HEALTHCARE,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,VA,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,VA TRICARE,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,WELLMED,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,HUMANA,MGD,58.01,,,,,,,per diem,58.01,58.01,"Per diem rate, code is bundled with other services"
PIPERAC/TAZO 3.375GM SYR      ,92120965,CDM,636,RC,J2543,HCPCS,,,,Inpatient,1,EA,58.01,58.01,HUMANA CHOICE PLUS,MGD,58.01,,,,,,,case rate,58.01,58.01,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML 10M     ,92121016,CDM,636,RC,J2765,HCPCS,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,AETNA,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,BCBS,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,CIGNA,COM,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,TRICARE,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,UNITED HEALTHCARE,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,UNITED HEALTHCARE,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,VA,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,VA TRICARE,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,WELLMED,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,HUMANA,MGD,65.05,,,,,,,per diem,65.05,65.05,"Per diem rate, code is bundled with other services"
VANCOMYCIN 750MG INJ          ,92121160,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,65.05,65.05,HUMANA CHOICE PLUS,MGD,65.05,,,,,,,case rate,65.05,65.05,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCO 1GM/NS 200ML PMX        ,92121170,CDM,636,RC,J3370,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,AETNA,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,BCBS,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,CIGNA,COM,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,TRICARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,UNITED HEALTHCARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,UNITED HEALTHCARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,VA,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,VA TRICARE,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,WELLMED,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,HUMANA,MGD,25.99,,,,,,,per diem,25.99,25.99,"Per diem rate, code is bundled with other services"
VIT B12 1000MCG/ML 1ML IN     ,92121179,CDM,636,RC,J3420,HCPCS,,,,Inpatient,1,EA,25.99,25.99,HUMANA CHOICE PLUS,MGD,25.99,,,,,,,case rate,25.99,25.99,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,AETNA,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,BCBS,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,CIGNA,COM,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,TRICARE,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,UNITED HEALTHCARE,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,UNITED HEALTHCARE,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,VA,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,VA TRICARE,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,WELLMED,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,HUMANA,MGD,143.47,,,,,,,per diem,143.47,143.47,"Per diem rate, code is bundled with other services"
HYALURONIDASE 150U/ML INJ     ,92121187,CDM,636,RC,J3470,HCPCS,,,,Inpatient,1,EA,143.47,143.47,HUMANA CHOICE PLUS,MGD,143.47,,,,,,,case rate,143.47,143.47,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,AETNA,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,BCBS,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,CIGNA,COM,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,TRICARE,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,UNITED HEALTHCARE,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,UNITED HEALTHCARE,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,VA,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,VA TRICARE,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,WELLMED,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,HUMANA,MGD,5.88,,,,,,,per diem,5.88,5.88,"Per diem rate, code is bundled with other services"
MAGNESIUM SUL 1GM/2ML INJ     ,92121191,CDM,636,RC,J3475,HCPCS,,,,Inpatient,1,EA,5.88,5.88,HUMANA CHOICE PLUS,MGD,5.88,,,,,,,case rate,5.88,5.88,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG INJ          ,92121251,CDM,636,RC,J3486,HCPCS,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,AETNA,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,BCBS,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,CIGNA,COM,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,TRICARE,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,UNITED HEALTHCARE,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,UNITED HEALTHCARE,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,VA,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,VA TRICARE,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,WELLMED,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,HUMANA,MGD,17.66,,,,,,,per diem,17.66,17.66,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 900MG/6ML INJ     ,92121318,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.66,17.66,HUMANA CHOICE PLUS,MGD,17.66,,,,,,,case rate,17.66,17.66,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUMAZENIL 0.05MG/1MLPDIV     ,92121340,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,AETNA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,CIGNA,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,VA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,VA TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,WELLMED,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,HUMANA,MGD,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.5PCT 270ML       ,92121376,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,17.33,17.33,HUMANA CHOICE PLUS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,AETNA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,CIGNA,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,VA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,VA TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,WELLMED,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,HUMANA,MGD,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
BUPIVACAIN 0.25PCT 270ML      ,92121380,CDM,636,RC,J3490,HCPCS,,,,Inpatient,1,EA,10.5,10.5,HUMANA CHOICE PLUS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
D5PCT RINGERS 500ML INJ       ,92121482,CDM,636,RC,J7121,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISOLONE 5MG TAB          ,92121532,CDM,636,RC,J7510,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,AETNA,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,CIGNA,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,TRICARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UNITED HEALTHCARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UNITED HEALTHCARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA TRICARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,WELLMED,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,HUMANA,MGD,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
AMIODARONE 200MG TAB          ,92125004,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,HUMANA CHOICE PLUS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92125006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG CAP         ,92125019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 0.088MG TAB     ,92125064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
HYDROXYZINE 25MG TAB          ,92125074,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92125112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92125180,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ONDANSETRON 4MG ODT           ,92125187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PRED NA PHOS 1PCT 10ML OPS    ,92125190,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,AETNA,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,BCBS,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,CIGNA,COM,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,TRICARE,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,UNITED HEALTHCARE,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,UNITED HEALTHCARE,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,VA,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,VA TRICARE,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,WELLMED,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,HUMANA,MGD,68.36,,,,,,,per diem,68.36,68.36,"Per diem rate, code is bundled with other services"
RIVAROXABAN 20MG TAB          ,92125207,CDM,250,RC,,,,,,Inpatient,1,EA,68.36,68.36,HUMANA CHOICE PLUS,MGD,68.36,,,,,,,case rate,68.36,68.36,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,AETNA,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,BCBS,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,CIGNA,COM,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,TRICARE,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,UNITED HEALTHCARE,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,UNITED HEALTHCARE,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,VA,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,VA TRICARE,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,WELLMED,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,HUMANA,MGD,35.48,,,,,,,per diem,35.48,35.48,"Per diem rate, code is bundled with other services"
APIXABAN 2.5MG TAB            ,92125226,CDM,250,RC,,,,,,Inpatient,1,EA,35.48,35.48,HUMANA CHOICE PLUS,MGD,35.48,,,,,,,case rate,35.48,35.48,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,AETNA,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,BCBS,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,CIGNA,COM,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,TRICARE,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,UNITED HEALTHCARE,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,UNITED HEALTHCARE,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,VA,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,VA TRICARE,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,WELLMED,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,HUMANA,MGD,49.35,,,,,,,per diem,49.35,49.35,"Per diem rate, code is bundled with other services"
VANCOMYC 125MG/2.5ML SUS      ,92125256,CDM,250,RC,,,,,,Inpatient,1,EA,49.35,49.35,HUMANA CHOICE PLUS,MGD,49.35,,,,,,,case rate,49.35,49.35,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE 10 MG TAB         ,92125279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,AETNA,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,BCBS,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,CIGNA,COM,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,TRICARE,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,UNITED HEALTHCARE,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,UNITED HEALTHCARE,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,VA,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,VA TRICARE,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,WELLMED,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,HUMANA,MGD,22.89,,,,,,,per diem,22.89,22.89,"Per diem rate, code is bundled with other services"
PREGABALIN 75 MG CAP          ,92125300,CDM,250,RC,,,,,,Inpatient,1,EA,22.89,22.89,HUMANA CHOICE PLUS,MGD,22.89,,,,,,,case rate,22.89,22.89,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION WELLBUTRIN XL ORAL 1,92125301,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125347,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,AETNA,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,BCBS,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,CIGNA,COM,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,TRICARE,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,UNITED HEALTHCARE,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,UNITED HEALTHCARE,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,VA,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,VA TRICARE,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,WELLMED,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,HUMANA,MGD,99.06,,,,,,,per diem,99.06,99.06,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE TOPICAL 1% TOPICA,92125352,CDM,250,RC,,,,,,Inpatient,1,EA,99.06,99.06,HUMANA CHOICE PLUS,MGD,99.06,,,,,,,case rate,99.06,99.06,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,AETNA,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,BCBS,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,CIGNA,COM,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,TRICARE,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,UNITED HEALTHCARE,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,UNITED HEALTHCARE,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,VA,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,VA TRICARE,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,WELLMED,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,HUMANA,MGD,16.67,,,,,,,per diem,16.67,16.67,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9% INTRAVENO,92125362,CDM,250,RC,,,,,,Inpatient,1,EA,16.67,16.67,HUMANA CHOICE PLUS,MGD,16.67,,,,,,,case rate,16.67,16.67,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOSE ORAL 4 G TC           ,92125368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,AETNA,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,CIGNA,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,TRICARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,UNITED HEALTHCARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,UNITED HEALTHCARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,VA,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,VA TRICARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,WELLMED,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,HUMANA,MGD,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
"INFLUENZA VIRUS VACCINE, INACT",92125397,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,HUMANA CHOICE PLUS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM ORAL 60 MG TAB      ,92125419,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CITALOPRAM ORAL 10 MG TAB     ,92125457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,AETNA,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,BCBS,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,CIGNA,COM,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,TRICARE,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,UNITED HEALTHCARE,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,UNITED HEALTHCARE,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,VA,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,VA TRICARE,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,WELLMED,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,HUMANA,MGD,15.71,,,,,,,per diem,15.71,15.71,"Per diem rate, code is bundled with other services"
ENTACAPONE 200 MG TAB         ,92125528,CDM,250,RC,,,,,,Inpatient,1,EA,15.71,15.71,HUMANA CHOICE PLUS,MGD,15.71,,,,,,,case rate,15.71,15.71,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,AETNA,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,BCBS,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,CIGNA,COM,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,TRICARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,UNITED HEALTHCARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,UNITED HEALTHCARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,VA,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,VA TRICARE,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,WELLMED,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,HUMANA,MGD,11.55,,,,,,,per diem,11.55,11.55,"Per diem rate, code is bundled with other services"
CLOBETASOL 0.05% 15GM CRM     ,92125574,CDM,250,RC,,,,,,Inpatient,1,EA,11.55,11.55,HUMANA CHOICE PLUS,MGD,11.55,,,,,,,case rate,11.55,11.55,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
SILDENAFIL 20 MG TAB          ,92125585,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,AETNA,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,BCBS,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,CIGNA,COM,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,TRICARE,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,UNITED HEALTHCARE,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,UNITED HEALTHCARE,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,VA,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,VA TRICARE,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,WELLMED,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,HUMANA,MGD,493.76,,,,,,,per diem,493.76,493.76,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U OIN          ,92125598,CDM,250,RC,,,,,,Inpatient,1,EA,493.76,493.76,HUMANA CHOICE PLUS,MGD,493.76,,,,,,,case rate,493.76,493.76,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,AETNA,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,BCBS,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,CIGNA,COM,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,TRICARE,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,UNITED HEALTHCARE,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,UNITED HEALTHCARE,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,VA,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,VA TRICARE,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,WELLMED,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,HUMANA,MGD,5.62,,,,,,,per diem,5.62,5.62,"Per diem rate, code is bundled with other services"
METFORMIN 850MG TAB           ,92125621,CDM,250,RC,,,,,,Inpatient,1,EA,5.62,5.62,HUMANA CHOICE PLUS,MGD,5.62,,,,,,,case rate,5.62,5.62,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,AETNA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,CIGNA,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,WELLMED,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA,MGD,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DILTIAZEM 300MG/24 HOURS ER CA,92125623,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA CHOICE PLUS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,AETNA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,BCBS,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,CIGNA,COM,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,UNITED HEALTHCARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,VA TRICARE,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,WELLMED,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA,MGD,6.56,,,,,,,per diem,6.56,6.56,"Per diem rate, code is bundled with other services"
DEPAKOTE ER 250MG             ,92125636,CDM,250,RC,,,,,,Inpatient,1,EA,6.56,6.56,HUMANA CHOICE PLUS,MGD,6.56,,,,,,,case rate,6.56,6.56,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG TAB       ,92125648,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG      ,92125703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,AETNA,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,BCBS,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,CIGNA,COM,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,TRICARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UNITED HEALTHCARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,UNITED HEALTHCARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,VA,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,VA TRICARE,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,WELLMED,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,HUMANA,MGD,6.85,,,,,,,per diem,6.85,6.85,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG PAT       ,92125712,CDM,250,RC,,,,,,Inpatient,1,EA,6.85,6.85,HUMANA CHOICE PLUS,MGD,6.85,,,,,,,case rate,6.85,6.85,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,AETNA,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,BCBS,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,CIGNA,COM,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,TRICARE,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,UNITED HEALTHCARE,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,UNITED HEALTHCARE,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,VA,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,VA TRICARE,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,WELLMED,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,HUMANA,MGD,106.33,,,,,,,per diem,106.33,106.33,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU 100     ,92125726,CDM,250,RC,,,,,,Inpatient,1,EA,106.33,106.33,HUMANA CHOICE PLUS,MGD,106.33,,,,,,,case rate,106.33,106.33,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,AETNA,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,BCBS,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,CIGNA,COM,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,TRICARE,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,UNITED HEALTHCARE,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,UNITED HEALTHCARE,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,VA,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,VA TRICARE,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,WELLMED,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,HUMANA,MGD,291.48,,,,,,,per diem,291.48,291.48,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX O/O            ,92125767,CDM,250,RC,,,,,,Inpatient,1,EA,291.48,291.48,HUMANA CHOICE PLUS,MGD,291.48,,,,,,,case rate,291.48,291.48,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,AETNA,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,BCBS,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,CIGNA,COM,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,TRICARE,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,UNITED HEALTHCARE,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,UNITED HEALTHCARE,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,VA,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,VA TRICARE,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,WELLMED,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,HUMANA,MGD,32.77,,,,,,,per diem,32.77,32.77,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92125823,CDM,250,RC,,,,,,Inpatient,1,EA,32.77,32.77,HUMANA CHOICE PLUS,MGD,32.77,,,,,,,case rate,32.77,32.77,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,AETNA,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,BCBS,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,CIGNA,COM,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,TRICARE,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,UNITED HEALTHCARE,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,UNITED HEALTHCARE,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,VA,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,VA TRICARE,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,WELLMED,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,HUMANA,MGD,25.5,,,,,,,per diem,25.5,25.5,"Per diem rate, code is bundled with other services"
"HEPARIN/D5W 25,000U SOL       ",92125841,CDM,250,RC,,,,,,Inpatient,1,EA,25.5,25.5,HUMANA CHOICE PLUS,MGD,25.5,,,,,,,case rate,25.5,25.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,AETNA,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,CIGNA,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,TRICARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,UNITED HEALTHCARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,UNITED HEALTHCARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,VA,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,VA TRICARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,WELLMED,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,HUMANA,MGD,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
DEX 5% 0.9% NS 1ML SOL        ,92125891,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,HUMANA CHOICE PLUS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,AETNA,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,BCBS,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,CIGNA,COM,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,TRICARE,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,UNITED HEALTHCARE,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,UNITED HEALTHCARE,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,VA,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,VA TRICARE,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,WELLMED,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,HUMANA,MGD,19.41,,,,,,,per diem,19.41,19.41,"Per diem rate, code is bundled with other services"
ZIPRASIDONE 20MG CAP          ,92125895,CDM,250,RC,,,,,,Inpatient,1,EA,19.41,19.41,HUMANA CHOICE PLUS,MGD,19.41,,,,,,,case rate,19.41,19.41,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,AETNA,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,BCBS,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,CIGNA,COM,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,TRICARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,UNITED HEALTHCARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,UNITED HEALTHCARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,VA,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,VA TRICARE,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,WELLMED,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,HUMANA,MGD,148.05,,,,,,,per diem,148.05,148.05,"Per diem rate, code is bundled with other services"
TRYPSIN/BAL PER/CAST SPY      ,92125896,CDM,250,RC,,,,,,Inpatient,1,EA,148.05,148.05,HUMANA CHOICE PLUS,MGD,148.05,,,,,,,case rate,148.05,148.05,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TERBINAFINE 250MG             ,92125923,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,AETNA,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,BCBS,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,CIGNA,COM,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,TRICARE,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,UNITED HEALTHCARE,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,UNITED HEALTHCARE,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,VA,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,VA TRICARE,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,WELLMED,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,HUMANA,MGD,40.16,,,,,,,per diem,40.16,40.16,"Per diem rate, code is bundled with other services"
AROMASIN   25MG TAB           ,92126049,CDM,250,RC,,,,,,Inpatient,1,EA,40.16,40.16,HUMANA CHOICE PLUS,MGD,40.16,,,,,,,case rate,40.16,40.16,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,AETNA,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,BCBS,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,CIGNA,COM,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,TRICARE,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,UNITED HEALTHCARE,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,UNITED HEALTHCARE,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,VA,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,VA TRICARE,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,WELLMED,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,HUMANA,MGD,9.68,,,,,,,per diem,9.68,9.68,"Per diem rate, code is bundled with other services"
ROSUVASTATIN(CRESTOR) 10MGTAB ,92126069,CDM,250,RC,,,,,,Inpatient,1,EA,9.68,9.68,HUMANA CHOICE PLUS,MGD,9.68,,,,,,,case rate,9.68,9.68,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,AETNA,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,BCBS,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,CIGNA,COM,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,TRICARE,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,UNITED HEALTHCARE,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,UNITED HEALTHCARE,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,VA,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,VA TRICARE,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,WELLMED,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,HUMANA,MGD,6.89,,,,,,,per diem,6.89,6.89,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92126076,CDM,250,RC,,,,,,Inpatient,1,EA,6.89,6.89,HUMANA CHOICE PLUS,MGD,6.89,,,,,,,case rate,6.89,6.89,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D (ERGOCAL) 50000     ,92126083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92126084,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,AETNA,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,BCBS,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,CIGNA,COM,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,TRICARE,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,UNITED HEALTHCARE,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,UNITED HEALTHCARE,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,VA,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,VA TRICARE,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,WELLMED,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,HUMANA,MGD,199.07,,,,,,,per diem,199.07,199.07,"Per diem rate, code is bundled with other services"
RIFAXIMIN 550MG TAB (XIFAXAN) ,92127108,CDM,250,RC,,,,,,Inpatient,1,EA,199.07,199.07,HUMANA CHOICE PLUS,MGD,199.07,,,,,,,case rate,199.07,199.07,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,AETNA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,BCBS,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,CIGNA,COM,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,UNITED HEALTHCARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,VA,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,VA TRICARE,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,WELLMED,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,HUMANA,MGD,12.08,,,,,,,per diem,12.08,12.08,"Per diem rate, code is bundled with other services"
PROTONIX 20MG TAB             ,92127121,CDM,250,RC,,,,,,Inpatient,1,EA,12.08,12.08,HUMANA CHOICE PLUS,MGD,12.08,,,,,,,case rate,12.08,12.08,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,AETNA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,CIGNA,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,WELLMED,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA,MGD,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% - INHAL (SOD     ,92127163,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA CHOICE PLUS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL (TENORMIN) 25MG      ,92127185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVODOPA (SINEM     ,92127193,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,AETNA,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,BCBS,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,CIGNA,COM,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,TRICARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UNITED HEALTHCARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,UNITED HEALTHCARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,VA,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,VA TRICARE,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,WELLMED,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,HUMANA,MGD,14.44,,,,,,,per diem,14.44,14.44,"Per diem rate, code is bundled with other services"
CEFAZOLIN (ANCEF) 1GM VL      ,92127194,CDM,250,RC,,,,,,Inpatient,1,EA,14.44,14.44,HUMANA CHOICE PLUS,MGD,14.44,,,,,,,case rate,14.44,14.44,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN (DIGITEK) 0.125MG     ,92127202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,AETNA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,BCBS,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,CIGNA,COM,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,UNITED HEALTHCARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,VA,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,VA TRICARE,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,WELLMED,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,HUMANA,MGD,9.71,,,,,,,per diem,9.71,9.71,"Per diem rate, code is bundled with other services"
FINASTERIDE (PROSCAR) 5MG     ,92127208,CDM,250,RC,,,,,,Inpatient,1,EA,9.71,9.71,HUMANA CHOICE PLUS,MGD,9.71,,,,,,,case rate,9.71,9.71,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
FLECAINIDE ACE (TAMBOCOR)     ,92127209,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,AETNA,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,BCBS,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,CIGNA,COM,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,TRICARE,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,UNITED HEALTHCARE,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,UNITED HEALTHCARE,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,VA,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,VA TRICARE,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,WELLMED,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,HUMANA,MGD,44.03,,,,,,,per diem,44.03,44.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE (NIZORAL) 2%     ,92127218,CDM,250,RC,,,,,,Inpatient,1,EA,44.03,44.03,HUMANA CHOICE PLUS,MGD,44.03,,,,,,,case rate,44.03,44.03,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,AETNA,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,BCBS,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,CIGNA,COM,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,TRICARE,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,UNITED HEALTHCARE,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,UNITED HEALTHCARE,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,VA,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,VA TRICARE,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,WELLMED,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,HUMANA,MGD,34.6,,,,,,,per diem,34.6,34.6,"Per diem rate, code is bundled with other services"
OLANZAPINE (ZYPREXA) 5MG      ,92127230,CDM,250,RC,,,,,,Inpatient,1,EA,34.6,34.6,HUMANA CHOICE PLUS,MGD,34.6,,,,,,,case rate,34.6,34.6,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,AETNA,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,BCBS,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,CIGNA,COM,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,TRICARE,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,UNITED HEALTHCARE,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,UNITED HEALTHCARE,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,VA,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,VA TRICARE,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,WELLMED,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,HUMANA,MGD,13.06,,,,,,,per diem,13.06,13.06,"Per diem rate, code is bundled with other services"
ONDANSETRON HCL (ZOFRAN)      ,92127231,CDM,250,RC,,,,,,Inpatient,1,EA,13.06,13.06,HUMANA CHOICE PLUS,MGD,13.06,,,,,,,case rate,13.06,13.06,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
OSELTAMIVIR PHOS (TAMIFLU     ,92127232,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,AETNA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,BCBS,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,CIGNA,COM,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,UNITED HEALTHCARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,VA,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,VA TRICARE,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,WELLMED,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,HUMANA,MGD,10.24,,,,,,,per diem,10.24,10.24,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA (PRAVACHOL     ,92127236,CDM,250,RC,,,,,,Inpatient,1,EA,10.24,10.24,HUMANA CHOICE PLUS,MGD,10.24,,,,,,,case rate,10.24,10.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,AETNA,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,BCBS,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,CIGNA,COM,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,TRICARE,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,UNITED HEALTHCARE,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,UNITED HEALTHCARE,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,VA,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,VA TRICARE,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,WELLMED,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,HUMANA,MGD,431.55,,,,,,,per diem,431.55,431.55,"Per diem rate, code is bundled with other services"
TOBRAMYCIN/DEX  SUSP (TOB     ,92127243,CDM,250,RC,,,,,,Inpatient,1,EA,431.55,431.55,HUMANA CHOICE PLUS,MGD,431.55,,,,,,,case rate,431.55,431.55,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN EC (ECOTRIN) 325M     ,92127248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,AETNA,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,BCBS,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,CIGNA,COM,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,TRICARE,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,UNITED HEALTHCARE,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,UNITED HEALTHCARE,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,VA,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,VA TRICARE,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,WELLMED,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,HUMANA,MGD,8.18,,,,,,,per diem,8.18,8.18,"Per diem rate, code is bundled with other services"
BENZOCAINE/MENTHOL (CHLOR     ,92127250,CDM,250,RC,,,,,,Inpatient,1,EA,8.18,8.18,HUMANA CHOICE PLUS,MGD,8.18,,,,,,,case rate,8.18,8.18,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,AETNA,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,BCBS,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,CIGNA,COM,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,TRICARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,UNITED HEALTHCARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,UNITED HEALTHCARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,VA,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,VA TRICARE,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,WELLMED,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,HUMANA,MGD,6.35,,,,,,,per diem,6.35,6.35,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 100ml (NS 10     ,92127285,CDM,250,RC,,,,,,Inpatient,1,EA,6.35,6.35,HUMANA CHOICE PLUS,MGD,6.35,,,,,,,case rate,6.35,6.35,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEET ENEMA 4.5OZ             ,92128306,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL (DILTIAZEM)     ,92128364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/APAP (PERCOCET)     ,92128390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,AETNA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,CIGNA,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,WELLMED,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA,MGD,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
SODIUM HYPOCHLORITE (DAKI     ,92128415,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA CHOICE PLUS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,AETNA,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,BCBS,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,CIGNA,COM,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,TRICARE,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,UNITED HEALTHCARE,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,UNITED HEALTHCARE,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,VA,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,VA TRICARE,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,WELLMED,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,HUMANA,MGD,50.07,,,,,,,per diem,50.07,50.07,"Per diem rate, code is bundled with other services"
NITROGLYCERIN (NITRO-BID)     ,92128428,CDM,250,RC,,,,,,Inpatient,1,EA,50.07,50.07,HUMANA CHOICE PLUS,MGD,50.07,,,,,,,case rate,50.07,50.07,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CITR SA (UROCIT     ,92128442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,AETNA,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,BCBS,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,CIGNA,COM,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,TRICARE,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,UNITED HEALTHCARE,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,UNITED HEALTHCARE,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,VA,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,VA TRICARE,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,WELLMED,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,HUMANA,MGD,17.41,,,,,,,per diem,17.41,17.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE SU (SO     ,92128444,CDM,250,RC,,,,,,Inpatient,1,EA,17.41,17.41,HUMANA CHOICE PLUS,MGD,17.41,,,,,,,case rate,17.41,17.41,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,AETNA,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,CIGNA,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,TRICARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,UNITED HEALTHCARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,UNITED HEALTHCARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,VA,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,VA TRICARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,WELLMED,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,HUMANA,MGD,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
SIMVASTATIN (ZOCOR) 10MG      ,92128445,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,HUMANA CHOICE PLUS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESEVELAM HCL (WELCHOL)     ,92128448,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS (ISOPTO      ,92128458,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT W/MIN (THERAGRA     ,92128468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,AETNA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,CIGNA,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,WELLMED,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA,MGD,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN (TYLENOL X-     ,92128471,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA CHOICE PLUS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,AETNA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,CIGNA,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,WELLMED,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA,MGD,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
SOD CHL 0.45% (SODIUM CHL     ,92128478,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA CHOICE PLUS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
DEX 5% 0.9%NS KCL 20 (D5N     ,92128479,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,AETNA,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,BCBS,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,CIGNA,COM,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,TRICARE,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,UNITED HEALTHCARE,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,UNITED HEALTHCARE,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,VA,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,VA TRICARE,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,WELLMED,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,HUMANA,MGD,16,,,,,,,per diem,16,16,"Per diem rate, code is bundled with other services"
SOD CHL 0.9% 250ml  (NS 2     ,92128481,CDM,250,RC,,,,,,Inpatient,1,EA,16,16,HUMANA CHOICE PLUS,MGD,16,,,,,,,case rate,16,16,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,AETNA,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,BCBS,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,CIGNA,COM,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,TRICARE,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,UNITED HEALTHCARE,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,UNITED HEALTHCARE,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,VA,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,VA TRICARE,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,WELLMED,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,HUMANA,MGD,590.69,,,,,,,per diem,590.69,590.69,"Per diem rate, code is bundled with other services"
FLUTICASONE/SALMETER 250/     ,92128492,CDM,250,RC,,,,,,Inpatient,1,EA,590.69,590.69,HUMANA CHOICE PLUS,MGD,590.69,,,,,,,case rate,590.69,590.69,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,AETNA,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,BCBS,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,CIGNA,COM,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,TRICARE,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UNITED HEALTHCARE,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,UNITED HEALTHCARE,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,VA,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,VA TRICARE,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,WELLMED,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,HUMANA,MGD,19.2,,,,,,,per diem,19.2,19.2,"Per diem rate, code is bundled with other services"
SEVELAMER CARBONATE 800MG TAB ,92128516,CDM,250,RC,,,,,,Inpatient,1,EA,19.2,19.2,HUMANA CHOICE PLUS,MGD,19.2,,,,,,,case rate,19.2,19.2,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
PAROXETINE 20MG TAB           ,92128584,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYMBALTA (DULOXETINE) 20MG    ,92128590,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN K (MEPHYTON) 5MG TAB  ,92128611,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,AETNA,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,BCBS,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,CIGNA,COM,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,TRICARE,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,UNITED HEALTHCARE,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,UNITED HEALTHCARE,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,VA,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,VA TRICARE,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,WELLMED,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,HUMANA,MGD,27.18,,,,,,,per diem,27.18,27.18,"Per diem rate, code is bundled with other services"
LIDOCAINE UROJET (LIDOCAI     ,92128635,CDM,250,RC,,,,,,Inpatient,1,EA,27.18,27.18,HUMANA CHOICE PLUS,MGD,27.18,,,,,,,case rate,27.18,27.18,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,AETNA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,CIGNA,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,WELLMED,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA,MGD,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHL SA (DITROP     ,92128647,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA CHOICE PLUS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,AETNA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,CIGNA,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,WELLMED,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA,MGD,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
TUBERCULIN PURIF (APLISOL     ,92128652,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA CHOICE PLUS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,AETNA,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,BCBS,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,CIGNA,COM,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,TRICARE,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,UNITED HEALTHCARE,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,UNITED HEALTHCARE,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,VA,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,VA TRICARE,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,WELLMED,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,HUMANA,MGD,3.68,,,,,,,per diem,3.68,3.68,"Per diem rate, code is bundled with other services"
DOXEPIN                       ,92128658,CDM,250,RC,,,,,,Inpatient,1,EA,3.68,3.68,HUMANA CHOICE PLUS,MGD,3.68,,,,,,,case rate,3.68,3.68,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZANAFLEX 2MG CAP              ,92128662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,AETNA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,CIGNA,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,WELLMED,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA,MGD,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
CELEXA 10MG TAB NDC # 001724  ,92128679,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA CHOICE PLUS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,AETNA,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,BCBS,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,CIGNA,COM,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,TRICARE,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,UNITED HEALTHCARE,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,UNITED HEALTHCARE,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,VA,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,VA TRICARE,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,WELLMED,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,HUMANA,MGD,710.61,,,,,,,per diem,710.61,710.61,"Per diem rate, code is bundled with other services"
TIMOPTIC XE .50% OPTH         ,92128707,CDM,250,RC,,,,,,Inpatient,1,EA,710.61,710.61,HUMANA CHOICE PLUS,MGD,710.61,,,,,,,case rate,710.61,710.61,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIORESAL 5MG TAB              ,92128715,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLEXERIL 5MG TAB              ,92128722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PACERONE TAB 100MG            ,92128723,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,AETNA,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,CIGNA,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,TRICARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,UNITED HEALTHCARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,UNITED HEALTHCARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,VA,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,VA TRICARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,WELLMED,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,HUMANA,MGD,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
"HEPARIN SOD INJ 10,000U       ",92128732,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,HUMANA CHOICE PLUS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,AETNA,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,BCBS,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,CIGNA,COM,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,TRICARE,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,UNITED HEALTHCARE,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,UNITED HEALTHCARE,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,VA,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,VA TRICARE,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,WELLMED,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,HUMANA,MGD,103.72,,,,,,,per diem,103.72,103.72,"Per diem rate, code is bundled with other services"
CAPSAICIN .075% CRM           ,92128779,CDM,250,RC,,,,,,Inpatient,1,EA,103.72,103.72,HUMANA CHOICE PLUS,MGD,103.72,,,,,,,case rate,103.72,103.72,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,AETNA,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,BCBS,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,CIGNA,COM,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,TRICARE,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,UNITED HEALTHCARE,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,UNITED HEALTHCARE,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,VA,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,VA TRICARE,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,WELLMED,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,HUMANA,MGD,55.63,,,,,,,per diem,55.63,55.63,"Per diem rate, code is bundled with other services"
ALFUZOSIN ER 10 MG TABLET     ,92128786,CDM,250,RC,,,,,,Inpatient,1,EA,55.63,55.63,HUMANA CHOICE PLUS,MGD,55.63,,,,,,,case rate,55.63,55.63,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,AETNA,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,BCBS,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,CIGNA,COM,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,TRICARE,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,UNITED HEALTHCARE,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,UNITED HEALTHCARE,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,VA,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,VA TRICARE,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,WELLMED,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,HUMANA,MGD,24.86,,,,,,,per diem,24.86,24.86,"Per diem rate, code is bundled with other services"
CEFAZOLIN/DEXTROSE DUP 2GM/50M,92128792,CDM,250,RC,,,,,,Inpatient,1,EA,24.86,24.86,HUMANA CHOICE PLUS,MGD,24.86,,,,,,,case rate,24.86,24.86,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,AETNA,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,BCBS,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,CIGNA,COM,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,TRICARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,UNITED HEALTHCARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,UNITED HEALTHCARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,VA,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,VA TRICARE,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,WELLMED,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,HUMANA,MGD,40.94,,,,,,,per diem,40.94,40.94,"Per diem rate, code is bundled with other services"
LINACLOTIDE 145MCG CAP        ,92128796,CDM,250,RC,,,,,,Inpatient,1,EA,40.94,40.94,HUMANA CHOICE PLUS,MGD,40.94,,,,,,,case rate,40.94,40.94,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,AETNA,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,BCBS,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,CIGNA,COM,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,TRICARE,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,UNITED HEALTHCARE,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,UNITED HEALTHCARE,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,VA,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,VA TRICARE,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,WELLMED,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,HUMANA,MGD,0.32,,,,,,,per diem,0.32,0.32,"Per diem rate, code is bundled with other services"
INSULIN REG/NPH HUMAN 70/30 VL,92128811,CDM,250,RC,,,,,,Inpatient,1,EA,0.32,0.32,HUMANA CHOICE PLUS,MGD,0.32,,,,,,,case rate,0.32,0.32,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,AETNA,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,BCBS,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,CIGNA,COM,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,TRICARE,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,UNITED HEALTHCARE,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,UNITED HEALTHCARE,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,VA,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,VA TRICARE,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,WELLMED,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,HUMANA,MGD,49.46,,,,,,,per diem,49.46,49.46,"Per diem rate, code is bundled with other services"
LINACLOTIDE 290MG CAP         ,92128813,CDM,250,RC,,,,,,Inpatient,1,EA,49.46,49.46,HUMANA CHOICE PLUS,MGD,49.46,,,,,,,case rate,49.46,49.46,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92128840,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,AETNA,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,BCBS,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,CIGNA,COM,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,TRICARE,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,UNITED HEALTHCARE,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,UNITED HEALTHCARE,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,VA,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,VA TRICARE,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,WELLMED,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,HUMANA,MGD,25.46,,,,,,,per diem,25.46,25.46,"Per diem rate, code is bundled with other services"
ESOMEPRAZOLE MAG 40MG CAP     ,92128843,CDM,250,RC,,,,,,Inpatient,1,EA,25.46,25.46,HUMANA CHOICE PLUS,MGD,25.46,,,,,,,case rate,25.46,25.46,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTI VIT THER TAB            ,92128863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,AETNA,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,BCBS,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,CIGNA,COM,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,TRICARE,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,UNITED HEALTHCARE,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,UNITED HEALTHCARE,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,VA,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,VA TRICARE,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,WELLMED,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,HUMANA,MGD,61.32,,,,,,,per diem,61.32,61.32,"Per diem rate, code is bundled with other services"
RIVAROXABAN 10MG TAB          ,92128869,CDM,250,RC,,,,,,Inpatient,1,EA,61.32,61.32,HUMANA CHOICE PLUS,MGD,61.32,,,,,,,case rate,61.32,61.32,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SOD CHL 1GM TAB               ,92128871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL 50MG TAB             ,92128872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,AETNA,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,BCBS,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,CIGNA,COM,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,TRICARE,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,UNITED HEALTHCARE,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,UNITED HEALTHCARE,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,VA,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,VA TRICARE,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,WELLMED,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,HUMANA,MGD,20.74,,,,,,,per diem,20.74,20.74,"Per diem rate, code is bundled with other services"
LIDOC.PATCH REMOVAL           ,92128894,CDM,252,RC,,,,,,Inpatient,1,EA,20.74,20.74,HUMANA CHOICE PLUS,MGD,20.74,,,,,,,case rate,20.74,20.74,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,AETNA,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,CIGNA,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,TRICARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,UNITED HEALTHCARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,UNITED HEALTHCARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,VA,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,VA TRICARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,WELLMED,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,HUMANA,MGD,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 10% SO     ,92128898,CDM,257,RC,,,,,,Inpatient,1,EA,40.43,40.43,HUMANA CHOICE PLUS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,AETNA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,BCBS,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,CIGNA,COM,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,UNITED HEALTHCARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,VA,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,VA TRICARE,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,WELLMED,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,HUMANA,MGD,59.85,,,,,,,per diem,59.85,59.85,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACE 0.12% SU     ,92128914,CDM,250,RC,,,,,,Inpatient,1,EA,59.85,59.85,HUMANA CHOICE PLUS,MGD,59.85,,,,,,,case rate,59.85,59.85,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,AETNA,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,BCBS,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,CIGNA,COM,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,TRICARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,UNITED HEALTHCARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,UNITED HEALTHCARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,VA,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,VA TRICARE,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,WELLMED,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,HUMANA,MGD,648.9,,,,,,,per diem,648.9,648.9,"Per diem rate, code is bundled with other services"
BUDESONIDE/FORM INH 6GM       ,92128921,CDM,250,RC,,,,,,Inpatient,1,EA,648.9,648.9,HUMANA CHOICE PLUS,MGD,648.9,,,,,,,case rate,648.9,648.9,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,AETNA,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,CIGNA,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,TRICARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,UNITED HEALTHCARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,UNITED HEALTHCARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,VA,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,VA TRICARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,WELLMED,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,HUMANA,MGD,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
MAGIC MOUTH WASH              ,92128925,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,HUMANA CHOICE PLUS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALUMINUM-MAG HYDROXIDE-SI     ,92128939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,AETNA,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,CIGNA,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,TRICARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,UNITED HEALTHCARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,UNITED HEALTHCARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,VA,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,VA TRICARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,WELLMED,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,HUMANA,MGD,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
APIXABAN 5 MG TABLET          ,92128946,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,HUMANA CHOICE PLUS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,AETNA,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,BCBS,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,CIGNA,COM,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,TRICARE,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,UNITED HEALTHCARE,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,UNITED HEALTHCARE,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,VA,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,VA TRICARE,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,WELLMED,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,HUMANA,MGD,24.36,,,,,,,per diem,24.36,24.36,"Per diem rate, code is bundled with other services"
ARTIFICIAL SALIVA YERBA       ,92128949,CDM,250,RC,,,,,,Inpatient,1,EA,24.36,24.36,HUMANA CHOICE PLUS,MGD,24.36,,,,,,,case rate,24.36,24.36,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
AZELASTINE 137 MCG 0.1 PCT    ,92128954,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,AETNA,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,BCBS,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,CIGNA,COM,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,TRICARE,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,UNITED HEALTHCARE,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,UNITED HEALTHCARE,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,VA,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,VA TRICARE,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,WELLMED,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,HUMANA,MGD,5.41,,,,,,,per diem,5.41,5.41,"Per diem rate, code is bundled with other services"
BENZTROPINE 0.5 MG TABLET     ,92128969,CDM,250,RC,,,,,,Inpatient,1,EA,5.41,5.41,HUMANA CHOICE PLUS,MGD,5.41,,,,,,,case rate,5.41,5.41,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,AETNA,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,BCBS,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,CIGNA,COM,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,TRICARE,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,UNITED HEALTHCARE,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,UNITED HEALTHCARE,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,VA,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,VA TRICARE,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,WELLMED,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,HUMANA,MGD,41.29,,,,,,,per diem,41.29,41.29,"Per diem rate, code is bundled with other services"
BUDESONIDE DR - ER 3 MG C     ,92128980,CDM,250,RC,,,,,,Inpatient,1,EA,41.29,41.29,HUMANA CHOICE PLUS,MGD,41.29,,,,,,,case rate,41.29,41.29,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE 5 MG TABLET         ,92128985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARBONATE-VITAMIN     ,92128989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,AETNA,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,BCBS,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,CIGNA,COM,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,TRICARE,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,UNITED HEALTHCARE,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,UNITED HEALTHCARE,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,VA,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,VA TRICARE,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,WELLMED,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,HUMANA,MGD,8.78,,,,,,,per diem,8.78,8.78,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUCONATE 0     ,92129010,CDM,250,RC,,,,,,Inpatient,1,EA,8.78,8.78,HUMANA CHOICE PLUS,MGD,8.78,,,,,,,case rate,8.78,8.78,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,AETNA,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,BCBS,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,CIGNA,COM,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,TRICARE,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,UNITED HEALTHCARE,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,UNITED HEALTHCARE,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,VA,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,VA TRICARE,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,WELLMED,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,HUMANA,MGD,11.43,,,,,,,per diem,11.43,11.43,"Per diem rate, code is bundled with other services"
CLINDAMYCIN 150 MG CAPSUL     ,92129014,CDM,250,RC,,,,,,Inpatient,1,EA,11.43,11.43,HUMANA CHOICE PLUS,MGD,11.43,,,,,,,case rate,11.43,11.43,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,AETNA,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,CIGNA,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,TRICARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,UNITED HEALTHCARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,UNITED HEALTHCARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,VA,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,VA TRICARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,WELLMED,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,HUMANA,MGD,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
DANTROLENE 25 MG CAPSULE      ,92129029,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,HUMANA CHOICE PLUS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,AETNA,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,BCBS,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,CIGNA,COM,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,TRICARE,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,UNITED HEALTHCARE,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,UNITED HEALTHCARE,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,VA,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,VA TRICARE,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,WELLMED,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,HUMANA,MGD,427.28,,,,,,,per diem,427.28,427.28,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 25 MCG/M     ,92129032,CDM,250,RC,,,,,,Inpatient,1,EA,427.28,427.28,HUMANA CHOICE PLUS,MGD,427.28,,,,,,,case rate,427.28,427.28,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,AETNA,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,BCBS,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,CIGNA,COM,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,TRICARE,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,UNITED HEALTHCARE,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,UNITED HEALTHCARE,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,VA,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,VA TRICARE,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,WELLMED,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,HUMANA,MGD,541.59,,,,,,,per diem,541.59,541.59,"Per diem rate, code is bundled with other services"
DARBEPOETIN ALFA 60 MCG/0     ,92129036,CDM,250,RC,,,,,,Inpatient,1,EA,541.59,541.59,HUMANA CHOICE PLUS,MGD,541.59,,,,,,,case rate,541.59,541.59,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROMETHORPHAN-GUAIFENE     ,92129042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,AETNA,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,CIGNA,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,TRICARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,UNITED HEALTHCARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,UNITED HEALTHCARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,VA,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,VA TRICARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,WELLMED,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,HUMANA,MGD,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
DIVALPROEX 125 MG SPRINKL     ,92129055,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,HUMANA CHOICE PLUS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,AETNA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,CIGNA,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,WELLMED,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA,MGD,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN 1 MG TABLET         ,92129063,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA CHOICE PLUS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,AETNA,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,BCBS,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,CIGNA,COM,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,TRICARE,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,UNITED HEALTHCARE,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,UNITED HEALTHCARE,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,VA,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,VA TRICARE,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,WELLMED,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,HUMANA,MGD,812.78,,,,,,,per diem,812.78,812.78,"Per diem rate, code is bundled with other services"
FLUTICASONE 44 MCG/ACTUAT     ,92129087,CDM,250,RC,,,,,,Inpatient,1,EA,812.78,812.78,HUMANA CHOICE PLUS,MGD,812.78,,,,,,,case rate,812.78,812.78,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,AETNA,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,BCBS,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,CIGNA,COM,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,TRICARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,UNITED HEALTHCARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,UNITED HEALTHCARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,VA,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,VA TRICARE,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,WELLMED,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,HUMANA,MGD,40.43,,,,,,,per diem,40.43,40.43,"Per diem rate, code is bundled with other services"
GENTAMICIN 0.3 PCT 3 MG/GR    ,92129096,CDM,250,RC,,,,,,Inpatient,1,EA,40.43,40.43,HUMANA CHOICE PLUS,MGD,40.43,,,,,,,case rate,40.43,40.43,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,AETNA,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,BCBS,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,CIGNA,COM,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,TRICARE,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,UNITED HEALTHCARE,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,UNITED HEALTHCARE,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,VA,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,VA TRICARE,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,WELLMED,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,HUMANA,MGD,36.67,,,,,,,per diem,36.67,36.67,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR 100 UNIT/     ,92129117,CDM,250,RC,,,,,,Inpatient,1,EA,36.67,36.67,HUMANA CHOICE PLUS,MGD,36.67,,,,,,,case rate,36.67,36.67,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,AETNA,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,BCBS,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,CIGNA,COM,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,TRICARE,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,UNITED HEALTHCARE,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,UNITED HEALTHCARE,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,VA,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,VA TRICARE,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,WELLMED,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,HUMANA,MGD,0.53,,,,,,,per diem,0.53,0.53,"Per diem rate, code is bundled with other services"
INSULIN NPH & REG HUMAN I     ,92129118,CDM,250,RC,,,,,,Inpatient,1,EA,0.53,0.53,HUMANA CHOICE PLUS,MGD,0.53,,,,,,,case rate,0.53,0.53,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL 20 MG/4 ML (5 M     ,92129130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,AETNA,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,BCBS,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,CIGNA,COM,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,TRICARE,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,UNITED HEALTHCARE,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,UNITED HEALTHCARE,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,VA,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,VA TRICARE,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,WELLMED,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,HUMANA,MGD,7.26,,,,,,,per diem,7.26,7.26,"Per diem rate, code is bundled with other services"
METHADONE 5 MG TABLET         ,92129163,CDM,250,RC,,,,,,Inpatient,1,EA,7.26,7.26,HUMANA CHOICE PLUS,MGD,7.26,,,,,,,case rate,7.26,7.26,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95 MG TAB     ,92129235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,AETNA,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,BCBS,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,CIGNA,COM,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,TRICARE,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,UNITED HEALTHCARE,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,UNITED HEALTHCARE,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,VA,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,VA TRICARE,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,WELLMED,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,HUMANA,MGD,411.16,,,,,,,per diem,411.16,411.16,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 13-VAL CONJ      ,92129245,CDM,250,RC,,,,,,Inpatient,1,EA,411.16,411.16,HUMANA CHOICE PLUS,MGD,411.16,,,,,,,case rate,411.16,411.16,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,AETNA,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,BCBS,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,CIGNA,COM,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,TRICARE,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,UNITED HEALTHCARE,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,UNITED HEALTHCARE,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,VA,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,VA TRICARE,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,WELLMED,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,HUMANA,MGD,53.91,,,,,,,per diem,53.91,53.91,"Per diem rate, code is bundled with other services"
PNEUMOCOCCAL 23-VALPS VAC     ,92129247,CDM,250,RC,,,,,,Inpatient,1,EA,53.91,53.91,HUMANA CHOICE PLUS,MGD,53.91,,,,,,,case rate,53.91,53.91,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE ER 10      ,92129254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,AETNA,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,BCBS,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,CIGNA,COM,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,TRICARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,UNITED HEALTHCARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,UNITED HEALTHCARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,VA,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,VA TRICARE,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,WELLMED,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,HUMANA,MGD,22.62,,,,,,,per diem,22.62,22.62,"Per diem rate, code is bundled with other services"
PREGABALIN 50 MG CAPSULE      ,92129259,CDM,250,RC,,,,,,Inpatient,1,EA,22.62,22.62,HUMANA CHOICE PLUS,MGD,22.62,,,,,,,case rate,22.62,22.62,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 100 MG TABLET      ,92129265,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
QUETIAPINE 25 MG TABLET       ,92129266,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,AETNA,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,BCBS,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,CIGNA,COM,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,TRICARE,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,UNITED HEALTHCARE,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,UNITED HEALTHCARE,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,VA,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,VA TRICARE,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,WELLMED,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,HUMANA,MGD,84.55,,,,,,,per diem,84.55,84.55,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 1.5 MG TRANSD     ,92129275,CDM,250,RC,,,,,,Inpatient,1,EA,84.55,84.55,HUMANA CHOICE PLUS,MGD,84.55,,,,,,,case rate,84.55,84.55,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,AETNA,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,BCBS,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,CIGNA,COM,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,TRICARE,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,UNITED HEALTHCARE,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,UNITED HEALTHCARE,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,VA,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,VA TRICARE,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,WELLMED,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,HUMANA,MGD,8.62,,,,,,,per diem,8.62,8.62,"Per diem rate, code is bundled with other services"
SELEGILINE 5 MG CAPSULE       ,92129276,CDM,250,RC,,,,,,Inpatient,1,EA,8.62,8.62,HUMANA CHOICE PLUS,MGD,8.62,,,,,,,case rate,8.62,8.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB  NORMAL SA      ,92129285,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,AETNA,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,BCBS,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,CIGNA,COM,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,TRICARE,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,UNITED HEALTHCARE,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,UNITED HEALTHCARE,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,VA,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,VA TRICARE,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,WELLMED,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,HUMANA,MGD,39.69,,,,,,,per diem,39.69,39.69,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE 0.9 % INJ     ,92129288,CDM,250,RC,,,,,,Inpatient,1,EA,39.69,39.69,HUMANA CHOICE PLUS,MGD,39.69,,,,,,,case rate,39.69,39.69,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,AETNA,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,BCBS,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,CIGNA,COM,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,TRICARE,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,UNITED HEALTHCARE,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,UNITED HEALTHCARE,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,VA,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,VA TRICARE,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,WELLMED,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,HUMANA,MGD,15.59,,,,,,,per diem,15.59,15.59,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500 MG/100      ,92129306,CDM,250,RC,,,,,,Inpatient,1,EA,15.59,15.59,HUMANA CHOICE PLUS,MGD,15.59,,,,,,,case rate,15.59,15.59,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,AETNA,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,BCBS,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,CIGNA,COM,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,TRICARE,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,UNITED HEALTHCARE,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,UNITED HEALTHCARE,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,VA,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,VA TRICARE,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,WELLMED,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,HUMANA,MGD,42.67,,,,,,,per diem,42.67,42.67,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE SULFON     ,92129319,CDM,250,RC,,,,,,Inpatient,1,EA,42.67,42.67,HUMANA CHOICE PLUS,MGD,42.67,,,,,,,case rate,42.67,42.67,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,AETNA,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,BCBS,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,CIGNA,COM,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,TRICARE,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UNITED HEALTHCARE,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,UNITED HEALTHCARE,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,VA,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,VA TRICARE,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,WELLMED,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,HUMANA,MGD,5.55,,,,,,,per diem,5.55,5.55,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 120 MG        ,92129331,CDM,250,RC,,,,,,Inpatient,1,EA,5.55,5.55,HUMANA CHOICE PLUS,MGD,5.55,,,,,,,case rate,5.55,5.55,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
VERAPAMIL ER SR 180 MG        ,92129332,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,AETNA,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,BCBS,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,CIGNA,COM,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,TRICARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,UNITED HEALTHCARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,UNITED HEALTHCARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,VA,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,VA TRICARE,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,WELLMED,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,HUMANA,MGD,38.93,,,,,,,per diem,38.93,38.93,"Per diem rate, code is bundled with other services"
GENTAMICIN-NACL 100 MG IVPB 24,92129343,CDM,250,RC,,,,,,Inpatient,1,EA,38.93,38.93,HUMANA CHOICE PLUS,MGD,38.93,,,,,,,case rate,38.93,38.93,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 312     ,92129491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,AETNA,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,BCBS,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,CIGNA,COM,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,TRICARE,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,UNITED HEALTHCARE,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,UNITED HEALTHCARE,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,VA,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,VA TRICARE,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,WELLMED,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,HUMANA,MGD,93.53,,,,,,,per diem,93.53,93.53,"Per diem rate, code is bundled with other services"
LURASIDONE HCL 60 MG PO T     ,92129537,CDM,250,RC,,,,,,Inpatient,1,EA,93.53,93.53,HUMANA CHOICE PLUS,MGD,93.53,,,,,,,case rate,93.53,93.53,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,AETNA,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,BCBS,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,CIGNA,COM,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,TRICARE,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,UNITED HEALTHCARE,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,UNITED HEALTHCARE,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,VA,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,VA TRICARE,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,WELLMED,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,HUMANA,MGD,1431.77,,,,,,,per diem,1431.77,1431.77,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN-HYDROCORTIS     ,92129622,CDM,250,RC,,,,,,Inpatient,1,EA,1431.77,1431.77,HUMANA CHOICE PLUS,MGD,1431.77,,,,,,,case rate,1431.77,1431.77,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,AETNA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,BCBS,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,CIGNA,COM,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,UNITED HEALTHCARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,VA TRICARE,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,WELLMED,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA,MGD,8.27,,,,,,,per diem,8.27,8.27,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 0.1 MG TAB       ,92129627,CDM,250,RC,,,,,,Inpatient,1,EA,8.27,8.27,HUMANA CHOICE PLUS,MGD,8.27,,,,,,,case rate,8.27,8.27,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,AETNA,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,BCBS,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,CIGNA,COM,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,TRICARE,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,UNITED HEALTHCARE,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,UNITED HEALTHCARE,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,VA,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,VA TRICARE,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,WELLMED,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,HUMANA,MGD,33.99,,,,,,,per diem,33.99,33.99,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 0.5PCT OINT 1    ,92129639,CDM,250,RC,,,,,,Inpatient,1,EA,33.99,33.99,HUMANA CHOICE PLUS,MGD,33.99,,,,,,,case rate,33.99,33.99,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,AETNA,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,BCBS,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,CIGNA,COM,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,TRICARE,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,UNITED HEALTHCARE,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,UNITED HEALTHCARE,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,VA,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,VA TRICARE,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,WELLMED,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,HUMANA,MGD,458.85,,,,,,,per diem,458.85,458.85,"Per diem rate, code is bundled with other services"
FLUTICASONE-VILANTEROL 10     ,92129642,CDM,250,RC,,,,,,Inpatient,1,EA,458.85,458.85,HUMANA CHOICE PLUS,MGD,458.85,,,,,,,case rate,458.85,458.85,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,AETNA,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,BCBS,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,CIGNA,COM,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,TRICARE,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,UNITED HEALTHCARE,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,UNITED HEALTHCARE,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,VA,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,VA TRICARE,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,WELLMED,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,HUMANA,MGD,309.18,,,,,,,per diem,309.18,309.18,"Per diem rate, code is bundled with other services"
FOSFOMYCIN 3 GRAM PACK        ,92129643,CDM,250,RC,,,,,,Inpatient,1,EA,309.18,309.18,HUMANA CHOICE PLUS,MGD,309.18,,,,,,,case rate,309.18,309.18,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,AETNA,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,BCBS,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,CIGNA,COM,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,TRICARE,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,UNITED HEALTHCARE,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,UNITED HEALTHCARE,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,VA,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,VA TRICARE,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,WELLMED,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,HUMANA,MGD,18.64,,,,,,,per diem,18.64,18.64,"Per diem rate, code is bundled with other services"
PHENYLEPH-MIN OIL-PETROLA     ,92129667,CDM,250,RC,,,,,,Inpatient,1,EA,18.64,18.64,HUMANA CHOICE PLUS,MGD,18.64,,,,,,,case rate,18.64,18.64,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,AETNA,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,BCBS,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,CIGNA,COM,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,TRICARE,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,UNITED HEALTHCARE,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,UNITED HEALTHCARE,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,VA,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,VA TRICARE,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,WELLMED,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,HUMANA,MGD,109.44,,,,,,,per diem,109.44,109.44,"Per diem rate, code is bundled with other services"
SODIUM BICARBONATE 1 MEQ/     ,92129679,CDM,250,RC,,,,,,Inpatient,1,EA,109.44,109.44,HUMANA CHOICE PLUS,MGD,109.44,,,,,,,case rate,109.44,109.44,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,AETNA,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,BCBS,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,CIGNA,COM,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,TRICARE,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,UNITED HEALTHCARE,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,UNITED HEALTHCARE,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,VA,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,VA TRICARE,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,WELLMED,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,HUMANA,MGD,39.62,,,,,,,per diem,39.62,39.62,"Per diem rate, code is bundled with other services"
SODIUM POLYSTYRENE 15 GRA     ,92129684,CDM,250,RC,,,,,,Inpatient,1,EA,39.62,39.62,HUMANA CHOICE PLUS,MGD,39.62,,,,,,,case rate,39.62,39.62,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,AETNA,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,BCBS,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,CIGNA,COM,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,TRICARE,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,UNITED HEALTHCARE,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,UNITED HEALTHCARE,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,VA,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,VA TRICARE,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,WELLMED,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,HUMANA,MGD,42.93,,,,,,,per diem,42.93,42.93,"Per diem rate, code is bundled with other services"
LINAGLIPTIN 5 MG TAB          ,92129735,CDM,250,RC,,,,,,Inpatient,1,EA,42.93,42.93,HUMANA CHOICE PLUS,MGD,42.93,,,,,,,case rate,42.93,42.93,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,AETNA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,BCBS,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,CIGNA,COM,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,UNITED HEALTHCARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,VA,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,VA TRICARE,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,WELLMED,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,HUMANA,MGD,173.25,,,,,,,per diem,173.25,173.25,"Per diem rate, code is bundled with other services"
PENICILLIN G POTASSIUM CU     ,92129764,CDM,250,RC,,,,,,Inpatient,1,EA,173.25,173.25,HUMANA CHOICE PLUS,MGD,173.25,,,,,,,case rate,173.25,173.25,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,AETNA,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,BCBS,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,CIGNA,COM,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,TRICARE,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UNITED HEALTHCARE,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,UNITED HEALTHCARE,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,VA TRICARE,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,WELLMED,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,HUMANA,MGD,5.4,,,,,,,per diem,5.4,5.4,"Per diem rate, code is bundled with other services"
ALBUTEROL 2.5 MG /3 ML 0      ,92129784,CDM,250,RC,,,,,,Inpatient,1,EA,5.4,5.4,HUMANA CHOICE PLUS,MGD,5.4,,,,,,,case rate,5.4,5.4,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,AETNA,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,BCBS,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,CIGNA,COM,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,TRICARE,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,UNITED HEALTHCARE,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,UNITED HEALTHCARE,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,VA,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,VA TRICARE,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,WELLMED,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,HUMANA,MGD,58.76,,,,,,,per diem,58.76,58.76,"Per diem rate, code is bundled with other services"
ALBUTEROL 90 MCG/ACTUATIO     ,92129785,CDM,250,RC,,,,,,Inpatient,1,EA,58.76,58.76,HUMANA CHOICE PLUS,MGD,58.76,,,,,,,case rate,58.76,58.76,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,AETNA,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,BCBS,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,CIGNA,COM,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,TRICARE,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,UNITED HEALTHCARE,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,UNITED HEALTHCARE,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,VA,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,VA TRICARE,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,WELLMED,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,HUMANA,MGD,784.57,,,,,,,per diem,784.57,784.57,"Per diem rate, code is bundled with other services"
DESMOPRESSIN 10 MCG/SPRAY     ,92129799,CDM,250,RC,,,,,,Inpatient,1,EA,784.57,784.57,HUMANA CHOICE PLUS,MGD,784.57,,,,,,,case rate,784.57,784.57,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE 50 MG TAB          ,92129843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI  MINERAL, THERAPEUTI      ",92129919,CDM,250,RC,A9270,HCPCS,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"MVI LIQ, MULTIPLE LIQ 5ML     ",92129920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,AETNA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,CIGNA,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,WELLMED,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA,MGD,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
OXYCODONE  20MG SR TAB        ,92129927,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA CHOICE PLUS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 10MG SR TAB         ,92129928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENERGAN DM 118ML ORAL S     ,92129929,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS NEUTRAL 250 MG     ,92129931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN 2MG TAB             ,92129949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN 250MG CAP          ,92129987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROGEN CONJ 0.625MG TAB     ,92130033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,AETNA,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,BCBS,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,CIGNA,COM,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,TRICARE,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,UNITED HEALTHCARE,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,UNITED HEALTHCARE,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,VA,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,VA TRICARE,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,WELLMED,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,HUMANA,MGD,68.09,,,,,,,per diem,68.09,68.09,"Per diem rate, code is bundled with other services"
RASAGILINE 0.5MG TAB          ,92130036,CDM,250,RC,,,,,,Inpatient,1,EA,68.09,68.09,HUMANA CHOICE PLUS,MGD,68.09,,,,,,,case rate,68.09,68.09,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 2 MG/2ML INJ SOL,92130397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROATE SODIUM 250 MG/5ML PO,92130565,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,AETNA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,BCBS,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,CIGNA,COM,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,UNITED HEALTHCARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,VA,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,VA TRICARE,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,WELLMED,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,HUMANA,MGD,80.85,,,,,,,per diem,80.85,80.85,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.5 G IN SODIUM CHL,92130571,CDM,250,RC,,,,,,Inpatient,1,EA,80.85,80.85,HUMANA CHOICE PLUS,MGD,80.85,,,,,,,case rate,80.85,80.85,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,AETNA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,CIGNA,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,WELLMED,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA,MGD,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 2MEG/ML IV ,92130612,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA CHOICE PLUS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,AETNA,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,BCBS,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,CIGNA,COM,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,TRICARE,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,UNITED HEALTHCARE,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,UNITED HEALTHCARE,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,VA,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,VA TRICARE,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,WELLMED,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,HUMANA,MGD,7.18,,,,,,,per diem,7.18,7.18,"Per diem rate, code is bundled with other services"
MIDODRINE 5 MG TAB            ,92130625,CDM,250,RC,,,,,,Inpatient,1,EA,7.18,7.18,HUMANA CHOICE PLUS,MGD,7.18,,,,,,,case rate,7.18,7.18,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,AETNA,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,BCBS,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,CIGNA,COM,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,TRICARE,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,UNITED HEALTHCARE,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,UNITED HEALTHCARE,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,VA,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,VA TRICARE,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,WELLMED,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,HUMANA,MGD,8.39,,,,,,,per diem,8.39,8.39,"Per diem rate, code is bundled with other services"
PAROXETINE 10 MG TAB          ,92130706,CDM,250,RC,,,,,,Inpatient,1,EA,8.39,8.39,HUMANA CHOICE PLUS,MGD,8.39,,,,,,,case rate,8.39,8.39,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,AETNA,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,CIGNA,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,TRICARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UNITED HEALTHCARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UNITED HEALTHCARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,VA,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,VA TRICARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,WELLMED,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,HUMANA,MGD,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
ZOLPIDEM 5 MG TAB             ,92130741,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,HUMANA CHOICE PLUS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
BETAMETHASONE  DIPROPIO 0.05PC,92130777,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUB 262 MG TAB        ,92130778,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CHLORIDE INJ 100/MG SO,92130794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,AETNA,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,BCBS,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,CIGNA,COM,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,TRICARE,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,UNITED HEALTHCARE,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,UNITED HEALTHCARE,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,VA,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,VA TRICARE,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,WELLMED,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,HUMANA,MGD,35.14,,,,,,,per diem,35.14,35.14,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE INJ 100MG SO,92130795,CDM,250,RC,,,,,,Inpatient,1,EA,35.14,35.14,HUMANA CHOICE PLUS,MGD,35.14,,,,,,,case rate,35.14,35.14,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,AETNA,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,BCBS,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,CIGNA,COM,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,TRICARE,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,UNITED HEALTHCARE,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,UNITED HEALTHCARE,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,VA,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,VA TRICARE,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,WELLMED,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,HUMANA,MGD,24.44,,,,,,,per diem,24.44,24.44,"Per diem rate, code is bundled with other services"
LIDOCAINE 4PCT TOPICAL CRM    ,92130881,CDM,250,RC,,,,,,Inpatient,1,EA,24.44,24.44,HUMANA CHOICE PLUS,MGD,24.44,,,,,,,case rate,24.44,24.44,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,AETNA,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,BCBS,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,CIGNA,COM,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,TRICARE,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,UNITED HEALTHCARE,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,UNITED HEALTHCARE,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,VA,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,VA TRICARE,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,WELLMED,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,HUMANA,MGD,11.18,,,,,,,per diem,11.18,11.18,"Per diem rate, code is bundled with other services"
PIOGLITAZONE 15 MG TAB        ,92130962,CDM,250,RC,,,,,,Inpatient,1,EA,11.18,11.18,HUMANA CHOICE PLUS,MGD,11.18,,,,,,,case rate,11.18,11.18,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,AETNA,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,BCBS,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,CIGNA,COM,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,TRICARE,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,UNITED HEALTHCARE,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,UNITED HEALTHCARE,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,VA,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,VA TRICARE,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,WELLMED,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,HUMANA,MGD,29.35,,,,,,,per diem,29.35,29.35,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 12.5MG TAB         ,92130965,CDM,250,RC,,,,,,Inpatient,1,EA,29.35,29.35,HUMANA CHOICE PLUS,MGD,29.35,,,,,,,case rate,29.35,29.35,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,AETNA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,BCBS,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,CIGNA,COM,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,UNITED HEALTHCARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,VA TRICARE,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,WELLMED,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA,MGD,18.38,,,,,,,per diem,18.38,18.38,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92130972,CDM,250,RC,,,,,,Inpatient,1,EA,18.38,18.38,HUMANA CHOICE PLUS,MGD,18.38,,,,,,,case rate,18.38,18.38,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,AETNA,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,BCBS,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,CIGNA,COM,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,TRICARE,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,UNITED HEALTHCARE,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,UNITED HEALTHCARE,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,VA,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,VA TRICARE,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,WELLMED,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,HUMANA,MGD,59.37,,,,,,,per diem,59.37,59.37,"Per diem rate, code is bundled with other services"
BUDESONIDE ER                 ,92130985,CDM,250,RC,,,,,,Inpatient,1,EA,59.37,59.37,HUMANA CHOICE PLUS,MGD,59.37,,,,,,,case rate,59.37,59.37,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION                     ,92130986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,AETNA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,CIGNA,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,WELLMED,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA,MGD,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
DILTIAZEM SR                  ,92131005,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA CHOICE PLUS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PSYLLIUM *REG* PKT            ,92131070,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LANTUS INSUL GLARGINE 10ML VL ,92131100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN 50 MG ORAL CHEW     ,92131162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,AETNA,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,BCBS,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,CIGNA,COM,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,TRICARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UNITED HEALTHCARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,UNITED HEALTHCARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,VA,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,VA TRICARE,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,WELLMED,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,HUMANA,MGD,6.69,,,,,,,per diem,6.69,6.69,"Per diem rate, code is bundled with other services"
BENZONATATE 100 MG ORAL CAP   ,92131175,CDM,250,RC,,,,,,Inpatient,1,EA,6.69,6.69,HUMANA CHOICE PLUS,MGD,6.69,,,,,,,case rate,6.69,6.69,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,AETNA,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,BCBS,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,CIGNA,COM,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,TRICARE,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,UNITED HEALTHCARE,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,UNITED HEALTHCARE,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,VA,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,VA TRICARE,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,WELLMED,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,HUMANA,MGD,67.73,,,,,,,per diem,67.73,67.73,"Per diem rate, code is bundled with other services"
BRIMONIDINE 0.2  OPHT DROP    ,92131177,CDM,250,RC,,,,,,Inpatient,1,EA,67.73,67.73,HUMANA CHOICE PLUS,MGD,67.73,,,,,,,case rate,67.73,67.73,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,AETNA,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,BCBS,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,CIGNA,COM,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,TRICARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,UNITED HEALTHCARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,UNITED HEALTHCARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,VA,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,VA TRICARE,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,WELLMED,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,HUMANA,MGD,89.18,,,,,,,per diem,89.18,89.18,"Per diem rate, code is bundled with other services"
CEFTRIAXONE   2 GRAM INJ SOLR ,92131183,CDM,250,RC,,,,,,Inpatient,1,EA,89.18,89.18,HUMANA CHOICE PLUS,MGD,89.18,,,,,,,case rate,89.18,89.18,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,AETNA,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,BCBS,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,CIGNA,COM,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,TRICARE,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,UNITED HEALTHCARE,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,UNITED HEALTHCARE,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,VA,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,VA TRICARE,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,WELLMED,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,HUMANA,MGD,28.17,,,,,,,per diem,28.17,28.17,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6 MG ORAL TAB    ,92131187,CDM,250,RC,,,,,,Inpatient,1,EA,28.17,28.17,HUMANA CHOICE PLUS,MGD,28.17,,,,,,,case rate,28.17,28.17,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXEPIN  10 MG ORAL CAP       ,92131195,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,AETNA,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,CIGNA,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,TRICARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,UNITED HEALTHCARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,UNITED HEALTHCARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,VA,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,VA TRICARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,WELLMED,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,HUMANA,MGD,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
EZETIMIBE 10 MG ORAL TAB      ,92131202,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,HUMANA CHOICE PLUS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,AETNA,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,CIGNA,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,TRICARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,UNITED HEALTHCARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,UNITED HEALTHCARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,VA,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,VA TRICARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,WELLMED,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,HUMANA,MGD,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
FLUTICASONE  50 MCG/ACTUATION ,92131211,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,HUMANA CHOICE PLUS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,AETNA,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,BCBS,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,CIGNA,COM,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,TRICARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UNITED HEALTHCARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,UNITED HEALTHCARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,VA,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,VA TRICARE,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,WELLMED,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,HUMANA,MGD,6.91,,,,,,,per diem,6.91,6.91,"Per diem rate, code is bundled with other services"
GABAPENTIN 600 MG ORAL TAB    ,92131214,CDM,250,RC,,,,,,Inpatient,1,EA,6.91,6.91,HUMANA CHOICE PLUS,MGD,6.91,,,,,,,case rate,6.91,6.91,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE  75 MCG ORAL TAB,92131232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 100 MCG ORAL TAB,92131234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 125 MCG ORAL TAB,92131235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,AETNA,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,BCBS,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,CIGNA,COM,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,TRICARE,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,UNITED HEALTHCARE,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,UNITED HEALTHCARE,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,VA,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,VA TRICARE,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,WELLMED,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,HUMANA,MGD,49.58,,,,,,,per diem,49.58,49.58,"Per diem rate, code is bundled with other services"
LINACLOTIDE  72 MCG ORAL CAP  ,92131236,CDM,250,RC,,,,,,Inpatient,1,EA,49.58,49.58,HUMANA CHOICE PLUS,MGD,49.58,,,,,,,case rate,49.58,49.58,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,AETNA,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,BCBS,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,CIGNA,COM,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,TRICARE,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,UNITED HEALTHCARE,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,UNITED HEALTHCARE,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,VA,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,VA TRICARE,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,WELLMED,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,HUMANA,MGD,15.7,,,,,,,per diem,15.7,15.7,"Per diem rate, code is bundled with other services"
MELOXICAM 15 MG ORAL TAB      ,92131240,CDM,250,RC,,,,,,Inpatient,1,EA,15.7,15.7,HUMANA CHOICE PLUS,MGD,15.7,,,,,,,case rate,15.7,15.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,AETNA,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,BCBS,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,CIGNA,COM,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,TRICARE,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UNITED HEALTHCARE,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,UNITED HEALTHCARE,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,VA TRICARE,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,WELLMED,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,HUMANA,MGD,8.7,,,,,,,per diem,8.7,8.7,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE  4 MG ORAL ,92131244,CDM,250,RC,,,,,,Inpatient,1,EA,8.7,8.7,HUMANA CHOICE PLUS,MGD,8.7,,,,,,,case rate,8.7,8.7,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,AETNA,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,CIGNA,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,TRICARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UNITED HEALTHCARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UNITED HEALTHCARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,VA,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,VA TRICARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,WELLMED,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,HUMANA,MGD,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
OXYCODONE  30 MG ORAL TAB     ,92131262,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,HUMANA CHOICE PLUS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE  50 MG ORAL TAB     ,92131269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,AETNA,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,BCBS,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,CIGNA,COM,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,TRICARE,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UNITED HEALTHCARE,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,UNITED HEALTHCARE,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,VA,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,VA TRICARE,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,WELLMED,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,HUMANA,MGD,6.12,,,,,,,per diem,6.12,6.12,"Per diem rate, code is bundled with other services"
VENLAFAXINE 75 MG TABLET      ,92131303,CDM,250,RC,,,,,,Inpatient,1,EA,6.12,6.12,HUMANA CHOICE PLUS,MGD,6.12,,,,,,,case rate,6.12,6.12,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131341,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131343,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131344,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,AETNA,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,CIGNA,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,TRICARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UNITED HEALTHCARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UNITED HEALTHCARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA TRICARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,WELLMED,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,HUMANA,MGD,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
DEXTROSE 5  IN WATER D5W IN   ,92131349,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,HUMANA CHOICE PLUS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DOXAZOSIN 4 MG TABLET         ,92131369,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GABAPENTIN 400 MG CAPSULE     ,92131430,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,AETNA,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,BCBS,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,CIGNA,COM,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,TRICARE,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,UNITED HEALTHCARE,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,UNITED HEALTHCARE,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,VA,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,VA TRICARE,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,WELLMED,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,HUMANA,MGD,8.38,,,,,,,per diem,8.38,8.38,"Per diem rate, code is bundled with other services"
LACTULOSE 20 GRAM/30 ML ORAL S,92131478,CDM,250,RC,,,,,,Inpatient,1,EA,8.38,8.38,HUMANA CHOICE PLUS,MGD,8.38,,,,,,,case rate,8.38,8.38,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,AETNA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,CIGNA,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,WELLMED,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA,MGD,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LORATADINE 10 MG TABLET       ,92131483,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA CHOICE PLUS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131501,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,AETNA,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,BCBS,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,CIGNA,COM,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,TRICARE,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UNITED HEALTHCARE,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,UNITED HEALTHCARE,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,VA,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,VA TRICARE,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,WELLMED,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,HUMANA,MGD,6.75,,,,,,,per diem,6.75,6.75,"Per diem rate, code is bundled with other services"
METFORMIN 500 MG TABLET       ,92131502,CDM,250,RC,,,,,,Inpatient,1,EA,6.75,6.75,HUMANA CHOICE PLUS,MGD,6.75,,,,,,,case rate,6.75,6.75,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TABLET         ,92131602,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"PANTOPRAZOLE 40 MG TABLET,DELA",92131627,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,AETNA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,CIGNA,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,WELLMED,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA,MGD,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
PREDNISONE 1 MG TABLET        ,92131632,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA CHOICE PLUS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25 MG TABLET     ,92131669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE 0.25 MG TABLET    ,92131708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,AETNA,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,BCBS,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,CIGNA,COM,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,TRICARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,UNITED HEALTHCARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,UNITED HEALTHCARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,VA,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,VA TRICARE,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,WELLMED,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,HUMANA,MGD,34.84,,,,,,,per diem,34.84,34.84,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5 MG TAB          ,92131759,CDM,250,RC,,,,,,Inpatient,1,EA,34.84,34.84,HUMANA CHOICE PLUS,MGD,34.84,,,,,,,case rate,34.84,34.84,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 10 MG PO TABS  ,92131790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20 MG PO TABS      ,92131861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL-NALOXONE HCL,92131885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,AETNA,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,BCBS,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,CIGNA,COM,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,TRICARE,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,UNITED HEALTHCARE,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,UNITED HEALTHCARE,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,VA,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,VA TRICARE,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,WELLMED,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,HUMANA,MGD,7.55,,,,,,,per diem,7.55,7.55,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 75 MG PO TABS ,92131974,CDM,250,RC,,,,,,Inpatient,1,EA,7.55,7.55,HUMANA CHOICE PLUS,MGD,7.55,,,,,,,case rate,7.55,7.55,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN -DEX 3 OTIC SUS ,92132082,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NICOTINE 10 MG INHALATION INHA,92132135,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,AETNA,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,BCBS,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,CIGNA,COM,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,TRICARE,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,UNITED HEALTHCARE,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,UNITED HEALTHCARE,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,VA,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,VA TRICARE,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,WELLMED,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,HUMANA,MGD,101.21,,,,,,,per diem,101.21,101.21,"Per diem rate, code is bundled with other services"
ROTIGOTINE 4 MG/24HR TRANSDERM,92132159,CDM,250,RC,,,,,,Inpatient,1,EA,101.21,101.21,HUMANA CHOICE PLUS,MGD,101.21,,,,,,,case rate,101.21,101.21,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,AETNA,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,BCBS,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,CIGNA,COM,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,TRICARE,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,UNITED HEALTHCARE,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,UNITED HEALTHCARE,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,VA,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,VA TRICARE,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,WELLMED,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,HUMANA,MGD,65.84,,,,,,,per diem,65.84,65.84,"Per diem rate, code is bundled with other services"
VANCOMYCIN 1.75G IVPB         ,92132170,CDM,250,RC,,,,,,Inpatient,1,EA,65.84,65.84,HUMANA CHOICE PLUS,MGD,65.84,,,,,,,case rate,65.84,65.84,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,AETNA,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,BCBS,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,CIGNA,COM,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,TRICARE,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,UNITED HEALTHCARE,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,UNITED HEALTHCARE,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,VA,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,VA TRICARE,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,WELLMED,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,HUMANA,MGD,24.57,,,,,,,per diem,24.57,24.57,"Per diem rate, code is bundled with other services"
ALOGLIPTIN 6.25MG TAB         ,92132221,CDM,250,RC,,,,,,Inpatient,1,EA,24.57,24.57,HUMANA CHOICE PLUS,MGD,24.57,,,,,,,case rate,24.57,24.57,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,AETNA,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,BCBS,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,CIGNA,COM,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,TRICARE,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,UNITED HEALTHCARE,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,UNITED HEALTHCARE,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,VA,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,VA TRICARE,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,WELLMED,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,HUMANA,MGD,18.72,,,,,,,per diem,18.72,18.72,"Per diem rate, code is bundled with other services"
MESALAMINE 400MG CAPS         ,92132241,CDM,250,RC,,,,,,Inpatient,1,EA,18.72,18.72,HUMANA CHOICE PLUS,MGD,18.72,,,,,,,case rate,18.72,18.72,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SACCHAROMYCES BOULAR CAPS     ,92132254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,AETNA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,BCBS,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,CIGNA,COM,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,UNITED HEALTHCARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,VA,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,VA TRICARE,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,WELLMED,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,HUMANA,MGD,15.75,,,,,,,per diem,15.75,15.75,"Per diem rate, code is bundled with other services"
MYCOPHENOLICACID 360MG TABDR  ,92132291,CDM,250,RC,,,,,,Inpatient,1,EA,15.75,15.75,HUMANA CHOICE PLUS,MGD,15.75,,,,,,,case rate,15.75,15.75,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,AETNA,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,BCBS,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,CIGNA,COM,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,TRICARE,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,UNITED HEALTHCARE,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,UNITED HEALTHCARE,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,VA,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,VA TRICARE,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,WELLMED,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,HUMANA,MGD,7.01,,,,,,,per diem,7.01,7.01,"Per diem rate, code is bundled with other services"
DABIGATRAN ETEX 150MG CAP     ,92132333,CDM,250,RC,,,,,,Inpatient,1,EA,7.01,7.01,HUMANA CHOICE PLUS,MGD,7.01,,,,,,,case rate,7.01,7.01,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,AETNA,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,BCBS,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,CIGNA,COM,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,TRICARE,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,UNITED HEALTHCARE,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,UNITED HEALTHCARE,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,VA,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,VA TRICARE,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,WELLMED,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,HUMANA,MGD,9.44,,,,,,,per diem,9.44,9.44,"Per diem rate, code is bundled with other services"
REPAGLINIDE 1 MG TAB          ,92132353,CDM,250,RC,,,,,,Inpatient,1,EA,9.44,9.44,HUMANA CHOICE PLUS,MGD,9.44,,,,,,,case rate,9.44,9.44,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
KLONOPIN 1MG TAB              ,92132375,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ATIVAN 4MG 1ML                ,92132380,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,AETNA,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,BCBS,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,CIGNA,COM,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,TRICARE,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,UNITED HEALTHCARE,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,UNITED HEALTHCARE,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,VA,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,VA TRICARE,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,WELLMED,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,HUMANA,MGD,10.51,,,,,,,per diem,10.51,10.51,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE-ATROPINE 2.5-.02,92132399,CDM,250,RC,,,,,,Inpatient,1,EA,10.51,10.51,HUMANA CHOICE PLUS,MGD,10.51,,,,,,,case rate,10.51,10.51,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,AETNA,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,BCBS,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,CIGNA,COM,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,TRICARE,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,UNITED HEALTHCARE,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,UNITED HEALTHCARE,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,VA,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,VA TRICARE,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,WELLMED,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,HUMANA,MGD,142.09,,,,,,,per diem,142.09,142.09,"Per diem rate, code is bundled with other services"
FLUTICASONE FUROATE-VILANTEROL,92132405,CDM,250,RC,,,,,,Inpatient,1,EA,142.09,142.09,HUMANA CHOICE PLUS,MGD,142.09,,,,,,,case rate,142.09,142.09,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,AETNA,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,BCBS,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,CIGNA,COM,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,TRICARE,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,UNITED HEALTHCARE,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,UNITED HEALTHCARE,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,VA,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,VA TRICARE,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,WELLMED,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,HUMANA,MGD,7.64,,,,,,,per diem,7.64,7.64,"Per diem rate, code is bundled with other services"
OXYCODONE 5 MG TAB            ,92132440,CDM,250,RC,,,,,,Inpatient,1,EA,7.64,7.64,HUMANA CHOICE PLUS,MGD,7.64,,,,,,,case rate,7.64,7.64,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,AETNA,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,BCBS,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,CIGNA,COM,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,TRICARE,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,UNITED HEALTHCARE,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,UNITED HEALTHCARE,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,VA,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,VA TRICARE,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,WELLMED,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,HUMANA,MGD,37.73,,,,,,,per diem,37.73,37.73,"Per diem rate, code is bundled with other services"
RALOXIFENE 60 MG TAB          ,92132505,CDM,250,RC,,,,,,Inpatient,1,EA,37.73,37.73,HUMANA CHOICE PLUS,MGD,37.73,,,,,,,case rate,37.73,37.73,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,AETNA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,CIGNA,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,WELLMED,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA,MGD,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME 250MG TAB          ,92132509,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA CHOICE PLUS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,AETNA,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,BCBS,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,CIGNA,COM,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,TRICARE,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UNITED HEALTHCARE,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,UNITED HEALTHCARE,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,VA TRICARE,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,WELLMED,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,HUMANA,MGD,7.05,,,,,,,per diem,7.05,7.05,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20MEQ TBTQ      ,92132516,CDM,250,RC,,,,,,Inpatient,1,EA,7.05,7.05,HUMANA CHOICE PLUS,MGD,7.05,,,,,,,case rate,7.05,7.05,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,AETNA,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,BCBS,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,CIGNA,COM,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,TRICARE,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,UNITED HEALTHCARE,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,UNITED HEALTHCARE,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,VA,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,VA TRICARE,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,WELLMED,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,HUMANA,MGD,5.3,,,,,,,per diem,5.3,5.3,"Per diem rate, code is bundled with other services"
LOSARTAN 25 MG TAB            ,92132529,CDM,250,RC,,,,,,Inpatient,1,EA,5.3,5.3,HUMANA CHOICE PLUS,MGD,5.3,,,,,,,case rate,5.3,5.3,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
PROPRANOLOL 20 MG TAB         ,92132532,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,AETNA,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,BCBS,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,CIGNA,COM,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,TRICARE,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,UNITED HEALTHCARE,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,UNITED HEALTHCARE,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,VA,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,VA TRICARE,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,WELLMED,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,HUMANA,MGD,302.91,,,,,,,per diem,302.91,302.91,"Per diem rate, code is bundled with other services"
ISAVUCONAZONIUM NA 186MG CAP  ,92132546,CDM,250,RC,,,,,,Inpatient,1,EA,302.91,302.91,HUMANA CHOICE PLUS,MGD,302.91,,,,,,,case rate,302.91,302.91,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VANCOMYCIN 125MG CAP          ,92132577,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LOMOTIL 0.025 MG-2.5 MG Tablet,92132581,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,AETNA,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,BCBS,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,CIGNA,COM,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,TRICARE,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,UNITED HEALTHCARE,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,UNITED HEALTHCARE,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,VA,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,VA TRICARE,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,WELLMED,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,HUMANA,MGD,10.06,,,,,,,per diem,10.06,10.06,"Per diem rate, code is bundled with other services"
TRIAMTERENE 50MG CAP          ,92132608,CDM,250,RC,,,,,,Inpatient,1,EA,10.06,10.06,HUMANA CHOICE PLUS,MGD,10.06,,,,,,,case rate,10.06,10.06,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,AETNA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,BCBS,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,CIGNA,COM,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,UNITED HEALTHCARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,VA TRICARE,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,WELLMED,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA,MGD,19.76,,,,,,,per diem,19.76,19.76,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 20 MEG PO PK    ,92132618,CDM,250,RC,,,,,,Inpatient,1,EA,19.76,19.76,HUMANA CHOICE PLUS,MGD,19.76,,,,,,,case rate,19.76,19.76,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACTRIM 400-80MG TAB          ,92132619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
CYANOCOBALAMIN 2500MCG TAB    ,92132818,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 3000 UN TAB           ,92132850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,AETNA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,CIGNA,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,WELLMED,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA,MGD,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
ANCEF 1GM VIA                 ,92132940,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA CHOICE PLUS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,AETNA,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,BCBS,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,CIGNA,COM,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,TRICARE,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,UNITED HEALTHCARE,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,UNITED HEALTHCARE,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,VA,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,VA TRICARE,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,WELLMED,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,HUMANA,MGD,45.41,,,,,,,per diem,45.41,45.41,"Per diem rate, code is bundled with other services"
ANCEF 2GM PREMIX              ,92132941,CDM,250,RC,,,,,,Inpatient,1,EA,45.41,45.41,HUMANA CHOICE PLUS,MGD,45.41,,,,,,,case rate,45.41,45.41,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ANTIVERT 12.5                 ,92132942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 25 MG          ,92132943,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA 325MG TAB                 ,92132944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASA EC  81MG                  ,92132945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENADRYL TAB                  ,92132946,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,AETNA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,CIGNA,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,WELLMED,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA,MGD,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
BETAPACE TAB                  ,92132947,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA CHOICE PLUS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPAR TAB  5                 ,92132948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARAFATE TAB                  ,92132949,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CATAPRES TAB 0.1MG            ,92132950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFTIN TAB 25                 ,92132951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHULAC SYR                  ,92132952,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLARITIN TAB                  ,92132953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE CAP 10                 ,92132954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLACE LIQ 10                 ,92132955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,AETNA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,BCBS,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,CIGNA,COM,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,UNITED HEALTHCARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,VA,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,VA TRICARE,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,WELLMED,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,HUMANA,MGD,6.04,,,,,,,per diem,6.04,6.04,"Per diem rate, code is bundled with other services"
COREG 25 MG                   ,92132956,CDM,250,RC,,,,,,Inpatient,1,EA,6.04,6.04,HUMANA CHOICE PLUS,MGD,6.04,,,,,,,case rate,6.04,6.04,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,AETNA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,BCBS,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,CIGNA,COM,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,UNITED HEALTHCARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,VA TRICARE,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,WELLMED,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA,MGD,6.83,,,,,,,per diem,6.83,6.83,"Per diem rate, code is bundled with other services"
COREG 3.125 MG                ,92132957,CDM,250,RC,,,,,,Inpatient,1,EA,6.83,6.83,HUMANA CHOICE PLUS,MGD,6.83,,,,,,,case rate,6.83,6.83,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,AETNA,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,BCBS,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,CIGNA,COM,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,TRICARE,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,UNITED HEALTHCARE,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,UNITED HEALTHCARE,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,VA,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,VA TRICARE,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,WELLMED,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,HUMANA,MGD,16.28,,,,,,,per diem,16.28,16.28,"Per diem rate, code is bundled with other services"
CORGARD TAB 2                 ,92132958,CDM,250,RC,,,,,,Inpatient,1,EA,16.28,16.28,HUMANA CHOICE PLUS,MGD,16.28,,,,,,,case rate,16.28,16.28,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CORTEF TAB 10                 ,92132959,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COUMADIN 2.5M                 ,92132960,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
COZAAR TAB  5                 ,92132961,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON TAB                  ,92132962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DESYREL TAB 5                 ,92132963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DICOFLENAC GEL 1 1            ,92132964,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
DILAUDID TAB 4MG              ,92132965,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DITROPAN TAB                  ,92132966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,AETNA,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,BCBS,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,CIGNA,COM,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,TRICARE,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,UNITED HEALTHCARE,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,UNITED HEALTHCARE,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,VA,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,VA TRICARE,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,WELLMED,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,HUMANA,MGD,12.86,,,,,,,per diem,12.86,12.86,"Per diem rate, code is bundled with other services"
DITROPAN-XL 5 MG              ,92132967,CDM,250,RC,,,,,,Inpatient,1,EA,12.86,12.86,HUMANA CHOICE PLUS,MGD,12.86,,,,,,,case rate,12.86,12.86,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,AETNA,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,BCBS,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,CIGNA,COM,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,TRICARE,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,UNITED HEALTHCARE,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,UNITED HEALTHCARE,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,VA,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,VA TRICARE,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,WELLMED,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,HUMANA,MGD,66.94,,,,,,,per diem,66.94,66.94,"Per diem rate, code is bundled with other services"
DURAGESIC  25                 ,92132968,CDM,250,RC,,,,,,Inpatient,1,EA,66.94,66.94,HUMANA CHOICE PLUS,MGD,66.94,,,,,,,case rate,66.94,66.94,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 10                 ,92132969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ELAVIL TAB 25                 ,92132970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULFA                 ,92132971,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAGYL TAB 50                 ,92132972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLVITE TAB 1                 ,92132973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,AETNA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,BCBS,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,CIGNA,COM,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,UNITED HEALTHCARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,VA,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,VA TRICARE,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,WELLMED,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,HUMANA,MGD,43.05,,,,,,,per diem,43.05,43.05,"Per diem rate, code is bundled with other services"
FOSOMAX 70 MG                 ,92132974,CDM,250,RC,,,,,,Inpatient,1,EA,43.05,43.05,HUMANA CHOICE PLUS,MGD,43.05,,,,,,,case rate,43.05,43.05,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTROL TAB                 ,92132975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLUCOTRON XL 5 MG             ,92132976,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRODIURIL T                 ,92132977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL TAB 20MG              ,92132978,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 10 TAB 10                 ,92132979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KCL 20 MEQ ER                 ,92132980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
KEFLEX CAP 50                 ,92132981,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA TAB 50                 ,92132982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
LAMICTAL TAB                  ,92132983,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 20M                 ,92132984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LASIX TAB 40M                 ,92132985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
LEXPARO 10 MG                 ,92132986,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,AETNA,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,BCBS,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,CIGNA,COM,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,TRICARE,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,UNITED HEALTHCARE,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,UNITED HEALTHCARE,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,VA,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,VA TRICARE,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,WELLMED,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,HUMANA,MGD,4.85,,,,,,,per diem,4.85,4.85,"Per diem rate, code is bundled with other services"
LIDODERM 4pct P               ,92132987,CDM,250,RC,,,,,,Inpatient,1,EA,4.85,4.85,HUMANA CHOICE PLUS,MGD,4.85,,,,,,,case rate,4.85,4.85,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 25MG            ,92132988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPRESSOR TAB 50MG            ,92132989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 3                 ,92132990,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 4                 ,92132991,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
LOVENOX INJ 6                 ,92132992,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,AETNA,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,BCBS,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,CIGNA,COM,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,TRICARE,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,UNITED HEALTHCARE,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,UNITED HEALTHCARE,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,VA,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,VA TRICARE,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,WELLMED,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,HUMANA,MGD,26.08,,,,,,,per diem,26.08,26.08,"Per diem rate, code is bundled with other services"
LOVENOX INJ 8                 ,92132993,CDM,250,RC,,,,,,Inpatient,1,EA,26.08,26.08,HUMANA CHOICE PLUS,MGD,26.08,,,,,,,case rate,26.08,26.08,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MACROBID                      ,92132994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROL 4MG TA                 ,92132995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,AETNA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,CIGNA,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,WELLMED,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA,MGD,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
MEGACE SUSP 4                 ,92132996,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA CHOICE PLUS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,AETNA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,CIGNA,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,WELLMED,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA,MGD,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
MOBIC 15 GM                   ,92132997,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA CHOICE PLUS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
MOM  30ML                     ,92132998,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MOTRIN 800MG                  ,92132999,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MUCINEX TAB 6                 ,92133000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NACL 1000ML I                 ,92133001,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 100MG           ,92133002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 300MG           ,92133003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURONTIN CAP 400MG           ,92133004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE 4pct 3ML         ,92133005,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,AETNA,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,BCBS,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,CIGNA,COM,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,TRICARE,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,UNITED HEALTHCARE,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,UNITED HEALTHCARE,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,VA,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,VA TRICARE,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,WELLMED,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,HUMANA,MGD,34.13,,,,,,,per diem,34.13,34.13,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON MYRB           ,92133006,CDM,250,RC,,,,,,Inpatient,1,EA,34.13,34.13,HUMANA CHOICE PLUS,MGD,34.13,,,,,,,case rate,34.13,34.13,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NS 100ML IV                   ,92133007,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,AETNA,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,BCBS,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,CIGNA,COM,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,TRICARE,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,UNITED HEALTHCARE,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,UNITED HEALTHCARE,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,VA,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,VA TRICARE,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,WELLMED,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,HUMANA,MGD,59.33,,,,,,,per diem,59.33,59.33,"Per diem rate, code is bundled with other services"
NYSTOP PDW 1000U/GM           ,92133008,CDM,250,RC,,,,,,Inpatient,1,EA,59.33,59.33,HUMANA CHOICE PLUS,MGD,59.33,,,,,,,case rate,59.33,59.33,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSCAL W VITD 600-400          ,92133009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,AETNA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,CIGNA,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,WELLMED,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA,MGD,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP PERC           ,92133011,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA CHOICE PLUS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,AETNA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,BCBS,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,CIGNA,COM,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,UNITED HEALTHCARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,VA TRICARE,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,WELLMED,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA,MGD,7.61,,,,,,,per diem,7.61,7.61,"Per diem rate, code is bundled with other services"
PEPCID 20MG T                 ,92133012,CDM,250,RC,,,,,,Inpatient,1,EA,7.61,7.61,HUMANA CHOICE PLUS,MGD,7.61,,,,,,,case rate,7.61,7.61,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PLAQUENIL TAB                 ,92133013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POM #5                        ,92133014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 10MG                 ,92133015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRINIVIL 20 MG                ,92133016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,AETNA,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,CIGNA,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,TRICARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,UNITED HEALTHCARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,UNITED HEALTHCARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,VA,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,VA TRICARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,WELLMED,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,HUMANA,MGD,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
PROVENTIL INH                 ,92133017,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,HUMANA CHOICE PLUS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBAXIN TAB 5                 ,92133018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,AETNA,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,BCBS,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,CIGNA,COM,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,TRICARE,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,UNITED HEALTHCARE,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,UNITED HEALTHCARE,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,VA,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,VA TRICARE,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,WELLMED,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,HUMANA,MGD,16.41,,,,,,,per diem,16.41,16.41,"Per diem rate, code is bundled with other services"
ROCEPHIN IVPB                 ,92133019,CDM,250,RC,,,,,,Inpatient,1,EA,16.41,16.41,HUMANA CHOICE PLUS,MGD,16.41,,,,,,,case rate,16.41,16.41,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 5MG             ,92133020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALT 1G TABLE                 ,92133021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
SEROQUEL TAB                  ,92133022,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SYNTHROID TAB 0.1MG           ,92133023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TYLENOL #3                    ,92133024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ULTRAM 50MG T                 ,92133025,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
VALIUM TAB 5M                 ,92133026,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,AETNA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,BCBS,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,CIGNA,COM,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,UNITED HEALTHCARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,VA TRICARE,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,WELLMED,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA,MGD,14.7,,,,,,,per diem,14.7,14.7,"Per diem rate, code is bundled with other services"
VIBRATABS TAB                 ,92133027,CDM,250,RC,,,,,,Inpatient,1,EA,14.7,14.7,HUMANA CHOICE PLUS,MGD,14.7,,,,,,,case rate,14.7,14.7,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN C TAB                 ,92133028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
XANAX TAB 0.2                 ,92133029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,AETNA,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,BCBS,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,CIGNA,COM,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,TRICARE,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,UNITED HEALTHCARE,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,UNITED HEALTHCARE,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,VA,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,VA TRICARE,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,WELLMED,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,HUMANA,MGD,86.89,,,,,,,per diem,86.89,86.89,"Per diem rate, code is bundled with other services"
XIFAXAN TAB 5                 ,92133030,CDM,250,RC,,,,,,Inpatient,1,EA,86.89,86.89,HUMANA CHOICE PLUS,MGD,86.89,,,,,,,case rate,86.89,86.89,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC SULFATE                  ,92133031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,AETNA,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,CIGNA,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,TRICARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,UNITED HEALTHCARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,UNITED HEALTHCARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,VA,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,VA TRICARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,WELLMED,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,HUMANA,MGD,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR  40MG T                 ,92133032,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,HUMANA CHOICE PLUS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
ZOCOR 10 MG                   ,92133033,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,AETNA,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,BCBS,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,CIGNA,COM,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,TRICARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,UNITED HEALTHCARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,UNITED HEALTHCARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,VA,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,VA TRICARE,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,WELLMED,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,HUMANA,MGD,15.49,,,,,,,per diem,15.49,15.49,"Per diem rate, code is bundled with other services"
ZOCOR 20MG TA                 ,92133034,CDM,250,RC,,,,,,Inpatient,1,EA,15.49,15.49,HUMANA CHOICE PLUS,MGD,15.49,,,,,,,case rate,15.49,15.49,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLOFT 25 MG                  ,92133035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,AETNA,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,BCBS,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,CIGNA,COM,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,TRICARE,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,UNITED HEALTHCARE,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,UNITED HEALTHCARE,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,VA,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,VA TRICARE,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,WELLMED,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,HUMANA,MGD,8.93,,,,,,,per diem,8.93,8.93,"Per diem rate, code is bundled with other services"
ZOLOFT TAB 50                 ,92133036,CDM,250,RC,,,,,,Inpatient,1,EA,8.93,8.93,HUMANA CHOICE PLUS,MGD,8.93,,,,,,,case rate,8.93,8.93,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZYLOPRIM TAB 100MG            ,92133037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
CALAN SR                      ,92133038,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DUONEB                        ,92133039,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,AETNA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,BCBS,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,CIGNA,COM,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,UNITED HEALTHCARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,VA TRICARE,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,WELLMED,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA,MGD,10.5,,,,,,,per diem,10.5,10.5,"Per diem rate, code is bundled with other services"
IMDUR TAB                     ,92133040,CDM,250,RC,,,,,,Inpatient,1,EA,10.5,10.5,HUMANA CHOICE PLUS,MGD,10.5,,,,,,,case rate,10.5,10.5,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
PERIDEX 1                     ,92133041,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,AETNA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,BCBS,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,CIGNA,COM,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,UNITED HEALTHCARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,VA TRICARE,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,WELLMED,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA,MGD,7.35,,,,,,,per diem,7.35,7.35,"Per diem rate, code is bundled with other services"
CHLORTALIDONE 25              ,92133042,CDM,250,RC,,,,,,Inpatient,1,EA,7.35,7.35,HUMANA CHOICE PLUS,MGD,7.35,,,,,,,case rate,7.35,7.35,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARDURA 1MG TAB               ,92133043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENTYL 10MG CAP               ,92133044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATARAX TAB 25                 ,92133045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
APRESOLINE TAB 10MG           ,92133046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMODIUM CAP 2                 ,92133050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROXICODONE IR 10MG            ,92133051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXYFYLLINE TREN           ,92133052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO 95MG TAB                  ,92133061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,AETNA,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,BCBS,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,CIGNA,COM,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,TRICARE,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,UNITED HEALTHCARE,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,UNITED HEALTHCARE,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,VA,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,VA TRICARE,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,WELLMED,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,HUMANA,MGD,122.59,,,,,,,per diem,122.59,122.59,"Per diem rate, code is bundled with other services"
DURAGESIC 50                  ,92133062,CDM,250,RC,,,,,,Inpatient,1,EA,122.59,122.59,HUMANA CHOICE PLUS,MGD,122.59,,,,,,,case rate,122.59,122.59,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDERAL 10MG                  ,92133063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOCIN CAP 2                 ,92133064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN ER                     ,92133065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,AETNA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,BCBS,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,CIGNA,COM,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,UNITED HEALTHCARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,VA TRICARE,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,WELLMED,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA,MGD,11.29,,,,,,,per diem,11.29,11.29,"Per diem rate, code is bundled with other services"
TREXALL 2.5MG                 ,92133066,CDM,250,RC,,,,,,Inpatient,1,EA,11.29,11.29,HUMANA CHOICE PLUS,MGD,11.29,,,,,,,case rate,11.29,11.29,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,AETNA,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,BCBS,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,CIGNA,COM,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,TRICARE,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,UNITED HEALTHCARE,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,UNITED HEALTHCARE,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,VA,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,VA TRICARE,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,WELLMED,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,HUMANA,MGD,12.43,,,,,,,per diem,12.43,12.43,"Per diem rate, code is bundled with other services"
DOFETILIDE 125 MCG CAP        ,92133090,CDM,250,RC,,,,,,Inpatient,1,EA,12.43,12.43,HUMANA CHOICE PLUS,MGD,12.43,,,,,,,case rate,12.43,12.43,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDISYLATE 10 ,92133120,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,AETNA,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,BCBS,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,CIGNA,COM,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,TRICARE,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,UNITED HEALTHCARE,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,UNITED HEALTHCARE,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,VA,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,VA TRICARE,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,WELLMED,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,HUMANA,MGD,38.69,,,,,,,per diem,38.69,38.69,"Per diem rate, code is bundled with other services"
SODIUM ZIRCONIUM CYCOSL 10GM P,92133145,CDM,250,RC,,,,,,Inpatient,1,EA,38.69,38.69,HUMANA CHOICE PLUS,MGD,38.69,,,,,,,case rate,38.69,38.69,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,AETNA,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,BCBS,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,CIGNA,COM,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,TRICARE,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,UNITED HEALTHCARE,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,UNITED HEALTHCARE,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,VA,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,VA TRICARE,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,WELLMED,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,HUMANA,MGD,179.53,,,,,,,per diem,179.53,179.53,"Per diem rate, code is bundled with other services"
MOMETASONE/FORMOTEROL 200/5 MC,92133155,CDM,250,RC,,,,,,Inpatient,1,EA,179.53,179.53,HUMANA CHOICE PLUS,MGD,179.53,,,,,,,case rate,179.53,179.53,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHLORIDE 10 MEQ TABL,92133156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE 25MG TAB        ,92133170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,AETNA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,CIGNA,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,VA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,VA TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,WELLMED,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,HUMANA,MGD,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
PHENYTOIN 100MG/4ML ORAL SUS  ,92133272,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,HUMANA CHOICE PLUS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
ROPINIROLE ER 2MG TAB ER      ,92133284,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,AETNA,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,BCBS,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,CIGNA,COM,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,TRICARE,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,UNITED HEALTHCARE,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,UNITED HEALTHCARE,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,VA,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,VA TRICARE,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,WELLMED,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,HUMANA,MGD,442.51,,,,,,,per diem,442.51,442.51,"Per diem rate, code is bundled with other services"
ERTAPENEM NA 1 GM VL          ,92133291,CDM,250,RC,,,,,,Inpatient,1,EA,442.51,442.51,HUMANA CHOICE PLUS,MGD,442.51,,,,,,,case rate,442.51,442.51,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM-ALBUT 0.5-2.5     ,92133304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VENLAFAXINE 50MG TAB          ,92133347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE 5 MG TABLET        ,92133358,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,AETNA,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,BCBS,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,CIGNA,COM,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,TRICARE,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,UNITED HEALTHCARE,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,UNITED HEALTHCARE,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,VA,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,VA TRICARE,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,WELLMED,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,HUMANA,MGD,26.75,,,,,,,per diem,26.75,26.75,"Per diem rate, code is bundled with other services"
VANCOMYCIN 50 MG/ML ORAL SOLUT,92133369,CDM,250,RC,,,,,,Inpatient,1,EA,26.75,26.75,HUMANA CHOICE PLUS,MGD,26.75,,,,,,,case rate,26.75,26.75,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,AETNA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,CIGNA,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,WELLMED,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA,MGD,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN 10MG TAB        ,92133393,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA CHOICE PLUS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLTERODINE 1MG TAB           ,92133426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,AETNA,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,BCBS,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,CIGNA,COM,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,TRICARE,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,UNITED HEALTHCARE,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,UNITED HEALTHCARE,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,VA,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,VA TRICARE,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,WELLMED,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,HUMANA,MGD,37.71,,,,,,,per diem,37.71,37.71,"Per diem rate, code is bundled with other services"
MENTHOL 5.8 MG LOZENGES       ,92133456,CDM,250,RC,,,,,,Inpatient,1,EA,37.71,37.71,HUMANA CHOICE PLUS,MGD,37.71,,,,,,,case rate,37.71,37.71,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,AETNA,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,BCBS,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,CIGNA,COM,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,TRICARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,UNITED HEALTHCARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,UNITED HEALTHCARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,VA,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,VA TRICARE,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,WELLMED,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,HUMANA,MGD,9.17,,,,,,,per diem,9.17,9.17,"Per diem rate, code is bundled with other services"
COUMADIN TAB                  ,92133486,CDM,250,RC,,,,,,Inpatient,1,EA,9.17,9.17,HUMANA CHOICE PLUS,MGD,9.17,,,,,,,case rate,9.17,9.17,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,AETNA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,BCBS,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,CIGNA,COM,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,UNITED HEALTHCARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,VA,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,VA TRICARE,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,WELLMED,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,HUMANA,MGD,45.15,,,,,,,per diem,45.15,45.15,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133487,CDM,250,RC,,,,,,Inpatient,1,EA,45.15,45.15,HUMANA CHOICE PLUS,MGD,45.15,,,,,,,case rate,45.15,45.15,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIBERTY NON-FORMULARY         ,92133488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHOSPHORUS 250MG              ,92133489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,AETNA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,CIGNA,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,VA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,VA TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,WELLMED,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,HUMANA,MGD,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 600MCG      ,92133514,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,HUMANA CHOICE PLUS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEFAZOLIN NA NS 1GM           ,92133515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,AETNA,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,BCBS,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,CIGNA,COM,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,TRICARE,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,UNITED HEALTHCARE,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,UNITED HEALTHCARE,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,VA,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,VA TRICARE,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,WELLMED,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,HUMANA,MGD,44.01,,,,,,,per diem,44.01,44.01,"Per diem rate, code is bundled with other services"
FOSPHENYTOIN NA 100MG VL      ,92133516,CDM,250,RC,,,,,,Inpatient,1,EA,44.01,44.01,HUMANA CHOICE PLUS,MGD,44.01,,,,,,,case rate,44.01,44.01,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 20MG VL         ,92133517,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 40MG SOL        ,92133518,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CHL 8MEQ TAB        ,92133519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,AETNA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,CIGNA,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,WELLMED,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA,MGD,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
PROTAMINE SULF 50MG VL        ,92133520,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA CHOICE PLUS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 1 MEQ SYR       ,92133521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,AETNA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,CIGNA,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,WELLMED,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA,MGD,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133600,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA CHOICE PLUS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,AETNA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,CIGNA,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,WELLMED,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA,MGD,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133610,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA CHOICE PLUS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,AETNA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,BCBS,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,CIGNA,COM,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,UNITED HEALTHCARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,VA TRICARE,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,WELLMED,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA,MGD,71.22,,,,,,,per diem,71.22,71.22,"Per diem rate, code is bundled with other services"
DAPAGLIFLOZIN                 ,92133618,CDM,250,RC,,,,,,Inpatient,1,EA,71.22,71.22,HUMANA CHOICE PLUS,MGD,71.22,,,,,,,case rate,71.22,71.22,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,AETNA,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,BCBS,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,CIGNA,COM,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,TRICARE,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,UNITED HEALTHCARE,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,UNITED HEALTHCARE,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,VA,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,VA TRICARE,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,WELLMED,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,HUMANA,MGD,40.01,,,,,,,per diem,40.01,40.01,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133619,CDM,250,RC,,,,,,Inpatient,1,EA,40.01,40.01,HUMANA CHOICE PLUS,MGD,40.01,,,,,,,case rate,40.01,40.01,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SAXAGLIPTIN                   ,92133620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,AETNA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,CIGNA,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,WELLMED,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA,MGD,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
BUTALB/ACETAMINOPHEN/CAFFEINE ,92133621,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA CHOICE PLUS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
DIVALPROEX ER                 ,92133622,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN UD               ,92133710,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALOGLIPTIN                    ,92133711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IXEKIZUMAB 80 MG/ML SC SOAJ   ,92133737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HUMALOG SLIDING SCALE MEDIUM-L,92133738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PEDIALYTE ORAL SOLN           ,92133739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIOL 10 % CREA             ,92133740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AFATINIB DIMALEATE 20 MG ORAL ,92133741,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ADRENAL ORAL CAPS             ,92133742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMETHICONE 6 % EXTERNALLY CRE,92133743,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZOLPIDEM (AMBIEN) TABLET 2.5 M,92133744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BOSWELLIA SERRATA EXTRACT POWD,92133745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUDESONIDE POWD               ,92133746,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NEURIVA ORAL CHEW             ,92133747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FREMANEZUMAB-VFRM 225 MG/1.5ML,92133748,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM ASCORBATE POWD        ,92133749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREXPIPRAZOLE 0.25 MG ORAL TAB,92133750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALIROCUMAB 150 MG/ML SC SOAJ  ,92133751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GADOTERATE MEGLUMINE 0.5 MMOL/,92133752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZO BLADDER CONTROL/GO-LESS OR,92133753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,AETNA,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,BCBS,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,CIGNA,COM,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,TRICARE,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,UNITED HEALTHCARE,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,UNITED HEALTHCARE,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,VA,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,VA TRICARE,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,WELLMED,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,HUMANA,MGD,4.9,,,,,,,per diem,4.9,4.9,"Per diem rate, code is bundled with other services"
BUPROPION HCL ER (XL) 150 MG O,92133754,CDM,250,RC,,,,,,Inpatient,1,EA,4.9,4.9,HUMANA CHOICE PLUS,MGD,4.9,,,,,,,case rate,4.9,4.9,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,AETNA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,BCBS,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,CIGNA,COM,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,UNITED HEALTHCARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,VA,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,VA TRICARE,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,WELLMED,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,HUMANA,MGD,28.92,,,,,,,per diem,28.92,28.92,"Per diem rate, code is bundled with other services"
SODIUM CHLORIDE FLUSH 0.9 % IV,92133755,CDM,250,RC,,,,,,Inpatient,1,EA,28.92,28.92,HUMANA CHOICE PLUS,MGD,28.92,,,,,,,case rate,28.92,28.92,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,AETNA,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,BCBS,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,CIGNA,COM,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,TRICARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,UNITED HEALTHCARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,UNITED HEALTHCARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,VA,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,VA TRICARE,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,WELLMED,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,HUMANA,MGD,10.31,,,,,,,per diem,10.31,10.31,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE ER 200 MG ORAL T,92133756,CDM,250,RC,,,,,,Inpatient,1,EA,10.31,10.31,HUMANA CHOICE PLUS,MGD,10.31,,,,,,,case rate,10.31,10.31,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,AETNA,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,BCBS,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,CIGNA,COM,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,TRICARE,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,UNITED HEALTHCARE,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,UNITED HEALTHCARE,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,VA,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,VA TRICARE,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,WELLMED,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,HUMANA,MGD,4.71,,,,,,,per diem,4.71,4.71,"Per diem rate, code is bundled with other services"
LISINOPRIL 2.5 MG ORAL TABS   ,92133757,CDM,250,RC,,,,,,Inpatient,1,EA,4.71,4.71,HUMANA CHOICE PLUS,MGD,4.71,,,,,,,case rate,4.71,4.71,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,AETNA,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,BCBS,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,CIGNA,COM,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,TRICARE,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,UNITED HEALTHCARE,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,UNITED HEALTHCARE,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,VA,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,VA TRICARE,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,WELLMED,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,HUMANA,MGD,47.08,,,,,,,per diem,47.08,47.08,"Per diem rate, code is bundled with other services"
NIMODIPINE 30 MG ORAL CAPS    ,92133758,CDM,250,RC,,,,,,Inpatient,1,EA,47.08,47.08,HUMANA CHOICE PLUS,MGD,47.08,,,,,,,case rate,47.08,47.08,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,AETNA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,BCBS,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,CIGNA,COM,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,UNITED HEALTHCARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,VA TRICARE,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,WELLMED,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA,MGD,31.5,,,,,,,per diem,31.5,31.5,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135003,CDM,250,RC,,,,,,Inpatient,1,EA,31.5,31.5,HUMANA CHOICE PLUS,MGD,31.5,,,,,,,case rate,31.5,31.5,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135004,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135007,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135008,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NON FORMULARY                 ,92135009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,AETNA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,BCBS,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,CIGNA,COM,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,UNITED HEALTHCARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,VA,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,VA TRICARE,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,WELLMED,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,HUMANA,MGD,20.48,,,,,,,per diem,20.48,20.48,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135012,CDM,250,RC,,,,,,Inpatient,1,EA,20.48,20.48,HUMANA CHOICE PLUS,MGD,20.48,,,,,,,case rate,20.48,20.48,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LONGVIEW NF OPEN              ,92135017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135021,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,AETNA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,BCBS,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,CIGNA,COM,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,UNITED HEALTHCARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,VA,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,VA TRICARE,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,WELLMED,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,HUMANA,MGD,47.25,,,,,,,per diem,47.25,47.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135022,CDM,250,RC,,,,,,Inpatient,1,EA,47.25,47.25,HUMANA CHOICE PLUS,MGD,47.25,,,,,,,case rate,47.25,47.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NWA NF OPEN                   ,92135027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,AETNA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,BCBS,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,CIGNA,COM,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,UNITED HEALTHCARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,VA TRICARE,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,WELLMED,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA,MGD,13.13,,,,,,,per diem,13.13,13.13,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135030,CDM,250,RC,,,,,,Inpatient,1,EA,13.13,13.13,HUMANA CHOICE PLUS,MGD,13.13,,,,,,,case rate,13.13,13.13,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,AETNA,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,BCBS,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,CIGNA,COM,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,TRICARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,UNITED HEALTHCARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,UNITED HEALTHCARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,VA,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,VA TRICARE,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,WELLMED,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,HUMANA,MGD,150.68,,,,,,,per diem,150.68,150.68,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135031,CDM,250,RC,,,,,,Inpatient,1,EA,150.68,150.68,HUMANA CHOICE PLUS,MGD,150.68,,,,,,,case rate,150.68,150.68,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,AETNA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,CIGNA,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,WELLMED,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA,MGD,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135035,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA CHOICE PLUS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMPLE NF OPEN                ,92135037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KEPPRA PO SOLN                ,92135038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,AETNA,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,BCBS,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,CIGNA,COM,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,TRICARE,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,UNITED HEALTHCARE,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,UNITED HEALTHCARE,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,VA,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,VA TRICARE,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,WELLMED,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,HUMANA,MGD,37.28,,,,,,,per diem,37.28,37.28,"Per diem rate, code is bundled with other services"
PHENERAN SUPP                 ,92135039,CDM,250,RC,,,,,,Inpatient,1,EA,37.28,37.28,HUMANA CHOICE PLUS,MGD,37.28,,,,,,,case rate,37.28,37.28,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 30                    ,92135040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DECADRON 0.5 MG TAB           ,92135041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHOBID 150 MG CAP           ,92135042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,AETNA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,CIGNA,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,WELLMED,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA,MGD,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135043,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA CHOICE PLUS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,AETNA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,CIGNA,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,WELLMED,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA,MGD,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135044,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA CHOICE PLUS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,AETNA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,BCBS,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,CIGNA,COM,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,UNITED HEALTHCARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,VA TRICARE,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,WELLMED,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA,MGD,24.15,,,,,,,per diem,24.15,24.15,"Per diem rate, code is bundled with other services"
SACUBITRIL-VALSARTAN (ENTRESTO,92135045,CDM,250,RC,,,,,,Inpatient,1,EA,24.15,24.15,HUMANA CHOICE PLUS,MGD,24.15,,,,,,,case rate,24.15,24.15,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAVASTATIN (PRAVACHOL)       ,92135046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEXITIL 200 MG CAP            ,92135047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLESTID 1 GM TAB             ,92135048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,AETNA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,BCBS,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,CIGNA,COM,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,UNITED HEALTHCARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,VA TRICARE,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,WELLMED,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA,MGD,16.8,,,,,,,per diem,16.8,16.8,"Per diem rate, code is bundled with other services"
TICAGRELOR (BRILINTA)         ,92135049,CDM,250,RC,,,,,,Inpatient,1,EA,16.8,16.8,HUMANA CHOICE PLUS,MGD,16.8,,,,,,,case rate,16.8,16.8,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,AETNA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,BCBS,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,CIGNA,COM,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,UNITED HEALTHCARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,VA TRICARE,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,WELLMED,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA,MGD,25.2,,,,,,,per diem,25.2,25.2,"Per diem rate, code is bundled with other services"
NALOXEGOL (MOVANTIK)          ,92135050,CDM,250,RC,,,,,,Inpatient,1,EA,25.2,25.2,HUMANA CHOICE PLUS,MGD,25.2,,,,,,,case rate,25.2,25.2,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,AETNA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,BCBS,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,CIGNA,COM,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,UNITED HEALTHCARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,VA TRICARE,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,WELLMED,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA,MGD,13.65,,,,,,,per diem,13.65,13.65,"Per diem rate, code is bundled with other services"
NEBIVOLOL (BYSTOLIC)          ,92135051,CDM,250,RC,,,,,,Inpatient,1,EA,13.65,13.65,HUMANA CHOICE PLUS,MGD,13.65,,,,,,,case rate,13.65,13.65,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,AETNA,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,BCBS,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,CIGNA,COM,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,TRICARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,UNITED HEALTHCARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,UNITED HEALTHCARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,VA,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,VA TRICARE,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,WELLMED,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,HUMANA,MGD,135.45,,,,,,,per diem,135.45,135.45,"Per diem rate, code is bundled with other services"
FE SUCROSE COMPLEX 5X10ML     ,92135052,CDM,250,RC,,,,,,Inpatient,1,EA,135.45,135.45,HUMANA CHOICE PLUS,MGD,135.45,,,,,,,case rate,135.45,135.45,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 10 MG               ,92135053,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,AETNA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,BCBS,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,CIGNA,COM,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,UNITED HEALTHCARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,VA,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,VA TRICARE,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,WELLMED,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,HUMANA,MGD,39.9,,,,,,,per diem,39.9,39.9,"Per diem rate, code is bundled with other services"
JARDIANCE 25 MG               ,92135054,CDM,250,RC,,,,,,Inpatient,1,EA,39.9,39.9,HUMANA CHOICE PLUS,MGD,39.9,,,,,,,case rate,39.9,39.9,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
URECHOLINE 10 MG TAB          ,92135055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SINEMET 25-250 MG TAB         ,92135056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE-APAP (PERCOCET)     ,92135058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL                 ,92135059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ROBINUL 1 MG TAB              ,92135060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,AETNA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,BCBS,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,CIGNA,COM,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,UNITED HEALTHCARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,VA,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,VA TRICARE,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,WELLMED,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,HUMANA,MGD,58.8,,,,,,,per diem,58.8,58.8,"Per diem rate, code is bundled with other services"
DECADRON 0.1% OPHTH SOLN      ,92135061,CDM,250,RC,,,,,,Inpatient,1,EA,58.8,58.8,HUMANA CHOICE PLUS,MGD,58.8,,,,,,,case rate,58.8,58.8,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
UBIQUINONE (COENZYME Q-10)    ,92135062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OSTEO BI-FLEX                 ,92135063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
TYLENOL 160MG/5ML SOLN        ,92135064,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALIUM 2 MG TAB               ,92135065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM BICARB (EFFER-K)    ,92135066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE (MYSOLINE)          ,92135067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
BIOFREEZE 4%                  ,92135068,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRASUGREL (EFFIENT)           ,92135069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE (PAMELOR)       ,92135071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOZOL 2.5 MG TAB              ,92135072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
NAFCILLIN INJ                 ,92135073,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISORDIL 10 MG TAB             ,92135074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VISTARIL 10 MG                ,92135075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS (PROGRAF)          ,92135076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
OSELTAMIVIR (TAMIFLU)         ,92135077,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
RAMELTEON (ROZEREM)           ,92135078,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,AETNA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,BCBS,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,CIGNA,COM,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,UNITED HEALTHCARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,VA TRICARE,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,WELLMED,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA,MGD,38.85,,,,,,,per diem,38.85,38.85,"Per diem rate, code is bundled with other services"
BALSALM PERU CASTOR OIL       ,92135079,CDM,250,RC,,,,,,Inpatient,1,EA,38.85,38.85,HUMANA CHOICE PLUS,MGD,38.85,,,,,,,case rate,38.85,38.85,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,AETNA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,BCBS,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,CIGNA,COM,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,UNITED HEALTHCARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,VA,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,VA TRICARE,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,WELLMED,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,HUMANA,MGD,19.95,,,,,,,per diem,19.95,19.95,"Per diem rate, code is bundled with other services"
ZENPEP 20-63-84K UNITS        ,92135080,CDM,250,RC,,,,,,Inpatient,1,EA,19.95,19.95,HUMANA CHOICE PLUS,MGD,19.95,,,,,,,case rate,19.95,19.95,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,AETNA,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,CIGNA,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,TRICARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,UNITED HEALTHCARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,UNITED HEALTHCARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,VA,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,VA TRICARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,WELLMED,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,HUMANA,MGD,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
NALOXONE 2MG/ML               ,92135081,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,HUMANA CHOICE PLUS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NS 10ML                       ,92135082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,AETNA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,BCBS,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,CIGNA,COM,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,UNITED HEALTHCARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,VA TRICARE,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,WELLMED,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA,MGD,8.14,,,,,,,per diem,8.14,8.14,"Per diem rate, code is bundled with other services"
TYLENOL #4                    ,92135083,CDM,250,RC,,,,,,Inpatient,1,EA,8.14,8.14,HUMANA CHOICE PLUS,MGD,8.14,,,,,,,case rate,8.14,8.14,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,AETNA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,BCBS,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,CIGNA,COM,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,UNITED HEALTHCARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,VA TRICARE,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,WELLMED,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA,MGD,8.4,,,,,,,per diem,8.4,8.4,"Per diem rate, code is bundled with other services"
NF BIOFREEZE-MENTHOL 4% TOP   ,92135084,CDM,250,RC,,,,,,Inpatient,1,EA,8.4,8.4,HUMANA CHOICE PLUS,MGD,8.4,,,,,,,case rate,8.4,8.4,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NF BUSPIRONE 10 MG TAB        ,92135085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
NF DALIRESP 250 MCG TAB       ,92135086,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
NF DOCUSATE MINI ENEMA 283MG  ,92135087,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,AETNA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,BCBS,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,CIGNA,COM,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,UNITED HEALTHCARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,VA,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,VA TRICARE,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,WELLMED,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,HUMANA,MGD,28.35,,,,,,,per diem,28.35,28.35,"Per diem rate, code is bundled with other services"
NF MIRGABEGRON 25MG TAB       ,92135088,CDM,250,RC,,,,,,Inpatient,1,EA,28.35,28.35,HUMANA CHOICE PLUS,MGD,28.35,,,,,,,case rate,28.35,28.35,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,AETNA,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,BCBS,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,CIGNA,COM,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,TRICARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,UNITED HEALTHCARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,UNITED HEALTHCARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,VA,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,VA TRICARE,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,WELLMED,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,HUMANA,MGD,99.75,,,,,,,per diem,99.75,99.75,"Per diem rate, code is bundled with other services"
NF VANCOCIN 1.5 GM            ,92135089,CDM,250,RC,,,,,,Inpatient,1,EA,99.75,99.75,HUMANA CHOICE PLUS,MGD,99.75,,,,,,,case rate,99.75,99.75,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,AETNA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,BCBS,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,CIGNA,COM,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,UNITED HEALTHCARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,VA,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,VA TRICARE,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,WELLMED,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,HUMANA,MGD,85.05,,,,,,,per diem,85.05,85.05,"Per diem rate, code is bundled with other services"
NF VANCOMYCIN HCL             ,92135090,CDM,250,RC,,,,,,Inpatient,1,EA,85.05,85.05,HUMANA CHOICE PLUS,MGD,85.05,,,,,,,case rate,85.05,85.05,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,AETNA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,BCBS,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,CIGNA,COM,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,UNITED HEALTHCARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,VA TRICARE,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,WELLMED,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA,MGD,21,,,,,,,per diem,21,21,"Per diem rate, code is bundled with other services"
NF XARELO 2.5 MG TAB          ,92135091,CDM,250,RC,,,,,,Inpatient,1,EA,21,21,HUMANA CHOICE PLUS,MGD,21,,,,,,,case rate,21,21,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,AETNA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,CIGNA,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,WELLMED,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA,MGD,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ASP/PROTAMINE(CHG/ML) ,92200206,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA CHOICE PLUS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,AETNA,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,BCBS,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,CIGNA,COM,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,TRICARE,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,UNITED HEALTHCARE,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,UNITED HEALTHCARE,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,VA,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,VA TRICARE,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,WELLMED,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,HUMANA,MGD,27.54,,,,,,,per diem,27.54,27.54,"Per diem rate, code is bundled with other services"
INSULIN DETEMIR (CHG BY ML)   ,92200207,CDM,250,RC,,,,,,Inpatient,1,EA,27.54,27.54,HUMANA CHOICE PLUS,MGD,27.54,,,,,,,case rate,27.54,27.54,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,AETNA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,CIGNA,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,WELLMED,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA,MGD,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN HUMAN ISOPH NPH-CHG/ML,92200208,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA CHOICE PLUS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INSULIN HUMAN REG (CHG BY ML) ,92200209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,AETNA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,BCBS,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,CIGNA,COM,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,UNITED HEALTHCARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,VA TRICARE,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,WELLMED,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA,MGD,0.26,,,,,,,per diem,0.26,0.26,"Per diem rate, code is bundled with other services"
INSULIN ISOPHANERG70/30-CHG/ML,92200210,CDM,250,RC,,,,,,Inpatient,1,EA,0.26,0.26,HUMANA CHOICE PLUS,MGD,0.26,,,,,,,case rate,0.26,0.26,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,AETNA,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,BCBS,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,CIGNA,COM,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,TRICARE,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,UNITED HEALTHCARE,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,UNITED HEALTHCARE,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,VA,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,VA TRICARE,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,WELLMED,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,HUMANA,MGD,551.25,,,,,,,per diem,551.25,551.25,"Per diem rate, code is bundled with other services"
TPN CUSTOM                    ,92200250,CDM,250,RC,,,,,,Inpatient,1,EA,551.25,551.25,HUMANA CHOICE PLUS,MGD,551.25,,,,,,,case rate,551.25,551.25,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,AETNA,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,BCBS,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,CIGNA,COM,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,TRICARE,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,UNITED HEALTHCARE,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,UNITED HEALTHCARE,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,VA,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,VA TRICARE,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,WELLMED,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,HUMANA,MGD,12.65,,,,,,,per diem,12.65,12.65,"Per diem rate, code is bundled with other services"
INSULIN ASPART 100 UNITS/ML   ,92200251,CDM,250,RC,,,,,,Inpatient,1,EA,12.65,12.65,HUMANA CHOICE PLUS,MGD,12.65,,,,,,,case rate,12.65,12.65,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
IY-ICOSAPENT ETHYL 1GM CAP    ,92200253,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,AETNA,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,BCBS,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,CIGNA,COM,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,TRICARE,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,UNITED HEALTHCARE,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,UNITED HEALTHCARE,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,VA,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,VA TRICARE,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,WELLMED,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,HUMANA,MGD,91.89,,,,,,,per diem,91.89,91.89,"Per diem rate, code is bundled with other services"
ALBUTEROL                     ,92200254,CDM,250,RC,,,,,,Inpatient,1,EA,91.89,91.89,HUMANA CHOICE PLUS,MGD,91.89,,,,,,,case rate,91.89,91.89,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 01                ,92201001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 02                ,92201002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 03                ,92201003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 04                ,92201004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 05                ,92201005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 06                ,92201006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 07                ,92201007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 08                ,92201008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 09                ,92201009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 10                ,92201010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 11                ,92201011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 12                ,92201012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 13                ,92201013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 14                ,92201014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 15                ,92201015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 16                ,92201016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 17                ,92201017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 18                ,92201018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 19                ,92201019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 20                ,92201020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 21                ,92201021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 22                ,92201022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 23                ,92201023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 24                ,92201024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OPHTHALMICS 25                ,92201025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,AETNA,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,BCBS,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,CIGNA,COM,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,TRICARE,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,UNITED HEALTHCARE,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,UNITED HEALTHCARE,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,VA,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,VA TRICARE,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,WELLMED,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,HUMANA,MGD,86.18,,,,,,,per diem,86.18,86.18,"Per diem rate, code is bundled with other services"
TOPICALS 01                   ,92202001,CDM,250,RC,,,,,,Inpatient,1,EA,86.18,86.18,HUMANA CHOICE PLUS,MGD,86.18,,,,,,,case rate,86.18,86.18,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 02                   ,92202002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 03                   ,92202003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 04                   ,92202004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 05                   ,92202005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 06                   ,92202006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 07                   ,92202007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 08                   ,92202008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 09                   ,92202009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 10                   ,92202010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 11                   ,92202011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 12                   ,92202012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 13                   ,92202013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 14                   ,92202014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 15                   ,92202015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 16                   ,92202016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 17                   ,92202017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 18                   ,92202018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 19                   ,92202019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 20                   ,92202020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 21                   ,92202021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 22                   ,92202022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 23                   ,92202023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 24                   ,92202024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 25                   ,92202025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 26                   ,92202026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 27                   ,92202027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 28                   ,92202028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 29                   ,92202029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 30                   ,92202030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 31                   ,92202031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 32                   ,92202032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 33                   ,92202033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 34                   ,92202034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 35                   ,92202035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 36                   ,92202036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 37                   ,92202037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 38                   ,92202038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 39                   ,92202039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 40                   ,92202040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 41                   ,92202041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 42                   ,92202042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 43                   ,92202043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 44                   ,92202044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 45                   ,92202045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 46                   ,92202046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 47                   ,92202047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 48                   ,92202048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 49                   ,92202049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOPICALS 50                   ,92202050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 01                      ,92203001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 02                      ,92203002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 03                      ,92203003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 04                      ,92203004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 05                      ,92203005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 06                      ,92203006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 07                      ,92203007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 08                      ,92203008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 09                      ,92203009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 10                      ,92203010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 11                      ,92203011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 12                      ,92203012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 13                      ,92203013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 14                      ,92203014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 15                      ,92203015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 16                      ,92203016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 17                      ,92203017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 18                      ,92203018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 19                      ,92203019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 20                      ,92203020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 21                      ,92203021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 22                      ,92203022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 23                      ,92203023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 24                      ,92203024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 25                      ,92203025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 26                      ,92203026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 27                      ,92203027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 28                      ,92203028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 29                      ,92203029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 30                      ,92203030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 31                      ,92203031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 32                      ,92203032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 33                      ,92203033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 34                      ,92203034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 35                      ,92203035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 36                      ,92203036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 37                      ,92203037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 38                      ,92203038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 39                      ,92203039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 40                      ,92203040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 41                      ,92203041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 42                      ,92203042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 43                      ,92203043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 44                      ,92203044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 45                      ,92203045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 46                      ,92203046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 47                      ,92203047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 48                      ,92203048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 49                      ,92203049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 50                      ,92203050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 51                      ,92203051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 52                      ,92203052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 53                      ,92203053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 54                      ,92203054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 55                      ,92203055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 56                      ,92203056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 57                      ,92203057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 58                      ,92203058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 59                      ,92203059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 60                      ,92203060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 61                      ,92203061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 62                      ,92203062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 63                      ,92203063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 64                      ,92203064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 65                      ,92203065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 66                      ,92203066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 67                      ,92203067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 68                      ,92203068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 69                      ,92203069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 70                      ,92203070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 71                      ,92203071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 72                      ,92203072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 73                      ,92203073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 74                      ,92203074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 75                      ,92203075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 76                      ,92203076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 77                      ,92203077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 78                      ,92203078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 79                      ,92203079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 80                      ,92203080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 81                      ,92203081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 82                      ,92203082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 83                      ,92203083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 84                      ,92203084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 85                      ,92203085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 86                      ,92203086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 87                      ,92203087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 88                      ,92203088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 89                      ,92203089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 90                      ,92203090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 91                      ,92203091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 92                      ,92203092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 93                      ,92203093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 94                      ,92203094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 95                      ,92203095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 96                      ,92203096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 97                      ,92203097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 98                      ,92203098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 99                      ,92203099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ORALS 100                     ,92203100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 01               ,92204000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 02               ,92204001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 03               ,92204002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 04               ,92204003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 05               ,92204004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 06               ,92204005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 07               ,92204006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 08               ,92204007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 09               ,92204008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 10               ,92204009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 11               ,92204010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 12               ,92204011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 13               ,92204012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 14               ,92204013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 15               ,92204014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 16               ,92204015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 17               ,92204016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 18               ,92204017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 19               ,92204018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 20               ,92204019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 21               ,92204020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 22               ,92204021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 23               ,92204022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 24               ,92204023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 25               ,92204024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 26               ,92204025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 27               ,92204026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 28               ,92204027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 29               ,92204028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 30               ,92204029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 31               ,92204030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 32               ,92204031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 33               ,92204032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 34               ,92204033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 35               ,92204034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 36               ,92204036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 37               ,92204037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 38               ,92204038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 39               ,92204039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 40               ,92204040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 41               ,92204041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 42               ,92204042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 43               ,92204043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 44               ,92204044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 45               ,92204045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 46               ,92204046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 47               ,92204047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 48               ,92204048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 49               ,92204049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 50               ,92204050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 51               ,92204051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 52               ,92204052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 53               ,92204053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 54               ,92204054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 55               ,92204055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 56               ,92204056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 57               ,92204057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 58               ,92204058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 59               ,92204059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 60               ,92204060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 61               ,92204061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 62               ,92204062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 63               ,92204063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 64               ,92204064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 65               ,92204065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 66               ,92204066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 67               ,92204067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 68               ,92204068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 69               ,92204069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 70               ,92204070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 71               ,92204071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 72               ,92204072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 73               ,92204073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 74               ,92204074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 75               ,92204075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 76               ,92204076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 77               ,92204077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 78               ,92204078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 79               ,92204079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 80               ,92204080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 81               ,92204081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 82               ,92204082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 83               ,92204083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 84               ,92204084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 85               ,92204085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 86               ,92204086,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 87               ,92204087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 88               ,92204088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 89               ,92204089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 90               ,92204090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 91               ,92204091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 92               ,92204092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 93               ,92204093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 94               ,92204094,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 95               ,92204095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 96               ,92204096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 97               ,92204097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 98               ,92204098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 99               ,92204099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IV ADMIXTURE 100              ,92204100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 1                     ,92205001,CDM,258,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 2                     ,92205002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 3                     ,92205003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 4                     ,92205004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 5                     ,92205005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 6                     ,92205006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 7                     ,92205007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 8                     ,92205008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 9                     ,92205009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 10                    ,92205010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 11                    ,92205011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 12                    ,92205012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 13                    ,92205013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 14                    ,92205014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 15                    ,92205015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 16                    ,92205016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 17                    ,92205017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 18                    ,92205018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 19                    ,92205019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 20                    ,92205020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 21                    ,92205021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 22                    ,92205022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 23                    ,92205023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 24                    ,92205024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TPN/TNA 25                    ,92205025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 01     ,92206001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 02     ,92206002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 03     ,92206003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 04     ,92206004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 05     ,92206005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 06     ,92206006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 07     ,92206007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 08     ,92206008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 09     ,92206009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 10     ,92206010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 11     ,92206011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 12     ,92206012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 13     ,92206013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 14     ,92206014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 15     ,92206015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 16     ,92206016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 17     ,92206017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 18     ,92206018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 19     ,92206019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 20     ,92206020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 21     ,92206021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 22     ,92206022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 23     ,92206023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 24     ,92206024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMPLANTS/SUPPOSITORIES 25     ,92206025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 01                ,92207001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 02                ,92207002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 03                ,92207003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 04                ,92207004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 05                ,92207005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 06                ,92207006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 07                ,92207007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 08                ,92207008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 09                ,92207009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 10                ,92207010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 11                ,92207011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 12                ,92207012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 13                ,92207013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 14                ,92207014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 15                ,92207015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 16                ,92207016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 17                ,92207017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 18                ,92207018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 19                ,92207019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 20                ,92207020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 21                ,92207021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 22                ,92207022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 23                ,92207023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 24                ,92207024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IRRIGATIONS 25                ,92207025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTOBACILLUS POW             ,92209001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT SPINAL/BRAIN,92209002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PUMP REFILL MAINT BY DR       ,92209003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 125MCG (100+25) INJ   ,92209004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 140MCG (100+40) INJ   ,92209005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ARANESP 160MCG (100+60) INJ   ,92209006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.5MG(0.2+0.3) T,92209008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+75) TAB  ,92209010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 125MG (100+25) TAB  ,92209011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOZAPINE 175MG (100+3X25) TAB,92209012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 125MG (100+25) SG,92209015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 150MG (100+50) SG,92209016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 175MG(100+3X25) S,92209017,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 125MCG (100+25) INJ ,92209018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 140MCG (100+40) INJ ,92209019,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
EPOETIN A 160MCG (100+60) INJ ,92209020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 125MCG (100+25) TDM  ,92209026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL 150MCG (100+50) TDM  ,92209027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+25)MCG T,92209028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA (200+75)MCG T,92209029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN .5MG/HR (.4+.1)T,92209031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 130MG (100+30) CE,92209032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 12,000U(10K+2K) INJ ",92209033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 5,000U (2K+3K) INJ  ",92209034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 125MG (100+25) TAB ,92209037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+2X25) TA,92209038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+2X25) TA,92209039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (1/2 100+25) T,92209040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 125MG 100+25) T,92209041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 125MG(100+25) T,92209042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 225MCG(200+25) T,92209043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 275MCG(200+75) T,92209044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 4.5MG (4X1+0.5) CAP,92209045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TACROLIMUS 6MG (1+5) CAP      ,92209046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7MG (4+3) TAB     ,92209047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 8.5MG (7.5+1) TAB ,92209048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 125MG (100+25) T,92209049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE SULF (100+30+30)MG TA,92209050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 12.5MG (7.5+5) TAB,92209052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5+6) TAB    ,92209053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 11MG (5 + 6) TAB  ,92209054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 75MG (50+25) TA,92209055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 150MG (100+50) TAB ,92209056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 150MG(100+50) T,92209057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 250MG (200+50) TAB ,92209058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE FUM 250MG(200+50) T,92209059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTALINE HCL 75MG (50+25) TAB,92209060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 75MG (50+25) TA,92209061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 30,000U (20K+10K) IN",92209062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUETIAPINE 75MG (50MG+25) TAB ,92209063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 25MG (20+5) TAB    ,92209064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7MG (5+2X1) TAB    ,92209065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE 288MCG(200+88) T,92209067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 130MG (100+30) CER   ,92209068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 50MG(40+10) TER ,92209069,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 37.5MG (25+12.5) TAB,92209070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 7.5MG (5+2.5) TAB  ,92209071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 75MG(50+25) TE,92209072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROL SUCC 75MG (50+25)TAB ,92209073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"EPOETIN A 15,000U(10K+2K+3K) I",92209074,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 22MG (2X10+2) TAB ,92209075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 9MG (5+4) TAB     ,92209076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC .012% LIQ  ,92209077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FENTANYL DRIP 10 MCG/ML       ,92209078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 1MG/ML          ,92209079,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACOSAMIDE 100MG+NACL 100ML   ,92209080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 100MG/DSW 100ML IV  ,92209081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM DRIP 1MG/ML         ,92209082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM DRIP 100MG/100ML    ,92209083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/1ML PCA SYRINGE  ,92209084,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,AETNA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,CIGNA,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,VA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,VA TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,WELLMED,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,HUMANA,MGD,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92210002,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,HUMANA CHOICE PLUS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210003,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92210004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,AETNA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,BCBS,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,CIGNA,COM,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,UNITED HEALTHCARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,VA,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,VA TRICARE,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,WELLMED,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,HUMANA,MGD,31.06,,,,,,,per diem,31.06,31.06,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92210006,CDM,250,RC,,,,,,Inpatient,1,EA,31.06,31.06,HUMANA CHOICE PLUS,MGD,31.06,,,,,,,case rate,31.06,31.06,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210008,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210009,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,AETNA,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,BCBS,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,CIGNA,COM,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,TRICARE,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,UNITED HEALTHCARE,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,UNITED HEALTHCARE,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,VA,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,VA TRICARE,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,WELLMED,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,HUMANA,MGD,160.74,,,,,,,per diem,160.74,160.74,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210010,CDM,250,RC,,,,,,Inpatient,1,EA,160.74,160.74,HUMANA CHOICE PLUS,MGD,160.74,,,,,,,case rate,160.74,160.74,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,AETNA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,BCBS,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,CIGNA,COM,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,UNITED HEALTHCARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,VA,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,VA TRICARE,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,WELLMED,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,HUMANA,MGD,141.75,,,,,,,per diem,141.75,141.75,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210011,CDM,250,RC,,,,,,Inpatient,1,EA,141.75,141.75,HUMANA CHOICE PLUS,MGD,141.75,,,,,,,case rate,141.75,141.75,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210012,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210013,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIMETHOPRIM 100MG TAB        ,92210014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,AETNA,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,BCBS,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,CIGNA,COM,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,TRICARE,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,UNITED HEALTHCARE,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,UNITED HEALTHCARE,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,VA,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,VA TRICARE,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,WELLMED,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,HUMANA,MGD,64.07,,,,,,,per diem,64.07,64.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210017,CDM,250,RC,,,,,,Inpatient,1,EA,64.07,64.07,HUMANA CHOICE PLUS,MGD,64.07,,,,,,,case rate,64.07,64.07,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,AETNA,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,BCBS,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,CIGNA,COM,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,TRICARE,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,UNITED HEALTHCARE,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,UNITED HEALTHCARE,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,VA,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,VA TRICARE,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,WELLMED,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,HUMANA,MGD,73.05,,,,,,,per diem,73.05,73.05,"Per diem rate, code is bundled with other services"
PEPPERMINT OIL                ,92210018,CDM,250,RC,,,,,,Inpatient,1,EA,73.05,73.05,HUMANA CHOICE PLUS,MGD,73.05,,,,,,,case rate,73.05,73.05,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,AETNA,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,BCBS,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,CIGNA,COM,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,TRICARE,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,UNITED HEALTHCARE,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,UNITED HEALTHCARE,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,VA,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,VA TRICARE,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,WELLMED,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,HUMANA,MGD,15.72,,,,,,,per diem,15.72,15.72,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210019,CDM,250,RC,,,,,,Inpatient,1,EA,15.72,15.72,HUMANA CHOICE PLUS,MGD,15.72,,,,,,,case rate,15.72,15.72,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210020,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 60MG TAB              ,92210021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,AETNA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,CIGNA,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,WELLMED,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA,MGD,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
SULFADIAZINE 500MG TAB        ,92210023,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA CHOICE PLUS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,AETNA,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,BCBS,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,CIGNA,COM,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,TRICARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,UNITED HEALTHCARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,UNITED HEALTHCARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,VA,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,VA TRICARE,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,WELLMED,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,HUMANA,MGD,36.86,,,,,,,per diem,36.86,36.86,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92210024,CDM,250,RC,,,,,,Inpatient,1,EA,36.86,36.86,HUMANA CHOICE PLUS,MGD,36.86,,,,,,,case rate,36.86,36.86,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 100U SGL            ,92210025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.3MG TAB       ,92210027,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,AETNA,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,BCBS,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,CIGNA,COM,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,TRICARE,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,UNITED HEALTHCARE,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,UNITED HEALTHCARE,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,VA,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,VA TRICARE,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,WELLMED,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,HUMANA,MGD,33.8,,,,,,,per diem,33.8,33.8,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% CRE        ,92210028,CDM,250,RC,,,,,,Inpatient,1,EA,33.8,33.8,HUMANA CHOICE PLUS,MGD,33.8,,,,,,,case rate,33.8,33.8,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,AETNA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,BCBS,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,CIGNA,COM,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,UNITED HEALTHCARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,VA,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,VA TRICARE,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,WELLMED,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,HUMANA,MGD,47.41,,,,,,,per diem,47.41,47.41,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210029,CDM,250,RC,,,,,,Inpatient,1,EA,47.41,47.41,HUMANA CHOICE PLUS,MGD,47.41,,,,,,,case rate,47.41,47.41,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,AETNA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,CIGNA,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,WELLMED,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA,MGD,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 100MG/ML OIL,92210030,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA CHOICE PLUS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 1MG TAB        ,92210031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,AETNA,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,BCBS,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,CIGNA,COM,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,TRICARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,UNITED HEALTHCARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,UNITED HEALTHCARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,VA,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,VA TRICARE,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,WELLMED,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,HUMANA,MGD,85.62,,,,,,,per diem,85.62,85.62,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.25% SOL         ,92210032,CDM,250,RC,,,,,,Inpatient,1,EA,85.62,85.62,HUMANA CHOICE PLUS,MGD,85.62,,,,,,,case rate,85.62,85.62,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210033,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 1MG CAP           ,92210035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SPR     ,92210037,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 3% INH SOL          ,92210039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210040,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92210041,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,AETNA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,CIGNA,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,WELLMED,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA,MGD,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.W5MG TAB     ,92210044,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA CHOICE PLUS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210045,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,AETNA,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,BCBS,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,CIGNA,COM,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,TRICARE,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,UNITED HEALTHCARE,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,UNITED HEALTHCARE,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,VA,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,VA TRICARE,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,WELLMED,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,HUMANA,MGD,15.53,,,,,,,per diem,15.53,15.53,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92210047,CDM,250,RC,,,,,,Inpatient,1,EA,15.53,15.53,HUMANA CHOICE PLUS,MGD,15.53,,,,,,,case rate,15.53,15.53,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,AETNA,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,CIGNA,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,TRICARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,UNITED HEALTHCARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,UNITED HEALTHCARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,VA,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,VA TRICARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,WELLMED,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,HUMANA,MGD,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92210048,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,HUMANA CHOICE PLUS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,AETNA,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,BCBS,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,CIGNA,COM,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,TRICARE,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,UNITED HEALTHCARE,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,UNITED HEALTHCARE,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,VA,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,VA TRICARE,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,WELLMED,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,HUMANA,MGD,11.15,,,,,,,per diem,11.15,11.15,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210052,CDM,250,RC,,,,,,Inpatient,1,EA,11.15,11.15,HUMANA CHOICE PLUS,MGD,11.15,,,,,,,case rate,11.15,11.15,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,AETNA,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,CIGNA,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,TRICARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,UNITED HEALTHCARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,UNITED HEALTHCARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,VA,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,VA TRICARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,WELLMED,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,HUMANA,MGD,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
POTASSIUM CL 20MEQ/15ML SOL   ,92210053,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,HUMANA CHOICE PLUS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,AETNA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,CIGNA,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,WELLMED,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA,MGD,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210054,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA CHOICE PLUS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92210055,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92210057,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,AETNA,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,BCBS,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,CIGNA,COM,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,TRICARE,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,UNITED HEALTHCARE,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,UNITED HEALTHCARE,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,VA,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,VA TRICARE,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,WELLMED,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,HUMANA,MGD,30.46,,,,,,,per diem,30.46,30.46,"Per diem rate, code is bundled with other services"
HYDROCORTISONE                ,92210058,CDM,250,RC,,,,,,Inpatient,1,EA,30.46,30.46,HUMANA CHOICE PLUS,MGD,30.46,,,,,,,case rate,30.46,30.46,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG CTB              ,92210059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210060,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,AETNA,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,BCBS,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,CIGNA,COM,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,TRICARE,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,UNITED HEALTHCARE,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,UNITED HEALTHCARE,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,VA,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,VA TRICARE,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,WELLMED,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,HUMANA,MGD,387.36,,,,,,,per diem,387.36,387.36,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210061,CDM,250,RC,,,,,,Inpatient,1,EA,387.36,387.36,HUMANA CHOICE PLUS,MGD,387.36,,,,,,,case rate,387.36,387.36,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,AETNA,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,BCBS,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,CIGNA,COM,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,TRICARE,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,UNITED HEALTHCARE,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,UNITED HEALTHCARE,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,VA,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,VA TRICARE,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,WELLMED,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,HUMANA,MGD,125.97,,,,,,,per diem,125.97,125.97,"Per diem rate, code is bundled with other services"
ACETIC ACID 2% SOL            ,92210062,CDM,250,RC,,,,,,Inpatient,1,EA,125.97,125.97,HUMANA CHOICE PLUS,MGD,125.97,,,,,,,case rate,125.97,125.97,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 400MG CAP         ,92210063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92210064,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210066,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 10,000U SGL     ",92210067,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92210068,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,AETNA,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,BCBS,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,CIGNA,COM,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,TRICARE,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,UNITED HEALTHCARE,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,UNITED HEALTHCARE,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,VA,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,VA TRICARE,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,WELLMED,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,HUMANA,MGD,208.75,,,,,,,per diem,208.75,208.75,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210069,CDM,250,RC,,,,,,Inpatient,1,EA,208.75,208.75,HUMANA CHOICE PLUS,MGD,208.75,,,,,,,case rate,208.75,208.75,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,AETNA,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,CIGNA,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,TRICARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,UNITED HEALTHCARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,UNITED HEALTHCARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,VA,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,VA TRICARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,WELLMED,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,HUMANA,MGD,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG CER       ,92210070,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,HUMANA CHOICE PLUS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,AETNA,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,BCBS,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,CIGNA,COM,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,TRICARE,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,UNITED HEALTHCARE,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,UNITED HEALTHCARE,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,VA,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,VA TRICARE,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,WELLMED,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,HUMANA,MGD,14.65,,,,,,,per diem,14.65,14.65,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 10-15 C,92210071,CDM,250,RC,,,,,,Inpatient,1,EA,14.65,14.65,HUMANA CHOICE PLUS,MGD,14.65,,,,,,,case rate,14.65,14.65,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92210072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,AETNA,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,BCBS,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,CIGNA,COM,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,TRICARE,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,UNITED HEALTHCARE,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,UNITED HEALTHCARE,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,VA,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,VA TRICARE,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,WELLMED,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,HUMANA,MGD,670.89,,,,,,,per diem,670.89,670.89,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210073,CDM,250,RC,,,,,,Inpatient,1,EA,670.89,670.89,HUMANA CHOICE PLUS,MGD,670.89,,,,,,,case rate,670.89,670.89,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,AETNA,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,BCBS,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,CIGNA,COM,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,TRICARE,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,UNITED HEALTHCARE,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,UNITED HEALTHCARE,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,VA,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,VA TRICARE,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,WELLMED,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,HUMANA,MGD,131.7,,,,,,,per diem,131.7,131.7,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% OIN     ,92210074,CDM,250,RC,,,,,,Inpatient,1,EA,131.7,131.7,HUMANA CHOICE PLUS,MGD,131.7,,,,,,,case rate,131.7,131.7,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,AETNA,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,BCBS,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,CIGNA,COM,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,TRICARE,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,UNITED HEALTHCARE,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,UNITED HEALTHCARE,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,VA,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,VA TRICARE,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,WELLMED,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,HUMANA,MGD,17.51,,,,,,,per diem,17.51,17.51,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210077,CDM,250,RC,,,,,,Inpatient,1,EA,17.51,17.51,HUMANA CHOICE PLUS,MGD,17.51,,,,,,,case rate,17.51,17.51,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,AETNA,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,BCBS,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,CIGNA,COM,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,TRICARE,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,UNITED HEALTHCARE,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,UNITED HEALTHCARE,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,VA,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,VA TRICARE,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,WELLMED,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,HUMANA,MGD,64.35,,,,,,,per diem,64.35,64.35,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92210078,CDM,250,RC,,,,,,Inpatient,1,EA,64.35,64.35,HUMANA CHOICE PLUS,MGD,64.35,,,,,,,case rate,64.35,64.35,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,AETNA,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,BCBS,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,CIGNA,COM,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,TRICARE,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,UNITED HEALTHCARE,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,UNITED HEALTHCARE,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,VA,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,VA TRICARE,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,WELLMED,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,HUMANA,MGD,21.74,,,,,,,per diem,21.74,21.74,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92210079,CDM,250,RC,,,,,,Inpatient,1,EA,21.74,21.74,HUMANA CHOICE PLUS,MGD,21.74,,,,,,,case rate,21.74,21.74,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210081,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,AETNA,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,BCBS,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,CIGNA,COM,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,TRICARE,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,UNITED HEALTHCARE,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,UNITED HEALTHCARE,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,VA,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,VA TRICARE,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,WELLMED,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,HUMANA,MGD,183.83,,,,,,,per diem,183.83,183.83,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210082,CDM,250,RC,,,,,,Inpatient,1,EA,183.83,183.83,HUMANA CHOICE PLUS,MGD,183.83,,,,,,,case rate,183.83,183.83,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 80MG CTB        ,92210083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,AETNA,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,BCBS,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,CIGNA,COM,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,TRICARE,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,UNITED HEALTHCARE,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,UNITED HEALTHCARE,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,VA,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,VA TRICARE,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,WELLMED,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,HUMANA,MGD,15.03,,,,,,,per diem,15.03,15.03,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 200MG TAB        ,92210084,CDM,250,RC,,,,,,Inpatient,1,EA,15.03,15.03,HUMANA CHOICE PLUS,MGD,15.03,,,,,,,case rate,15.03,15.03,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210085,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,AETNA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,CIGNA,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,WELLMED,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA,MGD,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210086,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA CHOICE PLUS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,AETNA,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,CIGNA,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,TRICARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,UNITED HEALTHCARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,UNITED HEALTHCARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,VA,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,VA TRICARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,WELLMED,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,HUMANA,MGD,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 80MG/15ML LIQ    ,92210087,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,HUMANA CHOICE PLUS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92210088,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHROMIUM PICO 200MCG TAB      ,92210089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,AETNA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,CIGNA,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,WELLMED,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA,MGD,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210090,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA CHOICE PLUS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92210091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92210092,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,AETNA,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,BCBS,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,CIGNA,COM,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,TRICARE,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,UNITED HEALTHCARE,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,UNITED HEALTHCARE,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,VA,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,VA TRICARE,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,WELLMED,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,HUMANA,MGD,88.07,,,,,,,per diem,88.07,88.07,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210093,CDM,250,RC,,,,,,Inpatient,1,EA,88.07,88.07,HUMANA CHOICE PLUS,MGD,88.07,,,,,,,case rate,88.07,88.07,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,AETNA,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,BCBS,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,CIGNA,COM,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,TRICARE,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,UNITED HEALTHCARE,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,UNITED HEALTHCARE,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,VA,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,VA TRICARE,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,WELLMED,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,HUMANA,MGD,88.7,,,,,,,per diem,88.7,88.7,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210094,CDM,250,RC,,,,,,Inpatient,1,EA,88.7,88.7,HUMANA CHOICE PLUS,MGD,88.7,,,,,,,case rate,88.7,88.7,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,AETNA,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,BCBS,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,CIGNA,COM,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,TRICARE,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,UNITED HEALTHCARE,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,UNITED HEALTHCARE,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,VA,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,VA TRICARE,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,WELLMED,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,HUMANA,MGD,5327.72,,,,,,,per diem,5327.72,5327.72,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 10GM INJ      ,92210095,CDM,250,RC,,,,,,Inpatient,1,EA,5327.72,5327.72,HUMANA CHOICE PLUS,MGD,5327.72,,,,,,,case rate,5327.72,5327.72,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92210097,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92210098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENDIMETRAZINE 35MG TAB      ,92210100,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210101,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM BICARB 7.5% INJ        ,92210102,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 95MG TAB      ,92210104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,AETNA,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,BCBS,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,CIGNA,COM,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,TRICARE,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,UNITED HEALTHCARE,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,UNITED HEALTHCARE,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,VA,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,VA TRICARE,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,WELLMED,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,HUMANA,MGD,65.71,,,,,,,per diem,65.71,65.71,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210105,CDM,250,RC,,,,,,Inpatient,1,EA,65.71,65.71,HUMANA CHOICE PLUS,MGD,65.71,,,,,,,case rate,65.71,65.71,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,AETNA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,CIGNA,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,WELLMED,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,HUMANA,MGD,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210106,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,HUMANA CHOICE PLUS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210109,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,AETNA,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,CIGNA,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,TRICARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,UNITED HEALTHCARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,UNITED HEALTHCARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,VA,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,VA TRICARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,WELLMED,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,HUMANA,MGD,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE OIN    ,92210110,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,HUMANA CHOICE PLUS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 100MG/ML SOL    ,92210111,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,AETNA,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,BCBS,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,CIGNA,COM,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,TRICARE,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,UNITED HEALTHCARE,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,UNITED HEALTHCARE,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,VA,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,VA TRICARE,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,WELLMED,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,HUMANA,MGD,18.84,,,,,,,per diem,18.84,18.84,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210112,CDM,250,RC,,,,,,Inpatient,1,EA,18.84,18.84,HUMANA CHOICE PLUS,MGD,18.84,,,,,,,case rate,18.84,18.84,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92210113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,AETNA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,CIGNA,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,WELLMED,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA,MGD,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG CAP            ,92210114,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA CHOICE PLUS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210115,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 25MG TAB         ,92210116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,AETNA,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,BCBS,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,CIGNA,COM,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,TRICARE,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,UNITED HEALTHCARE,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,UNITED HEALTHCARE,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,VA,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,VA TRICARE,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,WELLMED,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,HUMANA,MGD,6.77,,,,,,,per diem,6.77,6.77,"Per diem rate, code is bundled with other services"
DESIPRAMINE HCL 25MG TAB      ,92210118,CDM,250,RC,,,,,,Inpatient,1,EA,6.77,6.77,HUMANA CHOICE PLUS,MGD,6.77,,,,,,,case rate,6.77,6.77,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN ASPIRIN CAFF TAB,92210119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,AETNA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,BCBS,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,CIGNA,COM,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,UNITED HEALTHCARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,VA,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,VA TRICARE,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,WELLMED,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,HUMANA,MGD,17.33,,,,,,,per diem,17.33,17.33,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210120,CDM,250,RC,,,,,,Inpatient,1,EA,17.33,17.33,HUMANA CHOICE PLUS,MGD,17.33,,,,,,,case rate,17.33,17.33,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210121,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,AETNA,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,BCBS,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,CIGNA,COM,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,TRICARE,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,UNITED HEALTHCARE,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,UNITED HEALTHCARE,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,VA,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,VA TRICARE,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,WELLMED,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,HUMANA,MGD,318.94,,,,,,,per diem,318.94,318.94,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210122,CDM,250,RC,,,,,,Inpatient,1,EA,318.94,318.94,HUMANA CHOICE PLUS,MGD,318.94,,,,,,,case rate,318.94,318.94,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210123,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92210124,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92210126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,AETNA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,CIGNA,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,WELLMED,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA,MGD,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92210128,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA CHOICE PLUS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,AETNA,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,BCBS,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,CIGNA,COM,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,TRICARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,UNITED HEALTHCARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,UNITED HEALTHCARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,VA,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,VA TRICARE,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,WELLMED,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,HUMANA,MGD,13.42,,,,,,,per diem,13.42,13.42,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210129,CDM,250,RC,,,,,,Inpatient,1,EA,13.42,13.42,HUMANA CHOICE PLUS,MGD,13.42,,,,,,,case rate,13.42,13.42,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,AETNA,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,CIGNA,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,TRICARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,UNITED HEALTHCARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,UNITED HEALTHCARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,VA,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,VA TRICARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,WELLMED,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,HUMANA,MGD,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE OIN      ,92210132,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,HUMANA CHOICE PLUS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,AETNA,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,CIGNA,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,TRICARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,UNITED HEALTHCARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,UNITED HEALTHCARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,VA,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,VA TRICARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,WELLMED,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,HUMANA,MGD,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210133,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,HUMANA CHOICE PLUS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92210134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92210136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,AETNA,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,BCBS,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,CIGNA,COM,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,TRICARE,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,UNITED HEALTHCARE,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,UNITED HEALTHCARE,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,VA,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,VA TRICARE,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,WELLMED,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,HUMANA,MGD,43.79,,,,,,,per diem,43.79,43.79,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210137,CDM,250,RC,,,,,,Inpatient,1,EA,43.79,43.79,HUMANA CHOICE PLUS,MGD,43.79,,,,,,,case rate,43.79,43.79,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,AETNA,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,BCBS,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,CIGNA,COM,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,TRICARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,UNITED HEALTHCARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,UNITED HEALTHCARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,VA,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,VA TRICARE,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,WELLMED,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,HUMANA,MGD,109.78,,,,,,,per diem,109.78,109.78,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210139,CDM,250,RC,,,,,,Inpatient,1,EA,109.78,109.78,HUMANA CHOICE PLUS,MGD,109.78,,,,,,,case rate,109.78,109.78,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,AETNA,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,BCBS,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,CIGNA,COM,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,TRICARE,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,UNITED HEALTHCARE,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,UNITED HEALTHCARE,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,VA,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,VA TRICARE,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,WELLMED,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,HUMANA,MGD,72.77,,,,,,,per diem,72.77,72.77,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210140,CDM,250,RC,,,,,,Inpatient,1,EA,72.77,72.77,HUMANA CHOICE PLUS,MGD,72.77,,,,,,,case rate,72.77,72.77,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,AETNA,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,BCBS,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,CIGNA,COM,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,TRICARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,UNITED HEALTHCARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,UNITED HEALTHCARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,VA,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,VA TRICARE,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,WELLMED,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,HUMANA,MGD,97.71,,,,,,,per diem,97.71,97.71,"Per diem rate, code is bundled with other services"
HYPROMELLOSE 0.5% SOL         ,92210143,CDM,250,RC,,,,,,Inpatient,1,EA,97.71,97.71,HUMANA CHOICE PLUS,MGD,97.71,,,,,,,case rate,97.71,97.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,AETNA,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,BCBS,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,CIGNA,COM,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,TRICARE,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,UNITED HEALTHCARE,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,UNITED HEALTHCARE,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,VA,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,VA TRICARE,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,WELLMED,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,HUMANA,MGD,20.85,,,,,,,per diem,20.85,20.85,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML LIQ     ,92210144,CDM,250,RC,,,,,,Inpatient,1,EA,20.85,20.85,HUMANA CHOICE PLUS,MGD,20.85,,,,,,,case rate,20.85,20.85,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,AETNA,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,BCBS,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,CIGNA,COM,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,TRICARE,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UNITED HEALTHCARE,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,UNITED HEALTHCARE,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,VA,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,VA TRICARE,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,WELLMED,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,HUMANA,MGD,7.65,,,,,,,per diem,7.65,7.65,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG SGL      ,92210146,CDM,250,RC,,,,,,Inpatient,1,EA,7.65,7.65,HUMANA CHOICE PLUS,MGD,7.65,,,,,,,case rate,7.65,7.65,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210147,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 12.5MG TAB          ,92210148,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,AETNA,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,BCBS,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,CIGNA,COM,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,TRICARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UNITED HEALTHCARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,UNITED HEALTHCARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,VA TRICARE,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,WELLMED,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,HUMANA,MGD,10.8,,,,,,,per diem,10.8,10.8,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 50MG TAB       ,92210149,CDM,250,RC,,,,,,Inpatient,1,EA,10.8,10.8,HUMANA CHOICE PLUS,MGD,10.8,,,,,,,case rate,10.8,10.8,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92210150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALAMAG SUS                    ,92210151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,AETNA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,CIGNA,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,WELLMED,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA,MGD,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210152,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA CHOICE PLUS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,AETNA,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,BCBS,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,CIGNA,COM,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,TRICARE,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,UNITED HEALTHCARE,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,UNITED HEALTHCARE,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,VA,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,VA TRICARE,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,WELLMED,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,HUMANA,MGD,20.44,,,,,,,per diem,20.44,20.44,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.5% SPR    ,92210154,CDM,250,RC,,,,,,Inpatient,1,EA,20.44,20.44,HUMANA CHOICE PLUS,MGD,20.44,,,,,,,case rate,20.44,20.44,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 20MG/0.3ML SUS    ,92210158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92210159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,AETNA,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,BCBS,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,CIGNA,COM,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,TRICARE,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,UNITED HEALTHCARE,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,UNITED HEALTHCARE,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,VA,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,VA TRICARE,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,WELLMED,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,HUMANA,MGD,142.19,,,,,,,per diem,142.19,142.19,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210161,CDM,250,RC,,,,,,Inpatient,1,EA,142.19,142.19,HUMANA CHOICE PLUS,MGD,142.19,,,,,,,case rate,142.19,142.19,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,AETNA,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,CIGNA,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,TRICARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,UNITED HEALTHCARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,UNITED HEALTHCARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,VA,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,VA TRICARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,WELLMED,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,HUMANA,MGD,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210162,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,HUMANA CHOICE PLUS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMILORIDE HCL HCTZ 5-50 TAB   ,92210163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 5MG/ML SOL     ,92210164,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210165,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92210166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,AETNA,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,BCBS,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,CIGNA,COM,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,TRICARE,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,UNITED HEALTHCARE,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,UNITED HEALTHCARE,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,VA,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,VA TRICARE,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,WELLMED,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,HUMANA,MGD,344.26,,,,,,,per diem,344.26,344.26,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210168,CDM,250,RC,,,,,,Inpatient,1,EA,344.26,344.26,HUMANA CHOICE PLUS,MGD,344.26,,,,,,,case rate,344.26,344.26,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 250MG CAP      ,92210169,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,AETNA,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,BCBS,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,CIGNA,COM,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,TRICARE,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UNITED HEALTHCARE,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,UNITED HEALTHCARE,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,VA,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,VA TRICARE,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,WELLMED,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,HUMANA,MGD,21.39,,,,,,,per diem,21.39,21.39,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92210170,CDM,250,RC,,,,,,Inpatient,1,EA,21.39,21.39,HUMANA CHOICE PLUS,MGD,21.39,,,,,,,case rate,21.39,21.39,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210171,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,AETNA,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,BCBS,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,CIGNA,COM,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,TRICARE,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,UNITED HEALTHCARE,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,UNITED HEALTHCARE,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,VA,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,VA TRICARE,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,WELLMED,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,HUMANA,MGD,25.55,,,,,,,per diem,25.55,25.55,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP SUS      ,92210172,CDM,250,RC,,,,,,Inpatient,1,EA,25.55,25.55,HUMANA CHOICE PLUS,MGD,25.55,,,,,,,case rate,25.55,25.55,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,AETNA,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,BCBS,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,CIGNA,COM,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,TRICARE,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,UNITED HEALTHCARE,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,UNITED HEALTHCARE,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,VA,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,VA TRICARE,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,WELLMED,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,HUMANA,MGD,721.41,,,,,,,per diem,721.41,721.41,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92210173,CDM,250,RC,,,,,,Inpatient,1,EA,721.41,721.41,HUMANA CHOICE PLUS,MGD,721.41,,,,,,,case rate,721.41,721.41,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,AETNA,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,CIGNA,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,TRICARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UNITED HEALTHCARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UNITED HEALTHCARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA TRICARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,WELLMED,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,HUMANA,MGD,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
CALAMINE PRZMOXINE HCL 8%-1% L,92210174,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,HUMANA CHOICE PLUS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,AETNA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,CIGNA,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,WELLMED,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA,MGD,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 50MG CAP      ,92210176,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA CHOICE PLUS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,AETNA,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,BCBS,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,CIGNA,COM,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,TRICARE,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,UNITED HEALTHCARE,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,UNITED HEALTHCARE,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,VA,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,VA TRICARE,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,WELLMED,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,HUMANA,MGD,858.5,,,,,,,per diem,858.5,858.5,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92210177,CDM,250,RC,,,,,,Inpatient,1,EA,858.5,858.5,HUMANA CHOICE PLUS,MGD,858.5,,,,,,,case rate,858.5,858.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210178,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,AETNA,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,BCBS,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,CIGNA,COM,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,TRICARE,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,UNITED HEALTHCARE,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,UNITED HEALTHCARE,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,VA,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,VA TRICARE,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,WELLMED,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,HUMANA,MGD,50.21,,,,,,,per diem,50.21,50.21,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210179,CDM,250,RC,,,,,,Inpatient,1,EA,50.21,50.21,HUMANA CHOICE PLUS,MGD,50.21,,,,,,,case rate,50.21,50.21,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,AETNA,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,BCBS,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,CIGNA,COM,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,TRICARE,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,UNITED HEALTHCARE,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,UNITED HEALTHCARE,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,VA,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,VA TRICARE,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,WELLMED,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,HUMANA,MGD,15.37,,,,,,,per diem,15.37,15.37,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210180,CDM,250,RC,,,,,,Inpatient,1,EA,15.37,15.37,HUMANA CHOICE PLUS,MGD,15.37,,,,,,,case rate,15.37,15.37,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 30MG CAP            ,92210182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN ZINC SULF TAB    ,92210183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,AETNA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,CIGNA,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,WELLMED,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA,MGD,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210184,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA CHOICE PLUS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92210185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92210186,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,AETNA,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,BCBS,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,CIGNA,COM,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,TRICARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UNITED HEALTHCARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,UNITED HEALTHCARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,VA,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,VA TRICARE,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,WELLMED,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,HUMANA,MGD,19.47,,,,,,,per diem,19.47,19.47,"Per diem rate, code is bundled with other services"
CLOZAPINE 25MG TAB            ,92210187,CDM,250,RC,,,,,,Inpatient,1,EA,19.47,19.47,HUMANA CHOICE PLUS,MGD,19.47,,,,,,,case rate,19.47,19.47,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,AETNA,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,CIGNA,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,TRICARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,UNITED HEALTHCARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,UNITED HEALTHCARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,VA,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,VA TRICARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,WELLMED,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,HUMANA,MGD,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 50-25 TAB  ,92210188,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,HUMANA CHOICE PLUS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,AETNA,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,BCBS,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,CIGNA,COM,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,TRICARE,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,UNITED HEALTHCARE,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,UNITED HEALTHCARE,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,VA,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,VA TRICARE,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,WELLMED,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,HUMANA,MGD,10.62,,,,,,,per diem,10.62,10.62,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% POW             ,92210189,CDM,250,RC,,,,,,Inpatient,1,EA,10.62,10.62,HUMANA CHOICE PLUS,MGD,10.62,,,,,,,case rate,10.62,10.62,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210190,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210191,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92210192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,AETNA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,CIGNA,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,WELLMED,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA,MGD,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TER             ,92210193,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA CHOICE PLUS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,AETNA,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,BCBS,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,CIGNA,COM,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,TRICARE,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,UNITED HEALTHCARE,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,UNITED HEALTHCARE,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,VA,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,VA TRICARE,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,WELLMED,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,HUMANA,MGD,175.61,,,,,,,per diem,175.61,175.61,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210194,CDM,250,RC,,,,,,Inpatient,1,EA,175.61,175.61,HUMANA CHOICE PLUS,MGD,175.61,,,,,,,case rate,175.61,175.61,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,AETNA,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,BCBS,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,CIGNA,COM,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,TRICARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,UNITED HEALTHCARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,UNITED HEALTHCARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,VA,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,VA TRICARE,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,WELLMED,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,HUMANA,MGD,10.84,,,,,,,per diem,10.84,10.84,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92210195,CDM,250,RC,,,,,,Inpatient,1,EA,10.84,10.84,HUMANA CHOICE PLUS,MGD,10.84,,,,,,,case rate,10.84,10.84,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210196,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,AETNA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,CIGNA,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,VA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,VA TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,WELLMED,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,HUMANA,MGD,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92210200,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,HUMANA CHOICE PLUS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210201,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92210202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,AETNA,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,BCBS,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,CIGNA,COM,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,TRICARE,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,UNITED HEALTHCARE,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,UNITED HEALTHCARE,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,VA,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,VA TRICARE,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,WELLMED,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,HUMANA,MGD,19.75,,,,,,,per diem,19.75,19.75,"Per diem rate, code is bundled with other services"
DICLOFENAC NA MISOPRO 50-0.2 E,92210203,CDM,250,RC,,,,,,Inpatient,1,EA,19.75,19.75,HUMANA CHOICE PLUS,MGD,19.75,,,,,,,case rate,19.75,19.75,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,AETNA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,CIGNA,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,WELLMED,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA,MGD,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 150MG TAB       ,92210204,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA CHOICE PLUS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210205,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,AETNA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,CIGNA,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,WELLMED,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA,MGD,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210206,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA CHOICE PLUS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CER   ,92210208,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,AETNA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,CIGNA,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,WELLMED,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA,MGD,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
ARTIFICIAL TEARS 1.4% SOL     ,92210209,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA CHOICE PLUS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210210,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210211,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,AETNA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,CIGNA,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,WELLMED,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA,MGD,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210212,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA CHOICE PLUS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,AETNA,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,BCBS,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,CIGNA,COM,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,TRICARE,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,UNITED HEALTHCARE,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,UNITED HEALTHCARE,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,VA,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,VA TRICARE,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,WELLMED,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,HUMANA,MGD,174.6,,,,,,,per diem,174.6,174.6,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 500MCG INJ   ,92210213,CDM,250,RC,,,,,,Inpatient,1,EA,174.6,174.6,HUMANA CHOICE PLUS,MGD,174.6,,,,,,,case rate,174.6,174.6,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 200U SGL            ,92210214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,AETNA,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,BCBS,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,CIGNA,COM,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,TRICARE,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,UNITED HEALTHCARE,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,UNITED HEALTHCARE,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,VA,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,VA TRICARE,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,WELLMED,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,HUMANA,MGD,92.26,,,,,,,per diem,92.26,92.26,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 250MG/ML INJ    ,92210216,CDM,250,RC,,,,,,Inpatient,1,EA,92.26,92.26,HUMANA CHOICE PLUS,MGD,92.26,,,,,,,case rate,92.26,92.26,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,AETNA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,CIGNA,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,WELLMED,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA,MGD,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210218,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA CHOICE PLUS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,AETNA,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,BCBS,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,CIGNA,COM,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,TRICARE,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,UNITED HEALTHCARE,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,UNITED HEALTHCARE,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,VA,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,VA TRICARE,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,WELLMED,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,HUMANA,MGD,54.27,,,,,,,per diem,54.27,54.27,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92210219,CDM,250,RC,,,,,,Inpatient,1,EA,54.27,54.27,HUMANA CHOICE PLUS,MGD,54.27,,,,,,,case rate,54.27,54.27,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,AETNA,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,BCBS,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,CIGNA,COM,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,TRICARE,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,UNITED HEALTHCARE,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,UNITED HEALTHCARE,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,VA,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,VA TRICARE,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,WELLMED,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,HUMANA,MGD,18.99,,,,,,,per diem,18.99,18.99,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 1GM INJ        ,92210220,CDM,250,RC,,,,,,Inpatient,1,EA,18.99,18.99,HUMANA CHOICE PLUS,MGD,18.99,,,,,,,case rate,18.99,18.99,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,AETNA,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,CIGNA,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,TRICARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,UNITED HEALTHCARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,UNITED HEALTHCARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,VA,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,VA TRICARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,WELLMED,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,HUMANA,MGD,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210221,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,HUMANA CHOICE PLUS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,AETNA,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,BCBS,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,CIGNA,COM,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,TRICARE,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,UNITED HEALTHCARE,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,UNITED HEALTHCARE,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,VA,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,VA TRICARE,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,WELLMED,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,HUMANA,MGD,229.82,,,,,,,per diem,229.82,229.82,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210222,CDM,250,RC,,,,,,Inpatient,1,EA,229.82,229.82,HUMANA CHOICE PLUS,MGD,229.82,,,,,,,case rate,229.82,229.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,AETNA,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,BCBS,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,CIGNA,COM,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,TRICARE,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,UNITED HEALTHCARE,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,UNITED HEALTHCARE,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,VA,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,VA TRICARE,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,WELLMED,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,HUMANA,MGD,17.58,,,,,,,per diem,17.58,17.58,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210223,CDM,250,RC,,,,,,Inpatient,1,EA,17.58,17.58,HUMANA CHOICE PLUS,MGD,17.58,,,,,,,case rate,17.58,17.58,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210224,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,AETNA,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,BCBS,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,CIGNA,COM,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,TRICARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,UNITED HEALTHCARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,UNITED HEALTHCARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,VA,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,VA TRICARE,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,WELLMED,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,HUMANA,MGD,171.86,,,,,,,per diem,171.86,171.86,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.0375MG/DAY TDM    ,92210225,CDM,250,RC,,,,,,Inpatient,1,EA,171.86,171.86,HUMANA CHOICE PLUS,MGD,171.86,,,,,,,case rate,171.86,171.86,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210227,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 100MG TAB    ,92210228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,AETNA,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,BCBS,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,CIGNA,COM,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,TRICARE,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,UNITED HEALTHCARE,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,UNITED HEALTHCARE,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,VA,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,VA TRICARE,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,WELLMED,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,HUMANA,MGD,179.87,,,,,,,per diem,179.87,179.87,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210230,CDM,250,RC,,,,,,Inpatient,1,EA,179.87,179.87,HUMANA CHOICE PLUS,MGD,179.87,,,,,,,case rate,179.87,179.87,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92210231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TER   ",92210232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,AETNA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,CIGNA,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,WELLMED,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA,MGD,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TER        ,92210233,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA CHOICE PLUS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210234,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92210235,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,AETNA,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,CIGNA,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,TRICARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,UNITED HEALTHCARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,UNITED HEALTHCARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,VA,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,VA TRICARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,WELLMED,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,HUMANA,MGD,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.125MG TAB         ,92210236,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,HUMANA CHOICE PLUS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,AETNA,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,BCBS,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,CIGNA,COM,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,TRICARE,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,UNITED HEALTHCARE,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,UNITED HEALTHCARE,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,VA,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,VA TRICARE,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,WELLMED,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,HUMANA,MGD,10.58,,,,,,,per diem,10.58,10.58,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210238,CDM,250,RC,,,,,,Inpatient,1,EA,10.58,10.58,HUMANA CHOICE PLUS,MGD,10.58,,,,,,,case rate,10.58,10.58,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92210239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE GLUC 324MG TER      ,92210240,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 7.5MG TAB         ,92210241,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 10MG CAP           ,92210242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,AETNA,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,BCBS,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,CIGNA,COM,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,TRICARE,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,UNITED HEALTHCARE,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,UNITED HEALTHCARE,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,VA,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,VA TRICARE,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,WELLMED,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,HUMANA,MGD,6.71,,,,,,,per diem,6.71,6.71,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210245,CDM,250,RC,,,,,,Inpatient,1,EA,6.71,6.71,HUMANA CHOICE PLUS,MGD,6.71,,,,,,,case rate,6.71,6.71,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,AETNA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,BCBS,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,CIGNA,COM,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,UNITED HEALTHCARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,VA,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,VA TRICARE,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,WELLMED,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,HUMANA,MGD,67.22,,,,,,,per diem,67.22,67.22,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 5GM INJ        ,92210246,CDM,250,RC,,,,,,Inpatient,1,EA,67.22,67.22,HUMANA CHOICE PLUS,MGD,67.22,,,,,,,case rate,67.22,67.22,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,AETNA,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,CIGNA,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,TRICARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,UNITED HEALTHCARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,UNITED HEALTHCARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,VA,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,VA TRICARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,WELLMED,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,HUMANA,MGD,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 1.25MG TA,92210248,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,HUMANA CHOICE PLUS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210249,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,AETNA,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,BCBS,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,CIGNA,COM,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,TRICARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,UNITED HEALTHCARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,UNITED HEALTHCARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,VA,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,VA TRICARE,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,WELLMED,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,HUMANA,MGD,48.51,,,,,,,per diem,48.51,48.51,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% SOL           ,92210250,CDM,250,RC,,,,,,Inpatient,1,EA,48.51,48.51,HUMANA CHOICE PLUS,MGD,48.51,,,,,,,case rate,48.51,48.51,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,AETNA,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,BCBS,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,CIGNA,COM,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,TRICARE,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,UNITED HEALTHCARE,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,UNITED HEALTHCARE,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,VA,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,VA TRICARE,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,WELLMED,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,HUMANA,MGD,11.75,,,,,,,per diem,11.75,11.75,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 4% LIQ     ,92210251,CDM,250,RC,,,,,,Inpatient,1,EA,11.75,11.75,HUMANA CHOICE PLUS,MGD,11.75,,,,,,,case rate,11.75,11.75,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92210252,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,AETNA,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,CIGNA,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,TRICARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,UNITED HEALTHCARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,UNITED HEALTHCARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,VA,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,VA TRICARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,WELLMED,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,HUMANA,MGD,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
CEFADROXIL 250MG/5ML PDR      ,92210253,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,HUMANA CHOICE PLUS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92210254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE PSE 8-120MG C,92210255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,AETNA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,CIGNA,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,WELLMED,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA,MGD,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92210257,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA CHOICE PLUS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210258,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE-2 SUS                ,92210259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92210260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92210261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210262,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,AETNA,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,BCBS,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,CIGNA,COM,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,TRICARE,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,UNITED HEALTHCARE,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,UNITED HEALTHCARE,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,VA,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,VA TRICARE,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,WELLMED,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,HUMANA,MGD,36.92,,,,,,,per diem,36.92,36.92,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210263,CDM,250,RC,,,,,,Inpatient,1,EA,36.92,36.92,HUMANA CHOICE PLUS,MGD,36.92,,,,,,,case rate,36.92,36.92,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,AETNA,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,BCBS,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,CIGNA,COM,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,TRICARE,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,UNITED HEALTHCARE,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,UNITED HEALTHCARE,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,VA,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,VA TRICARE,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,WELLMED,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,HUMANA,MGD,6.99,,,,,,,per diem,6.99,6.99,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210265,CDM,250,RC,,,,,,Inpatient,1,EA,6.99,6.99,HUMANA CHOICE PLUS,MGD,6.99,,,,,,,case rate,6.99,6.99,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,AETNA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,CIGNA,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,WELLMED,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA,MGD,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210266,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA CHOICE PLUS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,AETNA,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,BCBS,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,CIGNA,COM,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,TRICARE,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,UNITED HEALTHCARE,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,UNITED HEALTHCARE,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,VA,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,VA TRICARE,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,WELLMED,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,HUMANA,MGD,96.48,,,,,,,per diem,96.48,96.48,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210267,CDM,250,RC,,,,,,Inpatient,1,EA,96.48,96.48,HUMANA CHOICE PLUS,MGD,96.48,,,,,,,case rate,96.48,96.48,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,AETNA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,CIGNA,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,VA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,VA TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,WELLMED,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,HUMANA,MGD,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10% SOL     ,92210268,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,HUMANA CHOICE PLUS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210269,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,AETNA,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,BCBS,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,CIGNA,COM,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,TRICARE,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,UNITED HEALTHCARE,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,UNITED HEALTHCARE,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,VA,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,VA TRICARE,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,WELLMED,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,HUMANA,MGD,229.6,,,,,,,per diem,229.6,229.6,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92210270,CDM,250,RC,,,,,,Inpatient,1,EA,229.6,229.6,HUMANA CHOICE PLUS,MGD,229.6,,,,,,,case rate,229.6,229.6,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92210271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92210272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,AETNA,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,CIGNA,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,TRICARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,UNITED HEALTHCARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,UNITED HEALTHCARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,VA,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,VA TRICARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,WELLMED,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,HUMANA,MGD,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92210273,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,HUMANA CHOICE PLUS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92210274,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92210275,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,AETNA,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,BCBS,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,CIGNA,COM,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,TRICARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,UNITED HEALTHCARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,UNITED HEALTHCARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,VA,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,VA TRICARE,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,WELLMED,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,HUMANA,MGD,90.56,,,,,,,per diem,90.56,90.56,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92210277,CDM,250,RC,,,,,,Inpatient,1,EA,90.56,90.56,HUMANA CHOICE PLUS,MGD,90.56,,,,,,,case rate,90.56,90.56,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92210278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92210279,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,AETNA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,CIGNA,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,WELLMED,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA,MGD,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/BAC Z O,92210281,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA CHOICE PLUS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210282,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,AETNA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,CIGNA,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,WELLMED,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA,MGD,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92210284,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA CHOICE PLUS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,AETNA,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,BCBS,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,CIGNA,COM,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,TRICARE,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,UNITED HEALTHCARE,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,UNITED HEALTHCARE,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,VA,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,VA TRICARE,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,WELLMED,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,HUMANA,MGD,30.21,,,,,,,per diem,30.21,30.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210285,CDM,250,RC,,,,,,Inpatient,1,EA,30.21,30.21,HUMANA CHOICE PLUS,MGD,30.21,,,,,,,case rate,30.21,30.21,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,AETNA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,CIGNA,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,WELLMED,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA,MGD,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
LOVASTATIN 20MG TAB           ,92210286,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA CHOICE PLUS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92210287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 400/80 TA,92210288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,AETNA,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,BCBS,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,CIGNA,COM,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,TRICARE,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,UNITED HEALTHCARE,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,UNITED HEALTHCARE,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,VA,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,VA TRICARE,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,WELLMED,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,HUMANA,MGD,14.4,,,,,,,per diem,14.4,14.4,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210290,CDM,258,RC,,,,,,Inpatient,1,EA,14.4,14.4,HUMANA CHOICE PLUS,MGD,14.4,,,,,,,case rate,14.4,14.4,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,AETNA,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,BCBS,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,CIGNA,COM,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,TRICARE,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,UNITED HEALTHCARE,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,UNITED HEALTHCARE,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,VA,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,VA TRICARE,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,WELLMED,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,HUMANA,MGD,503.65,,,,,,,per diem,503.65,503.65,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 125MG/5ML SU,92210291,CDM,250,RC,,,,,,Inpatient,1,EA,503.65,503.65,HUMANA CHOICE PLUS,MGD,503.65,,,,,,,case rate,503.65,503.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,AETNA,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,BCBS,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,CIGNA,COM,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,TRICARE,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,UNITED HEALTHCARE,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,UNITED HEALTHCARE,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,VA,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,VA TRICARE,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,WELLMED,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,HUMANA,MGD,37.64,,,,,,,per diem,37.64,37.64,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92210292,CDM,250,RC,,,,,,Inpatient,1,EA,37.64,37.64,HUMANA CHOICE PLUS,MGD,37.64,,,,,,,case rate,37.64,37.64,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,AETNA,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,CIGNA,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,TRICARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,UNITED HEALTHCARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,UNITED HEALTHCARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,VA,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,VA TRICARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,WELLMED,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,HUMANA,MGD,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
OXYMETAZOLINE HCL 0.05% SPR   ,92210293,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,HUMANA CHOICE PLUS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92210294,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,AETNA,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,CIGNA,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,TRICARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,UNITED HEALTHCARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,UNITED HEALTHCARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,VA,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,VA TRICARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,WELLMED,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,HUMANA,MGD,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210295,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,HUMANA CHOICE PLUS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,AETNA,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,BCBS,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,CIGNA,COM,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,TRICARE,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,UNITED HEALTHCARE,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,UNITED HEALTHCARE,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,VA,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,VA TRICARE,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,WELLMED,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,HUMANA,MGD,55.79,,,,,,,per diem,55.79,55.79,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG SUP     ,92210296,CDM,250,RC,,,,,,Inpatient,1,EA,55.79,55.79,HUMANA CHOICE PLUS,MGD,55.79,,,,,,,case rate,55.79,55.79,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210297,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210298,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,AETNA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,CIGNA,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,WELLMED,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA,MGD,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
CEFUROXIME AXETIL 250MG TAB   ,92210300,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA CHOICE PLUS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,AETNA,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,BCBS,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,CIGNA,COM,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,TRICARE,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,UNITED HEALTHCARE,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,UNITED HEALTHCARE,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,VA,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,VA TRICARE,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,WELLMED,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,HUMANA,MGD,14.68,,,,,,,per diem,14.68,14.68,"Per diem rate, code is bundled with other services"
PRAMOXINE HCL Z ACET 1%-0.1% L,92210301,CDM,250,RC,,,,,,Inpatient,1,EA,14.68,14.68,HUMANA CHOICE PLUS,MGD,14.68,,,,,,,case rate,14.68,14.68,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92210302,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALENIC ALKA SUS               ,92210303,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 500MG CAP          ,92210304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,AETNA,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,BCBS,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,CIGNA,COM,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,TRICARE,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,UNITED HEALTHCARE,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,UNITED HEALTHCARE,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,VA,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,VA TRICARE,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,WELLMED,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,HUMANA,MGD,303.41,,,,,,,per diem,303.41,303.41,"Per diem rate, code is bundled with other services"
BUTORPHANOL 10MG/ML SPR       ,92210306,CDM,250,RC,,,,,,Inpatient,1,EA,303.41,303.41,HUMANA CHOICE PLUS,MGD,303.41,,,,,,,case rate,303.41,303.41,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BETA CAROTENE 25,000U SGL     ",92210307,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-3 STRENGTH TAB       ,92210308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210309,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,AETNA,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,BCBS,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,CIGNA,COM,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,TRICARE,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,UNITED HEALTHCARE,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,UNITED HEALTHCARE,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,VA,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,VA TRICARE,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,WELLMED,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,HUMANA,MGD,151.17,,,,,,,per diem,151.17,151.17,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% LOT    ,92210310,CDM,250,RC,,,,,,Inpatient,1,EA,151.17,151.17,HUMANA CHOICE PLUS,MGD,151.17,,,,,,,case rate,151.17,151.17,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,AETNA,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,BCBS,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,CIGNA,COM,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,TRICARE,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,UNITED HEALTHCARE,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,UNITED HEALTHCARE,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,VA,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,VA TRICARE,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,WELLMED,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,HUMANA,MGD,14.84,,,,,,,per diem,14.84,14.84,"Per diem rate, code is bundled with other services"
AMOXICILLIN 125MG/5ML PDR     ,92210311,CDM,250,RC,,,,,,Inpatient,1,EA,14.84,14.84,HUMANA CHOICE PLUS,MGD,14.84,,,,,,,case rate,14.84,14.84,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,AETNA,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,BCBS,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,CIGNA,COM,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,TRICARE,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,UNITED HEALTHCARE,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,UNITED HEALTHCARE,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,VA,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,VA TRICARE,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,WELLMED,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,HUMANA,MGD,143.64,,,,,,,per diem,143.64,143.64,"Per diem rate, code is bundled with other services"
DIPIVEFRIN HCL 0.1% SOL       ,92210312,CDM,250,RC,,,,,,Inpatient,1,EA,143.64,143.64,HUMANA CHOICE PLUS,MGD,143.64,,,,,,,case rate,143.64,143.64,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,AETNA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,BCBS,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,CIGNA,COM,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,UNITED HEALTHCARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,VA,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,VA TRICARE,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,WELLMED,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,HUMANA,MGD,113.4,,,,,,,per diem,113.4,113.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92210313,CDM,250,RC,,,,,,Inpatient,1,EA,113.4,113.4,HUMANA CHOICE PLUS,MGD,113.4,,,,,,,case rate,113.4,113.4,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 10MG TAB    ,92210314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,AETNA,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,BCBS,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,CIGNA,COM,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,TRICARE,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,UNITED HEALTHCARE,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,UNITED HEALTHCARE,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,VA,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,VA TRICARE,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,WELLMED,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,HUMANA,MGD,119.79,,,,,,,per diem,119.79,119.79,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210315,CDM,250,RC,,,,,,Inpatient,1,EA,119.79,119.79,HUMANA CHOICE PLUS,MGD,119.79,,,,,,,case rate,119.79,119.79,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 80MG I,92210316,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,AETNA,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,BCBS,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,CIGNA,COM,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,TRICARE,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,UNITED HEALTHCARE,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,UNITED HEALTHCARE,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,VA,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,VA TRICARE,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,WELLMED,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,HUMANA,MGD,163.17,,,,,,,per diem,163.17,163.17,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210317,CDM,250,RC,,,,,,Inpatient,1,EA,163.17,163.17,HUMANA CHOICE PLUS,MGD,163.17,,,,,,,case rate,163.17,163.17,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,AETNA,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,BCBS,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,CIGNA,COM,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,TRICARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,UNITED HEALTHCARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,UNITED HEALTHCARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,VA,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,VA TRICARE,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,WELLMED,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,HUMANA,MGD,22.55,,,,,,,per diem,22.55,22.55,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92210318,CDM,250,RC,,,,,,Inpatient,1,EA,22.55,22.55,HUMANA CHOICE PLUS,MGD,22.55,,,,,,,case rate,22.55,22.55,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92210320,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210321,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,AETNA,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,BCBS,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,CIGNA,COM,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,TRICARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,UNITED HEALTHCARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,UNITED HEALTHCARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,VA,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,VA TRICARE,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,WELLMED,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,HUMANA,MGD,15.21,,,,,,,per diem,15.21,15.21,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210322,CDM,250,RC,,,,,,Inpatient,1,EA,15.21,15.21,HUMANA CHOICE PLUS,MGD,15.21,,,,,,,case rate,15.21,15.21,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,AETNA,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,CIGNA,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,TRICARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,UNITED HEALTHCARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,UNITED HEALTHCARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,VA,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,VA TRICARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,WELLMED,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,HUMANA,MGD,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210324,CDM,250,RC,,,,,,Inpatient,1,EA,7.43,7.43,HUMANA CHOICE PLUS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92210327,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-4 TAB      ,92210328,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,AETNA,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,BCBS,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,CIGNA,COM,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,TRICARE,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,UNITED HEALTHCARE,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,UNITED HEALTHCARE,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,VA,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,VA TRICARE,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,WELLMED,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,HUMANA,MGD,16.38,,,,,,,per diem,16.38,16.38,"Per diem rate, code is bundled with other services"
COLCHICINE                    ,92210329,CDM,250,RC,,,,,,Inpatient,1,EA,16.38,16.38,HUMANA CHOICE PLUS,MGD,16.38,,,,,,,case rate,16.38,16.38,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-50MG CAP  ,92210330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,AETNA,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,CIGNA,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,TRICARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,UNITED HEALTHCARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,UNITED HEALTHCARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,VA,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,VA TRICARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,WELLMED,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,HUMANA,MGD,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG SGL       ,92210331,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,HUMANA CHOICE PLUS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,AETNA,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,BCBS,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,CIGNA,COM,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,TRICARE,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,UNITED HEALTHCARE,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,UNITED HEALTHCARE,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,VA,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,VA TRICARE,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,WELLMED,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,HUMANA,MGD,307.13,,,,,,,per diem,307.13,307.13,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92210332,CDM,250,RC,,,,,,Inpatient,1,EA,307.13,307.13,HUMANA CHOICE PLUS,MGD,307.13,,,,,,,case rate,307.13,307.13,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210333,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 100MG TAB            ,92210334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  50MG/ML INJ         ,92210335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92210337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210340,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,AETNA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,CIGNA,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,WELLMED,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA,MGD,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
SODIUM CL CONC 4MEQ/ML INJ    ,92210341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA CHOICE PLUS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TAB            ,92210342,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE SUS                  ,92210343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 15MG/ML TAB     ,92210344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92210345,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,AETNA,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,BCBS,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,CIGNA,COM,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,TRICARE,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,UNITED HEALTHCARE,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,UNITED HEALTHCARE,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,VA,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,VA TRICARE,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,WELLMED,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,HUMANA,MGD,109.12,,,,,,,per diem,109.12,109.12,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 4MG TAB    ,92210346,CDM,250,RC,,,,,,Inpatient,1,EA,109.12,109.12,HUMANA CHOICE PLUS,MGD,109.12,,,,,,,case rate,109.12,109.12,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NP THYROID                    ,92210347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,AETNA,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,BCBS,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,CIGNA,COM,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,TRICARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,UNITED HEALTHCARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,UNITED HEALTHCARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,VA,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,VA TRICARE,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,WELLMED,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,HUMANA,MGD,17.14,,,,,,,per diem,17.14,17.14,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210348,CDM,250,RC,,,,,,Inpatient,1,EA,17.14,17.14,HUMANA CHOICE PLUS,MGD,17.14,,,,,,,case rate,17.14,17.14,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SOL ,92210349,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,AETNA,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,BCBS,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,CIGNA,COM,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,TRICARE,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,UNITED HEALTHCARE,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,UNITED HEALTHCARE,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,VA,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,VA TRICARE,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,WELLMED,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,HUMANA,MGD,329.65,,,,,,,per diem,329.65,329.65,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210350,CDM,250,RC,,,,,,Inpatient,1,EA,329.65,329.65,HUMANA CHOICE PLUS,MGD,329.65,,,,,,,case rate,329.65,329.65,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 1.5MG TAB         ,92210351,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210352,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92210354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92210355,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92210356,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,AETNA,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,BCBS,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,CIGNA,COM,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,TRICARE,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UNITED HEALTHCARE,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,UNITED HEALTHCARE,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,VA,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,VA TRICARE,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,WELLMED,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,HUMANA,MGD,6.33,,,,,,,per diem,6.33,6.33,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210358,CDM,250,RC,,,,,,Inpatient,1,EA,6.33,6.33,HUMANA CHOICE PLUS,MGD,6.33,,,,,,,case rate,6.33,6.33,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,AETNA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,CIGNA,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,VA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,VA TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,WELLMED,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,HUMANA,MGD,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
SODIUM BICARB POW             ,92210359,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,HUMANA CHOICE PLUS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 10MG TAB     ,92210360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,AETNA,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,BCBS,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,CIGNA,COM,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,TRICARE,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,UNITED HEALTHCARE,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,UNITED HEALTHCARE,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,VA,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,VA TRICARE,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,WELLMED,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,HUMANA,MGD,593.65,,,,,,,per diem,593.65,593.65,"Per diem rate, code is bundled with other services"
HYDROCORTISONE BUTYR 0.1% CRE ,92210361,CDM,250,RC,,,,,,Inpatient,1,EA,593.65,593.65,HUMANA CHOICE PLUS,MGD,593.65,,,,,,,case rate,593.65,593.65,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,AETNA,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,BCBS,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,CIGNA,COM,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,TRICARE,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,UNITED HEALTHCARE,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,UNITED HEALTHCARE,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,VA,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,VA TRICARE,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,WELLMED,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,HUMANA,MGD,59.41,,,,,,,per diem,59.41,59.41,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92210362,CDM,250,RC,,,,,,Inpatient,1,EA,59.41,59.41,HUMANA CHOICE PLUS,MGD,59.41,,,,,,,case rate,59.41,59.41,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210363,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,AETNA,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,BCBS,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,CIGNA,COM,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,TRICARE,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,UNITED HEALTHCARE,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,UNITED HEALTHCARE,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,VA,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,VA TRICARE,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,WELLMED,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,HUMANA,MGD,84.74,,,,,,,per diem,84.74,84.74,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210364,CDM,250,RC,,,,,,Inpatient,1,EA,84.74,84.74,HUMANA CHOICE PLUS,MGD,84.74,,,,,,,case rate,84.74,84.74,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX CAP         ,92210365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG CTB       ,92210366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,AETNA,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,CIGNA,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,TRICARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,UNITED HEALTHCARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,UNITED HEALTHCARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,VA,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,VA TRICARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,WELLMED,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,HUMANA,MGD,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210367,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,HUMANA CHOICE PLUS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,AETNA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,CIGNA,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,WELLMED,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA,MGD,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92210368,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA CHOICE PLUS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,AETNA,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,BCBS,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,CIGNA,COM,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,TRICARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,UNITED HEALTHCARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,UNITED HEALTHCARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,VA,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,VA TRICARE,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,WELLMED,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,HUMANA,MGD,283.5,,,,,,,per diem,283.5,283.5,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210369,CDM,250,RC,,,,,,Inpatient,1,EA,283.5,283.5,HUMANA CHOICE PLUS,MGD,283.5,,,,,,,case rate,283.5,283.5,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92210370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,AETNA,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,BCBS,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,CIGNA,COM,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,TRICARE,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,UNITED HEALTHCARE,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,UNITED HEALTHCARE,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,VA,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,VA TRICARE,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,WELLMED,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,HUMANA,MGD,193.69,,,,,,,per diem,193.69,193.69,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92210371,CDM,250,RC,,,,,,Inpatient,1,EA,193.69,193.69,HUMANA CHOICE PLUS,MGD,193.69,,,,,,,case rate,193.69,193.69,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,AETNA,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,BCBS,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,CIGNA,COM,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,TRICARE,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,UNITED HEALTHCARE,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,UNITED HEALTHCARE,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,VA,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,VA TRICARE,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,WELLMED,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,HUMANA,MGD,1587.6,,,,,,,per diem,1587.6,1587.6,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210372,CDM,250,RC,,,,,,Inpatient,1,EA,1587.6,1587.6,HUMANA CHOICE PLUS,MGD,1587.6,,,,,,,case rate,1587.6,1587.6,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,AETNA,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,BCBS,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,CIGNA,COM,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,TRICARE,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,UNITED HEALTHCARE,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,UNITED HEALTHCARE,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,VA,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,VA TRICARE,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,WELLMED,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,HUMANA,MGD,38.87,,,,,,,per diem,38.87,38.87,"Per diem rate, code is bundled with other services"
NIMODIPINE 30MG CAP           ,92210373,CDM,250,RC,,,,,,Inpatient,1,EA,38.87,38.87,HUMANA CHOICE PLUS,MGD,38.87,,,,,,,case rate,38.87,38.87,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,AETNA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,CIGNA,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,WELLMED,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA,MGD,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
MUMPS VIRUS VACCINE  INJ      ,92210374,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA CHOICE PLUS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92210375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML ELI   ,92210376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92210377,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 4MG TAB         ,92210378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,AETNA,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,BCBS,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,CIGNA,COM,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,TRICARE,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,UNITED HEALTHCARE,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,UNITED HEALTHCARE,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,VA,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,VA TRICARE,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,WELLMED,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,HUMANA,MGD,474.42,,,,,,,per diem,474.42,474.42,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92210379,CDM,250,RC,,,,,,Inpatient,1,EA,474.42,474.42,HUMANA CHOICE PLUS,MGD,474.42,,,,,,,case rate,474.42,474.42,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210380,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,AETNA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,CIGNA,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,WELLMED,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA,MGD,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 4MG TAB        ,92210381,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA CHOICE PLUS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92210382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,AETNA,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,BCBS,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,CIGNA,COM,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,TRICARE,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,UNITED HEALTHCARE,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,UNITED HEALTHCARE,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,VA,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,VA TRICARE,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,WELLMED,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,HUMANA,MGD,354.91,,,,,,,per diem,354.91,354.91,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05MG SPR   ,92210383,CDM,250,RC,,,,,,Inpatient,1,EA,354.91,354.91,HUMANA CHOICE PLUS,MGD,354.91,,,,,,,case rate,354.91,354.91,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,AETNA,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,BCBS,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,CIGNA,COM,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,TRICARE,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,UNITED HEALTHCARE,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,UNITED HEALTHCARE,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,VA,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,VA TRICARE,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,WELLMED,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,HUMANA,MGD,8.19,,,,,,,per diem,8.19,8.19,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92210384,CDM,250,RC,,,,,,Inpatient,1,EA,8.19,8.19,HUMANA CHOICE PLUS,MGD,8.19,,,,,,,case rate,8.19,8.19,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,AETNA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,CIGNA,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,WELLMED,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA,MGD,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210385,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA CHOICE PLUS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92210386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,AETNA,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,BCBS,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,CIGNA,COM,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,TRICARE,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,UNITED HEALTHCARE,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,UNITED HEALTHCARE,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,VA,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,VA TRICARE,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,WELLMED,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,HUMANA,MGD,5.32,,,,,,,per diem,5.32,5.32,"Per diem rate, code is bundled with other services"
"ERGOCALCIFEROL 50,000U CAP    ",92210387,CDM,250,RC,,,,,,Inpatient,1,EA,5.32,5.32,HUMANA CHOICE PLUS,MGD,5.32,,,,,,,case rate,5.32,5.32,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,AETNA,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,CIGNA,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,TRICARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,UNITED HEALTHCARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,UNITED HEALTHCARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,VA,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,VA TRICARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,WELLMED,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,HUMANA,MGD,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
MINERAL OIL                   ,92210388,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,HUMANA CHOICE PLUS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92210389,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 200MG TAB          ,92210390,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,AETNA,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,BCBS,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,CIGNA,COM,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,TRICARE,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,UNITED HEALTHCARE,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,UNITED HEALTHCARE,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,VA,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,VA TRICARE,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,WELLMED,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,HUMANA,MGD,14.11,,,,,,,per diem,14.11,14.11,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210391,CDM,250,RC,,,,,,Inpatient,1,EA,14.11,14.11,HUMANA CHOICE PLUS,MGD,14.11,,,,,,,case rate,14.11,14.11,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,AETNA,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,CIGNA,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,TRICARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,UNITED HEALTHCARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,UNITED HEALTHCARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,VA,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,VA TRICARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,WELLMED,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,HUMANA,MGD,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
RAMIPRIL 5MG CAP              ,92210392,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,HUMANA CHOICE PLUS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CTB         ,92210393,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92210394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,AETNA,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,CIGNA,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,TRICARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UNITED HEALTHCARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UNITED HEALTHCARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,VA,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,VA TRICARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,WELLMED,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,HUMANA,MGD,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 5MG TAB    ,92210395,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,HUMANA CHOICE PLUS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 10MG TAB       ,92210396,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210397,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92210398,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210399,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,AETNA,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,BCBS,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,CIGNA,COM,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,TRICARE,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,UNITED HEALTHCARE,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,UNITED HEALTHCARE,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,VA,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,VA TRICARE,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,WELLMED,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,HUMANA,MGD,253.86,,,,,,,per diem,253.86,253.86,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% PAS        ,92210400,CDM,250,RC,,,,,,Inpatient,1,EA,253.86,253.86,HUMANA CHOICE PLUS,MGD,253.86,,,,,,,case rate,253.86,253.86,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,AETNA,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,BCBS,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,CIGNA,COM,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,TRICARE,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,UNITED HEALTHCARE,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,UNITED HEALTHCARE,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,VA,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,VA TRICARE,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,WELLMED,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,HUMANA,MGD,125.18,,,,,,,per diem,125.18,125.18,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92210401,CDM,250,RC,,,,,,Inpatient,1,EA,125.18,125.18,HUMANA CHOICE PLUS,MGD,125.18,,,,,,,case rate,125.18,125.18,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210403,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,AETNA,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,BCBS,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,CIGNA,COM,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,TRICARE,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,UNITED HEALTHCARE,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,UNITED HEALTHCARE,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,VA,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,VA TRICARE,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,WELLMED,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,HUMANA,MGD,249.67,,,,,,,per diem,249.67,249.67,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE ACET 0.1% SUS ,92210404,CDM,250,RC,,,,,,Inpatient,1,EA,249.67,249.67,HUMANA CHOICE PLUS,MGD,249.67,,,,,,,case rate,249.67,249.67,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,AETNA,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,BCBS,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,CIGNA,COM,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,TRICARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,UNITED HEALTHCARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,UNITED HEALTHCARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,VA,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,VA TRICARE,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,WELLMED,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,HUMANA,MGD,7.43,,,,,,,per diem,7.43,7.43,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210405,CDM,258,RC,,,,,,Inpatient,1,EA,7.43,7.43,HUMANA CHOICE PLUS,MGD,7.43,,,,,,,case rate,7.43,7.43,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 275MG TAB         ,92210406,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,AETNA,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,CIGNA,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,TRICARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,UNITED HEALTHCARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,UNITED HEALTHCARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,VA,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,VA TRICARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,WELLMED,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,HUMANA,MGD,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210407,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,HUMANA CHOICE PLUS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,AETNA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,CIGNA,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,WELLMED,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA,MGD,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92210409,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA CHOICE PLUS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,AETNA,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,BCBS,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,CIGNA,COM,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,TRICARE,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,UNITED HEALTHCARE,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,UNITED HEALTHCARE,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,VA,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,VA TRICARE,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,WELLMED,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,HUMANA,MGD,126.91,,,,,,,per diem,126.91,126.91,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% SOL          ,92210410,CDM,250,RC,,,,,,Inpatient,1,EA,126.91,126.91,HUMANA CHOICE PLUS,MGD,126.91,,,,,,,case rate,126.91,126.91,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210411,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 100MG CAP      ,92210412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92210413,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210414,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG CTB        ,92210415,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE                    ,92210416,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,AETNA,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,BCBS,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,CIGNA,COM,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,TRICARE,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,UNITED HEALTHCARE,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,UNITED HEALTHCARE,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,VA,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,VA TRICARE,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,WELLMED,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,HUMANA,MGD,291.82,,,,,,,per diem,291.82,291.82,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92210417,CDM,250,RC,,,,,,Inpatient,1,EA,291.82,291.82,HUMANA CHOICE PLUS,MGD,291.82,,,,,,,case rate,291.82,291.82,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210418,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,AETNA,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,BCBS,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,CIGNA,COM,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,TRICARE,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,UNITED HEALTHCARE,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,UNITED HEALTHCARE,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,VA,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,VA TRICARE,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,WELLMED,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,HUMANA,MGD,935.96,,,,,,,per diem,935.96,935.96,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% GEL       ,92210419,CDM,250,RC,,,,,,Inpatient,1,EA,935.96,935.96,HUMANA CHOICE PLUS,MGD,935.96,,,,,,,case rate,935.96,935.96,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210420,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92210421,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92210422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,AETNA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,CIGNA,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,WELLMED,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA,MGD,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210423,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA CHOICE PLUS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,AETNA,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,BCBS,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,CIGNA,COM,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,TRICARE,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UNITED HEALTHCARE,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,UNITED HEALTHCARE,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,VA,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,VA TRICARE,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,WELLMED,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,HUMANA,MGD,9.39,,,,,,,per diem,9.39,9.39,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE 10MG/ML INJ     ,92210424,CDM,250,RC,,,,,,Inpatient,1,EA,9.39,9.39,HUMANA CHOICE PLUS,MGD,9.39,,,,,,,case rate,9.39,9.39,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210425,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210426,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 400MG TER            ,92210427,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,AETNA,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,BCBS,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,CIGNA,COM,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,TRICARE,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,UNITED HEALTHCARE,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,UNITED HEALTHCARE,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,VA,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,VA TRICARE,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,WELLMED,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,HUMANA,MGD,160.84,,,,,,,per diem,160.84,160.84,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% SOL       ,92210429,CDM,250,RC,,,,,,Inpatient,1,EA,160.84,160.84,HUMANA CHOICE PLUS,MGD,160.84,,,,,,,case rate,160.84,160.84,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,AETNA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,CIGNA,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,WELLMED,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA,MGD,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG ECT       ,92210430,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA CHOICE PLUS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 75MG TAB    ,92210431,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210432,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,AETNA,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,CIGNA,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,TRICARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,UNITED HEALTHCARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,UNITED HEALTHCARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,VA,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,VA TRICARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,WELLMED,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,HUMANA,MGD,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 200MG CAP      ,92210433,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,HUMANA CHOICE PLUS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,AETNA,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,BCBS,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,CIGNA,COM,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,TRICARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,UNITED HEALTHCARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,UNITED HEALTHCARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,VA,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,VA TRICARE,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,WELLMED,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,HUMANA,MGD,23.09,,,,,,,per diem,23.09,23.09,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210434,CDM,250,RC,,,,,,Inpatient,1,EA,23.09,23.09,HUMANA CHOICE PLUS,MGD,23.09,,,,,,,case rate,23.09,23.09,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 450MG T12        ,92210435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TER       ,92210436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,AETNA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,BCBS,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,CIGNA,COM,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,UNITED HEALTHCARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,VA,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,VA TRICARE,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,WELLMED,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,HUMANA,MGD,33.2,,,,,,,per diem,33.2,33.2,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92210438,CDM,250,RC,,,,,,Inpatient,1,EA,33.2,33.2,HUMANA CHOICE PLUS,MGD,33.2,,,,,,,case rate,33.2,33.2,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 2MG CAP           ,92210439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92210440,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE/ASA 4.88/325 TAB    ,92210442,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
CEFAZOLIN 500MG INJ           ,92210443,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 50MG TAB     ,92210444,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92210445,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92210447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,AETNA,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,CIGNA,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,TRICARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,UNITED HEALTHCARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,UNITED HEALTHCARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,VA,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,VA TRICARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,WELLMED,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,HUMANA,MGD,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210448,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,HUMANA CHOICE PLUS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210449,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,AETNA,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,BCBS,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,CIGNA,COM,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,TRICARE,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,UNITED HEALTHCARE,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,UNITED HEALTHCARE,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,VA,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,VA TRICARE,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,WELLMED,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,HUMANA,MGD,36.07,,,,,,,per diem,36.07,36.07,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% LOT     ,92210450,CDM,250,RC,,,,,,Inpatient,1,EA,36.07,36.07,HUMANA CHOICE PLUS,MGD,36.07,,,,,,,case rate,36.07,36.07,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,AETNA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,CIGNA,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,VA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,VA TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,WELLMED,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,HUMANA,MGD,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210451,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,HUMANA CHOICE PLUS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL TAB ,92210452,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG ECT              ,92210454,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,AETNA,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,BCBS,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,CIGNA,COM,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,TRICARE,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,UNITED HEALTHCARE,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,UNITED HEALTHCARE,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,VA,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,VA TRICARE,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,WELLMED,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,HUMANA,MGD,32.7,,,,,,,per diem,32.7,32.7,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92210455,CDM,250,RC,,,,,,Inpatient,1,EA,32.7,32.7,HUMANA CHOICE PLUS,MGD,32.7,,,,,,,case rate,32.7,32.7,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210456,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TER      ,92210457,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210458,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92210459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,AETNA,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,BCBS,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,CIGNA,COM,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,TRICARE,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,UNITED HEALTHCARE,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,UNITED HEALTHCARE,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,VA,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,VA TRICARE,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,WELLMED,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,HUMANA,MGD,44.35,,,,,,,per diem,44.35,44.35,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG/5ML SUS   ,92210460,CDM,250,RC,,,,,,Inpatient,1,EA,44.35,44.35,HUMANA CHOICE PLUS,MGD,44.35,,,,,,,case rate,44.35,44.35,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,AETNA,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,CIGNA,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,TRICARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,UNITED HEALTHCARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,UNITED HEALTHCARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,VA,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,VA TRICARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,WELLMED,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,HUMANA,MGD,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92210461,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,HUMANA CHOICE PLUS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 250MG TAB       ,92210462,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210463,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,AETNA,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,BCBS,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,CIGNA,COM,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,TRICARE,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,UNITED HEALTHCARE,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,UNITED HEALTHCARE,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,VA,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,VA TRICARE,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,WELLMED,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,HUMANA,MGD,1218.36,,,,,,,per diem,1218.36,1218.36,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% CRE      ,92210464,CDM,250,RC,,,,,,Inpatient,1,EA,1218.36,1218.36,HUMANA CHOICE PLUS,MGD,1218.36,,,,,,,case rate,1218.36,1218.36,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 100MG TAB       ,92210465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,AETNA,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,CIGNA,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,TRICARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,UNITED HEALTHCARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,UNITED HEALTHCARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,VA,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,VA TRICARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,WELLMED,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,HUMANA,MGD,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210466,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,HUMANA CHOICE PLUS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,AETNA,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,BCBS,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,CIGNA,COM,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,TRICARE,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,UNITED HEALTHCARE,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,UNITED HEALTHCARE,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,VA,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,VA TRICARE,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,WELLMED,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,HUMANA,MGD,235.4,,,,,,,per diem,235.4,235.4,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% SOL           ,92210467,CDM,250,RC,,,,,,Inpatient,1,EA,235.4,235.4,HUMANA CHOICE PLUS,MGD,235.4,,,,,,,case rate,235.4,235.4,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,AETNA,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,BCBS,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,CIGNA,COM,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,TRICARE,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,UNITED HEALTHCARE,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,UNITED HEALTHCARE,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,VA,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,VA TRICARE,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,WELLMED,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,HUMANA,MGD,88.64,,,,,,,per diem,88.64,88.64,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92210469,CDM,250,RC,,,,,,Inpatient,1,EA,88.64,88.64,HUMANA CHOICE PLUS,MGD,88.64,,,,,,,case rate,88.64,88.64,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,AETNA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,CIGNA,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,VA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,VA TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,WELLMED,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,HUMANA,MGD,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92210470,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,HUMANA CHOICE PLUS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG C24        ,92210471,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 25MG TAB     ,92210472,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,AETNA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,CIGNA,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,WELLMED,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA,MGD,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
PINDOLOL 10MG TAB             ,92210473,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA CHOICE PLUS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92210474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,AETNA,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,BCBS,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,CIGNA,COM,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,TRICARE,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,UNITED HEALTHCARE,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,UNITED HEALTHCARE,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,VA,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,VA TRICARE,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,WELLMED,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,HUMANA,MGD,160.05,,,,,,,per diem,160.05,160.05,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 0.2MG INJ    ,92210475,CDM,250,RC,,,,,,Inpatient,1,EA,160.05,160.05,HUMANA CHOICE PLUS,MGD,160.05,,,,,,,case rate,160.05,160.05,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,AETNA,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,BCBS,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,CIGNA,COM,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,TRICARE,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,UNITED HEALTHCARE,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,UNITED HEALTHCARE,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,VA,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,VA TRICARE,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,WELLMED,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,HUMANA,MGD,75.92,,,,,,,per diem,75.92,75.92,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210476,CDM,250,RC,,,,,,Inpatient,1,EA,75.92,75.92,HUMANA CHOICE PLUS,MGD,75.92,,,,,,,case rate,75.92,75.92,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,AETNA,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,BCBS,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,CIGNA,COM,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,TRICARE,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,UNITED HEALTHCARE,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,UNITED HEALTHCARE,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,VA,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,VA TRICARE,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,WELLMED,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,HUMANA,MGD,1841.62,,,,,,,per diem,1841.62,1841.62,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/1.6ML INJ   ,92210477,CDM,250,RC,,,,,,Inpatient,1,EA,1841.62,1841.62,HUMANA CHOICE PLUS,MGD,1841.62,,,,,,,case rate,1841.62,1841.62,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,AETNA,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,BCBS,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,CIGNA,COM,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,TRICARE,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,UNITED HEALTHCARE,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,UNITED HEALTHCARE,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,VA,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,VA TRICARE,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,WELLMED,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,HUMANA,MGD,7.99,,,,,,,per diem,7.99,7.99,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210479,CDM,250,RC,,,,,,Inpatient,1,EA,7.99,7.99,HUMANA CHOICE PLUS,MGD,7.99,,,,,,,case rate,7.99,7.99,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92210481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92210482,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92210483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,AETNA,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,CIGNA,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,TRICARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UNITED HEALTHCARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UNITED HEALTHCARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA TRICARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,WELLMED,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,HUMANA,MGD,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
DIGOXIN 125MCG TAB            ,92210484,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,HUMANA CHOICE PLUS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 125MCG TAB   ,92210485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,AETNA,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,BCBS,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,CIGNA,COM,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,TRICARE,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,UNITED HEALTHCARE,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,UNITED HEALTHCARE,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,VA,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,VA TRICARE,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,WELLMED,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,HUMANA,MGD,13.49,,,,,,,per diem,13.49,13.49,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92210486,CDM,250,RC,,,,,,Inpatient,1,EA,13.49,13.49,HUMANA CHOICE PLUS,MGD,13.49,,,,,,,case rate,13.49,13.49,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,AETNA,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,BCBS,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,CIGNA,COM,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,TRICARE,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,UNITED HEALTHCARE,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,UNITED HEALTHCARE,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,VA,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,VA TRICARE,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,WELLMED,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,HUMANA,MGD,59.25,,,,,,,per diem,59.25,59.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB ELI      ,92210487,CDM,250,RC,,,,,,Inpatient,1,EA,59.25,59.25,HUMANA CHOICE PLUS,MGD,59.25,,,,,,,case rate,59.25,59.25,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,AETNA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,CIGNA,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,WELLMED,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA,MGD,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92210488,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA CHOICE PLUS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 25MG TAB       ,92210489,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,AETNA,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,BCBS,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,CIGNA,COM,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,TRICARE,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,UNITED HEALTHCARE,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,UNITED HEALTHCARE,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,VA,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,VA TRICARE,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,WELLMED,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,HUMANA,MGD,60.17,,,,,,,per diem,60.17,60.17,"Per diem rate, code is bundled with other services"
NALOXONE HCL 0.4MG/ML INJ     ,92210490,CDM,250,RC,,,,,,Inpatient,1,EA,60.17,60.17,HUMANA CHOICE PLUS,MGD,60.17,,,,,,,case rate,60.17,60.17,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92210491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,AETNA,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,BCBS,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,CIGNA,COM,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,TRICARE,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,UNITED HEALTHCARE,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,UNITED HEALTHCARE,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,VA,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,VA TRICARE,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,WELLMED,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,HUMANA,MGD,42.27,,,,,,,per diem,42.27,42.27,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92210492,CDM,250,RC,,,,,,Inpatient,1,EA,42.27,42.27,HUMANA CHOICE PLUS,MGD,42.27,,,,,,,case rate,42.27,42.27,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,AETNA,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,BCBS,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,CIGNA,COM,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,TRICARE,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,UNITED HEALTHCARE,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,UNITED HEALTHCARE,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,VA,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,VA TRICARE,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,WELLMED,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,HUMANA,MGD,78.91,,,,,,,per diem,78.91,78.91,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210493,CDM,250,RC,,,,,,Inpatient,1,EA,78.91,78.91,HUMANA CHOICE PLUS,MGD,78.91,,,,,,,case rate,78.91,78.91,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92210494,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 4MG TAB           ,92210495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,AETNA,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,BCBS,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,CIGNA,COM,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,TRICARE,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,UNITED HEALTHCARE,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,UNITED HEALTHCARE,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,VA,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,VA TRICARE,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,WELLMED,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,HUMANA,MGD,109.4,,,,,,,per diem,109.4,109.4,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210496,CDM,250,RC,,,,,,Inpatient,1,EA,109.4,109.4,HUMANA CHOICE PLUS,MGD,109.4,,,,,,,case rate,109.4,109.4,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,AETNA,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,BCBS,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,CIGNA,COM,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,TRICARE,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UNITED HEALTHCARE,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,UNITED HEALTHCARE,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,VA,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,VA TRICARE,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,WELLMED,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,HUMANA,MGD,10.68,,,,,,,per diem,10.68,10.68,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92210497,CDM,250,RC,,,,,,Inpatient,1,EA,10.68,10.68,HUMANA CHOICE PLUS,MGD,10.68,,,,,,,case rate,10.68,10.68,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,AETNA,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,BCBS,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,CIGNA,COM,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,TRICARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,UNITED HEALTHCARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,UNITED HEALTHCARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,VA,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,VA TRICARE,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,WELLMED,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,HUMANA,MGD,33.86,,,,,,,per diem,33.86,33.86,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210498,CDM,250,RC,,,,,,Inpatient,1,EA,33.86,33.86,HUMANA CHOICE PLUS,MGD,33.86,,,,,,,case rate,33.86,33.86,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92210500,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,AETNA,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,CIGNA,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,TRICARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,UNITED HEALTHCARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,UNITED HEALTHCARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,VA,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,VA TRICARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,WELLMED,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,HUMANA,MGD,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 50MG TAB   ,92210501,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,HUMANA CHOICE PLUS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,AETNA,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,BCBS,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,CIGNA,COM,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,TRICARE,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,UNITED HEALTHCARE,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,UNITED HEALTHCARE,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,VA,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,VA TRICARE,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,WELLMED,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,HUMANA,MGD,43.88,,,,,,,per diem,43.88,43.88,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210503,CDM,250,RC,,,,,,Inpatient,1,EA,43.88,43.88,HUMANA CHOICE PLUS,MGD,43.88,,,,,,,case rate,43.88,43.88,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,AETNA,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,BCBS,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,CIGNA,COM,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,TRICARE,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,UNITED HEALTHCARE,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,UNITED HEALTHCARE,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,VA,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,VA TRICARE,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,WELLMED,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,HUMANA,MGD,226.7,,,,,,,per diem,226.7,226.7,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML INJ,92210504,CDM,250,RC,,,,,,Inpatient,1,EA,226.7,226.7,HUMANA CHOICE PLUS,MGD,226.7,,,,,,,case rate,226.7,226.7,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,AETNA,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,BCBS,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,CIGNA,COM,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,TRICARE,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,UNITED HEALTHCARE,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,UNITED HEALTHCARE,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,VA,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,VA TRICARE,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,WELLMED,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,HUMANA,MGD,117.68,,,,,,,per diem,117.68,117.68,"Per diem rate, code is bundled with other services"
"POLYMYXIN B/TMP 10,000U/1MG SO",92210505,CDM,250,RC,,,,,,Inpatient,1,EA,117.68,117.68,HUMANA CHOICE PLUS,MGD,117.68,,,,,,,case rate,117.68,117.68,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 50MG TAB         ,92210506,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 600 W/D 200U TAB ,92210507,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,AETNA,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,BCBS,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,CIGNA,COM,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,TRICARE,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,UNITED HEALTHCARE,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,UNITED HEALTHCARE,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,VA,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,VA TRICARE,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,WELLMED,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,HUMANA,MGD,388.33,,,,,,,per diem,388.33,388.33,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.5% EYE SOL    ,92210508,CDM,250,RC,,,,,,Inpatient,1,EA,388.33,388.33,HUMANA CHOICE PLUS,MGD,388.33,,,,,,,case rate,388.33,388.33,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210509,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92210510,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92210511,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,AETNA,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,BCBS,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,CIGNA,COM,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,TRICARE,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,UNITED HEALTHCARE,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,UNITED HEALTHCARE,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,VA,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,VA TRICARE,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,WELLMED,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,HUMANA,MGD,389.81,,,,,,,per diem,389.81,389.81,"Per diem rate, code is bundled with other services"
NEOMYIN SULF/POLYMYX B/DEXAM O,92210512,CDM,250,RC,,,,,,Inpatient,1,EA,389.81,389.81,HUMANA CHOICE PLUS,MGD,389.81,,,,,,,case rate,389.81,389.81,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92210513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92210514,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUANFACINE HCL 2MG TAB        ,92210515,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 650MG TAB   ,92210516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TAB     ",92210517,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92210518,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210519,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,AETNA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,BCBS,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,CIGNA,COM,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,UNITED HEALTHCARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,VA,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,VA TRICARE,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,WELLMED,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,HUMANA,MGD,18.74,,,,,,,per diem,18.74,18.74,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.2MG/HR TDM    ,92210520,CDM,250,RC,,,,,,Inpatient,1,EA,18.74,18.74,HUMANA CHOICE PLUS,MGD,18.74,,,,,,,case rate,18.74,18.74,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,AETNA,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,BCBS,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,CIGNA,COM,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,TRICARE,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,UNITED HEALTHCARE,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,UNITED HEALTHCARE,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,VA,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,VA TRICARE,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,WELLMED,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,HUMANA,MGD,17.55,,,,,,,per diem,17.55,17.55,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210521,CDM,250,RC,,,,,,Inpatient,1,EA,17.55,17.55,HUMANA CHOICE PLUS,MGD,17.55,,,,,,,case rate,17.55,17.55,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210522,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,AETNA,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,BCBS,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,CIGNA,COM,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,TRICARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,UNITED HEALTHCARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,UNITED HEALTHCARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,VA,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,VA TRICARE,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,WELLMED,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,HUMANA,MGD,23.88,,,,,,,per diem,23.88,23.88,"Per diem rate, code is bundled with other services"
LAMIVUDINE 150MG TAB          ,92210523,CDM,250,RC,,,,,,Inpatient,1,EA,23.88,23.88,HUMANA CHOICE PLUS,MGD,23.88,,,,,,,case rate,23.88,23.88,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92210525,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210526,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,AETNA,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,BCBS,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,CIGNA,COM,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,TRICARE,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,UNITED HEALTHCARE,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,UNITED HEALTHCARE,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,VA,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,VA TRICARE,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,WELLMED,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,HUMANA,MGD,555.28,,,,,,,per diem,555.28,555.28,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210527,CDM,250,RC,,,,,,Inpatient,1,EA,555.28,555.28,HUMANA CHOICE PLUS,MGD,555.28,,,,,,,case rate,555.28,555.28,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
BENZONATATE 100MG SGL         ,92210528,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210530,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,AETNA,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,BCBS,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,CIGNA,COM,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,TRICARE,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,UNITED HEALTHCARE,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,UNITED HEALTHCARE,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,VA,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,VA TRICARE,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,WELLMED,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,HUMANA,MGD,13.89,,,,,,,per diem,13.89,13.89,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG CAP       ,92210531,CDM,250,RC,,,,,,Inpatient,1,EA,13.89,13.89,HUMANA CHOICE PLUS,MGD,13.89,,,,,,,case rate,13.89,13.89,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 2MG TAB             ,92210532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,AETNA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,CIGNA,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,WELLMED,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA,MGD,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
MAGNESIUM CITR 1.75GM/30ML LIQ,92210533,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA CHOICE PLUS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,AETNA,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,BCBS,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,CIGNA,COM,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,TRICARE,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,UNITED HEALTHCARE,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,UNITED HEALTHCARE,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,VA,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,VA TRICARE,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,WELLMED,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,HUMANA,MGD,306.4,,,,,,,per diem,306.4,306.4,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 4% EYE SOL    ,92210534,CDM,250,RC,,,,,,Inpatient,1,EA,306.4,306.4,HUMANA CHOICE PLUS,MGD,306.4,,,,,,,case rate,306.4,306.4,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,AETNA,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,BCBS,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,CIGNA,COM,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,TRICARE,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,UNITED HEALTHCARE,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,UNITED HEALTHCARE,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,VA,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,VA TRICARE,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,WELLMED,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,HUMANA,MGD,14.49,,,,,,,per diem,14.49,14.49,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% SOL             ,92210535,CDM,250,RC,,,,,,Inpatient,1,EA,14.49,14.49,HUMANA CHOICE PLUS,MGD,14.49,,,,,,,case rate,14.49,14.49,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,AETNA,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,BCBS,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,CIGNA,COM,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,TRICARE,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,UNITED HEALTHCARE,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,UNITED HEALTHCARE,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,VA,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,VA TRICARE,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,WELLMED,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,HUMANA,MGD,1329.17,,,,,,,per diem,1329.17,1329.17,"Per diem rate, code is bundled with other services"
SALMETEROL XINAFOATE 46MCG DSK,92210536,CDM,250,RC,,,,,,Inpatient,1,EA,1329.17,1329.17,HUMANA CHOICE PLUS,MGD,1329.17,,,,,,,case rate,1329.17,1329.17,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,AETNA,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,BCBS,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,CIGNA,COM,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,TRICARE,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,UNITED HEALTHCARE,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,UNITED HEALTHCARE,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,VA,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,VA TRICARE,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,WELLMED,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,HUMANA,MGD,140.4,,,,,,,per diem,140.4,140.4,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210537,CDM,250,RC,,,,,,Inpatient,1,EA,140.4,140.4,HUMANA CHOICE PLUS,MGD,140.4,,,,,,,case rate,140.4,140.4,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92210538,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92210539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210540,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 1.25MG TAB         ,92210541,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,AETNA,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,BCBS,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,CIGNA,COM,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,TRICARE,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,UNITED HEALTHCARE,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,UNITED HEALTHCARE,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,VA,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,VA TRICARE,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,WELLMED,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,HUMANA,MGD,14.36,,,,,,,per diem,14.36,14.36,"Per diem rate, code is bundled with other services"
CROMOLYN NA 10MG/ML SOL       ,92210544,CDM,250,RC,,,,,,Inpatient,1,EA,14.36,14.36,HUMANA CHOICE PLUS,MGD,14.36,,,,,,,case rate,14.36,14.36,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210545,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,AETNA,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,BCBS,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,CIGNA,COM,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,TRICARE,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,UNITED HEALTHCARE,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,UNITED HEALTHCARE,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,VA,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,VA TRICARE,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,WELLMED,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,HUMANA,MGD,40.86,,,,,,,per diem,40.86,40.86,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92210546,CDM,250,RC,,,,,,Inpatient,1,EA,40.86,40.86,HUMANA CHOICE PLUS,MGD,40.86,,,,,,,case rate,40.86,40.86,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,AETNA,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,BCBS,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,CIGNA,COM,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,TRICARE,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,UNITED HEALTHCARE,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,UNITED HEALTHCARE,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,VA,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,VA TRICARE,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,WELLMED,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,HUMANA,MGD,813.8,,,,,,,per diem,813.8,813.8,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% OIN   ,92210547,CDM,250,RC,,,,,,Inpatient,1,EA,813.8,813.8,HUMANA CHOICE PLUS,MGD,813.8,,,,,,,case rate,813.8,813.8,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL 100MG TAB       ,92210548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92210549,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,AETNA,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,BCBS,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,CIGNA,COM,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,TRICARE,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,UNITED HEALTHCARE,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,UNITED HEALTHCARE,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,VA,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,VA TRICARE,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,WELLMED,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,HUMANA,MGD,1307.88,,,,,,,per diem,1307.88,1307.88,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210550,CDM,250,RC,,,,,,Inpatient,1,EA,1307.88,1307.88,HUMANA CHOICE PLUS,MGD,1307.88,,,,,,,case rate,1307.88,1307.88,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210551,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92210552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210553,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM IODIDE 1GM/ML SOL   ,92210554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,AETNA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,CIGNA,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,VA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,VA TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,WELLMED,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,HUMANA,MGD,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 160MG CER     ,92210555,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,HUMANA CHOICE PLUS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210556,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,AETNA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,CIGNA,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,WELLMED,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA,MGD,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210557,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA CHOICE PLUS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 25MCG TAB    ,92210558,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LITHIUM CARBONATE 300MG CAP   ,92210559,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92210560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,AETNA,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,BCBS,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,CIGNA,COM,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,TRICARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,UNITED HEALTHCARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,UNITED HEALTHCARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,VA,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,VA TRICARE,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,WELLMED,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,HUMANA,MGD,13.23,,,,,,,per diem,13.23,13.23,"Per diem rate, code is bundled with other services"
NUTRILYTE 20ML INJ            ,92210561,CDM,250,RC,,,,,,Inpatient,1,EA,13.23,13.23,HUMANA CHOICE PLUS,MGD,13.23,,,,,,,case rate,13.23,13.23,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210562,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,AETNA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,CIGNA,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,WELLMED,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA,MGD,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG CAP        ,92210564,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA CHOICE PLUS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/9GM PDR    ,92210565,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 5MG TAB   ,92210566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,AETNA,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,BCBS,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,CIGNA,COM,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,TRICARE,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,UNITED HEALTHCARE,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,UNITED HEALTHCARE,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,VA,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,VA TRICARE,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,WELLMED,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,HUMANA,MGD,22.43,,,,,,,per diem,22.43,22.43,"Per diem rate, code is bundled with other services"
METHYLERGONOVINE MAL 0.2MG INJ,92210568,CDM,250,RC,,,,,,Inpatient,1,EA,22.43,22.43,HUMANA CHOICE PLUS,MGD,22.43,,,,,,,case rate,22.43,22.43,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,AETNA,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,BCBS,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,CIGNA,COM,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,TRICARE,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,UNITED HEALTHCARE,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,UNITED HEALTHCARE,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,VA,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,VA TRICARE,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,WELLMED,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,HUMANA,MGD,24.41,,,,,,,per diem,24.41,24.41,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TER  ,92210569,CDM,250,RC,,,,,,Inpatient,1,EA,24.41,24.41,HUMANA CHOICE PLUS,MGD,24.41,,,,,,,case rate,24.41,24.41,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92210570,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,AETNA,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,BCBS,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,CIGNA,COM,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,TRICARE,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,UNITED HEALTHCARE,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,UNITED HEALTHCARE,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,VA,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,VA TRICARE,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,WELLMED,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,HUMANA,MGD,23.69,,,,,,,per diem,23.69,23.69,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP INJ      ,92210571,CDM,250,RC,,,,,,Inpatient,1,EA,23.69,23.69,HUMANA CHOICE PLUS,MGD,23.69,,,,,,,case rate,23.69,23.69,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,AETNA,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,BCBS,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,CIGNA,COM,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,TRICARE,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,UNITED HEALTHCARE,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,UNITED HEALTHCARE,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,VA,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,VA TRICARE,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,WELLMED,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,HUMANA,MGD,261.45,,,,,,,per diem,261.45,261.45,"Per diem rate, code is bundled with other services"
LEVOBUNOLOL 0.5% EYE SOL      ,92210572,CDM,250,RC,,,,,,Inpatient,1,EA,261.45,261.45,HUMANA CHOICE PLUS,MGD,261.45,,,,,,,case rate,261.45,261.45,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,AETNA,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,BCBS,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,CIGNA,COM,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,TRICARE,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,UNITED HEALTHCARE,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,UNITED HEALTHCARE,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,VA,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,VA TRICARE,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,WELLMED,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,HUMANA,MGD,49.14,,,,,,,per diem,49.14,49.14,"Per diem rate, code is bundled with other services"
ATRACURIUM BESYLATE 10MG/ML IN,92210574,CDM,250,RC,,,,,,Inpatient,1,EA,49.14,49.14,HUMANA CHOICE PLUS,MGD,49.14,,,,,,,case rate,49.14,49.14,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210575,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92210576,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,AETNA,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,BCBS,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,CIGNA,COM,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,TRICARE,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,UNITED HEALTHCARE,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,UNITED HEALTHCARE,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,VA,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,VA TRICARE,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,WELLMED,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,HUMANA,MGD,43.25,,,,,,,per diem,43.25,43.25,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% LOT         ,92210577,CDM,250,RC,,,,,,Inpatient,1,EA,43.25,43.25,HUMANA CHOICE PLUS,MGD,43.25,,,,,,,case rate,43.25,43.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 25MG TAB    ,92210578,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
PAPAVERINE HCL 30MG/ML INJ    ,92210579,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,AETNA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,BCBS,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,CIGNA,COM,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,UNITED HEALTHCARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,VA,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,VA TRICARE,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,WELLMED,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,HUMANA,MGD,19.28,,,,,,,per diem,19.28,19.28,"Per diem rate, code is bundled with other services"
FLUVASTATIN NA 20MG CAP       ,92210580,CDM,250,RC,,,,,,Inpatient,1,EA,19.28,19.28,HUMANA CHOICE PLUS,MGD,19.28,,,,,,,case rate,19.28,19.28,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,AETNA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,CIGNA,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,WELLMED,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA,MGD,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 50MG CAP   ,92210581,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA CHOICE PLUS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92210582,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,AETNA,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,BCBS,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,CIGNA,COM,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,TRICARE,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,UNITED HEALTHCARE,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,UNITED HEALTHCARE,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,VA,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,VA TRICARE,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,WELLMED,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,HUMANA,MGD,6.52,,,,,,,per diem,6.52,6.52,"Per diem rate, code is bundled with other services"
DIFLUNISAL 500MG TAB          ,92210583,CDM,250,RC,,,,,,Inpatient,1,EA,6.52,6.52,HUMANA CHOICE PLUS,MGD,6.52,,,,,,,case rate,6.52,6.52,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210584,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92210585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,AETNA,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,CIGNA,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,TRICARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,UNITED HEALTHCARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,UNITED HEALTHCARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,VA,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,VA TRICARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,WELLMED,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,HUMANA,MGD,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210586,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,HUMANA CHOICE PLUS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,AETNA,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,BCBS,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,CIGNA,COM,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,TRICARE,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,UNITED HEALTHCARE,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,UNITED HEALTHCARE,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,VA,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,VA TRICARE,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,WELLMED,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,HUMANA,MGD,26.18,,,,,,,per diem,26.18,26.18,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210587,CDM,250,RC,,,,,,Inpatient,1,EA,26.18,26.18,HUMANA CHOICE PLUS,MGD,26.18,,,,,,,case rate,26.18,26.18,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,AETNA,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,BCBS,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,CIGNA,COM,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,TRICARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UNITED HEALTHCARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,UNITED HEALTHCARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,VA TRICARE,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,WELLMED,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,HUMANA,MGD,6.39,,,,,,,per diem,6.39,6.39,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92210588,CDM,250,RC,,,,,,Inpatient,1,EA,6.39,6.39,HUMANA CHOICE PLUS,MGD,6.39,,,,,,,case rate,6.39,6.39,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,AETNA,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,BCBS,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,CIGNA,COM,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,TRICARE,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,UNITED HEALTHCARE,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,UNITED HEALTHCARE,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,VA,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,VA TRICARE,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,WELLMED,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,HUMANA,MGD,12.82,,,,,,,per diem,12.82,12.82,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210590,CDM,250,RC,,,,,,Inpatient,1,EA,12.82,12.82,HUMANA CHOICE PLUS,MGD,12.82,,,,,,,case rate,12.82,12.82,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN A 10,000U CAP         ",92210591,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210592,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210594,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,AETNA,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,BCBS,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,CIGNA,COM,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,TRICARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,UNITED HEALTHCARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,UNITED HEALTHCARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,VA,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,VA TRICARE,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,WELLMED,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,HUMANA,MGD,10.49,,,,,,,per diem,10.49,10.49,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92210595,CDM,250,RC,,,,,,Inpatient,1,EA,10.49,10.49,HUMANA CHOICE PLUS,MGD,10.49,,,,,,,case rate,10.49,10.49,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-2 TAB      ,92210596,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTAZOLAM 1MG TAB             ,92210597,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN NA 220MG TAB         ,92210598,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAZODONE HCL 50MG TAB        ,92210600,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92210601,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,AETNA,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,BCBS,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,CIGNA,COM,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,TRICARE,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,UNITED HEALTHCARE,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,UNITED HEALTHCARE,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,VA,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,VA TRICARE,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,WELLMED,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,HUMANA,MGD,21.45,,,,,,,per diem,21.45,21.45,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.1%  SOL     ,92210602,CDM,250,RC,,,,,,Inpatient,1,EA,21.45,21.45,HUMANA CHOICE PLUS,MGD,21.45,,,,,,,case rate,21.45,21.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,AETNA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,BCBS,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,CIGNA,COM,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,UNITED HEALTHCARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,VA TRICARE,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,WELLMED,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA,MGD,5.45,,,,,,,per diem,5.45,5.45,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210603,CDM,250,RC,,,,,,Inpatient,1,EA,5.45,5.45,HUMANA CHOICE PLUS,MGD,5.45,,,,,,,case rate,5.45,5.45,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92210604,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210605,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92210606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,AETNA,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,BCBS,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,CIGNA,COM,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,TRICARE,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,UNITED HEALTHCARE,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,UNITED HEALTHCARE,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,VA,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,VA TRICARE,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,WELLMED,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,HUMANA,MGD,9.2,,,,,,,per diem,9.2,9.2,"Per diem rate, code is bundled with other services"
SELEGILINE HCL 5MG TAB        ,92210607,CDM,250,RC,,,,,,Inpatient,1,EA,9.2,9.2,HUMANA CHOICE PLUS,MGD,9.2,,,,,,,case rate,9.2,9.2,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG TAB   ,92210608,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 100MG TAB           ,92210609,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210610,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,AETNA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,BCBS,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,CIGNA,COM,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,UNITED HEALTHCARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,VA,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,VA TRICARE,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,WELLMED,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,HUMANA,MGD,50.4,,,,,,,per diem,50.4,50.4,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210611,CDM,250,RC,,,,,,Inpatient,1,EA,50.4,50.4,HUMANA CHOICE PLUS,MGD,50.4,,,,,,,case rate,50.4,50.4,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,AETNA,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,CIGNA,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,TRICARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,UNITED HEALTHCARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,UNITED HEALTHCARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,VA,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,VA TRICARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,WELLMED,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,HUMANA,MGD,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
MEXILETINE HCL 150MG CAP      ,92210612,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,HUMANA CHOICE PLUS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92210613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,AETNA,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,BCBS,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,CIGNA,COM,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,TRICARE,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,UNITED HEALTHCARE,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,UNITED HEALTHCARE,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,VA,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,VA TRICARE,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,WELLMED,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,HUMANA,MGD,237.92,,,,,,,per diem,237.92,237.92,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92210614,CDM,250,RC,,,,,,Inpatient,1,EA,237.92,237.92,HUMANA CHOICE PLUS,MGD,237.92,,,,,,,case rate,237.92,237.92,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92210615,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92210616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92210617,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 30MG TER           ,92210618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92210619,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210621,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92210622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,AETNA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,CIGNA,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,WELLMED,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA,MGD,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
CPM PLOY HYDROCODONE SER      ,92210623,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA CHOICE PLUS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,AETNA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,BCBS,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,CIGNA,COM,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,UNITED HEALTHCARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,VA,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,VA TRICARE,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,WELLMED,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,HUMANA,MGD,22.14,,,,,,,per diem,22.14,22.14,"Per diem rate, code is bundled with other services"
LOTION MULTI INGREDIENT LOT   ,92210624,CDM,250,RC,,,,,,Inpatient,1,EA,22.14,22.14,HUMANA CHOICE PLUS,MGD,22.14,,,,,,,case rate,22.14,22.14,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-2 STRENGTH TAB       ,92210625,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,AETNA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,BCBS,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,CIGNA,COM,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,UNITED HEALTHCARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,VA TRICARE,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,WELLMED,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA,MGD,14.18,,,,,,,per diem,14.18,14.18,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210626,CDM,250,RC,,,,,,Inpatient,1,EA,14.18,14.18,HUMANA CHOICE PLUS,MGD,14.18,,,,,,,case rate,14.18,14.18,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,AETNA,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,BCBS,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,CIGNA,COM,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,TRICARE,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,UNITED HEALTHCARE,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,UNITED HEALTHCARE,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,VA,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,VA TRICARE,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,WELLMED,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,HUMANA,MGD,164.75,,,,,,,per diem,164.75,164.75,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210627,CDM,250,RC,,,,,,Inpatient,1,EA,164.75,164.75,HUMANA CHOICE PLUS,MGD,164.75,,,,,,,case rate,164.75,164.75,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  15MG TAB            ,92210628,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,AETNA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,BCBS,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,CIGNA,COM,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,UNITED HEALTHCARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,VA TRICARE,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,WELLMED,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA,MGD,56.7,,,,,,,per diem,56.7,56.7,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 10% INJ    ,92210629,CDM,250,RC,,,,,,Inpatient,1,EA,56.7,56.7,HUMANA CHOICE PLUS,MGD,56.7,,,,,,,case rate,56.7,56.7,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,AETNA,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,BCBS,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,CIGNA,COM,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,TRICARE,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,UNITED HEALTHCARE,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,UNITED HEALTHCARE,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,VA,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,VA TRICARE,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,WELLMED,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,HUMANA,MGD,93.15,,,,,,,per diem,93.15,93.15,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92210630,CDM,250,RC,,,,,,Inpatient,1,EA,93.15,93.15,HUMANA CHOICE PLUS,MGD,93.15,,,,,,,case rate,93.15,93.15,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92210631,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,AETNA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,CIGNA,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,WELLMED,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA,MGD,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210633,CDM,258,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA CHOICE PLUS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210634,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TEMAZEPAM 15MG CAP            ,92210635,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,AETNA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,BCBS,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,CIGNA,COM,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,UNITED HEALTHCARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,VA,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,VA TRICARE,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,WELLMED,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,HUMANA,MGD,9.95,,,,,,,per diem,9.95,9.95,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210636,CDM,250,RC,,,,,,Inpatient,1,EA,9.95,9.95,HUMANA CHOICE PLUS,MGD,9.95,,,,,,,case rate,9.95,9.95,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,AETNA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,CIGNA,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,WELLMED,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA,MGD,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG/HR TDM    ,92210637,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA CHOICE PLUS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL CHLORTHAL 100-25 TAB ,92210638,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,AETNA,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,BCBS,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,CIGNA,COM,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,TRICARE,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,UNITED HEALTHCARE,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,UNITED HEALTHCARE,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,VA,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,VA TRICARE,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,WELLMED,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,HUMANA,MGD,170.67,,,,,,,per diem,170.67,170.67,"Per diem rate, code is bundled with other services"
CYCLOPENTOLATE 1% EYE SOL     ,92210640,CDM,250,RC,,,,,,Inpatient,1,EA,170.67,170.67,HUMANA CHOICE PLUS,MGD,170.67,,,,,,,case rate,170.67,170.67,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92210641,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210642,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG TAB           ,92210643,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92210644,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,AETNA,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,BCBS,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,CIGNA,COM,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,TRICARE,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,UNITED HEALTHCARE,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,UNITED HEALTHCARE,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,VA,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,VA TRICARE,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,WELLMED,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,HUMANA,MGD,72.17,,,,,,,per diem,72.17,72.17,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210645,CDM,250,RC,,,,,,Inpatient,1,EA,72.17,72.17,HUMANA CHOICE PLUS,MGD,72.17,,,,,,,case rate,72.17,72.17,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,AETNA,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,CIGNA,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,TRICARE,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,UNITED HEALTHCARE,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,UNITED HEALTHCARE,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,VA,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,VA TRICARE,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,WELLMED,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,HUMANA,MGD,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92210646,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,HUMANA CHOICE PLUS,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,AETNA,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,BCBS,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,CIGNA,COM,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,TRICARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,UNITED HEALTHCARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,UNITED HEALTHCARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,VA,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,VA TRICARE,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,WELLMED,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,HUMANA,MGD,7.06,,,,,,,per diem,7.06,7.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 100MG CAP          ,92210647,CDM,250,RC,,,,,,Inpatient,1,EA,7.06,7.06,HUMANA CHOICE PLUS,MGD,7.06,,,,,,,case rate,7.06,7.06,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210648,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,AETNA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,BCBS,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,CIGNA,COM,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,UNITED HEALTHCARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,VA,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,VA TRICARE,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,WELLMED,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,HUMANA,MGD,28.41,,,,,,,per diem,28.41,28.41,"Per diem rate, code is bundled with other services"
NAPHAZOLINE HCL 0.025%-0.3% SO,92210649,CDM,250,RC,,,,,,Inpatient,1,EA,28.41,28.41,HUMANA CHOICE PLUS,MGD,28.41,,,,,,,case rate,28.41,28.41,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,AETNA,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,BCBS,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,CIGNA,COM,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,TRICARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,UNITED HEALTHCARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,UNITED HEALTHCARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,VA,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,VA TRICARE,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,WELLMED,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,HUMANA,MGD,5.95,,,,,,,per diem,5.95,5.95,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92210650,CDM,250,RC,,,,,,Inpatient,1,EA,5.95,5.95,HUMANA CHOICE PLUS,MGD,5.95,,,,,,,case rate,5.95,5.95,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,AETNA,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,BCBS,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,CIGNA,COM,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,TRICARE,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,UNITED HEALTHCARE,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,UNITED HEALTHCARE,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,VA,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,VA TRICARE,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,WELLMED,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,HUMANA,MGD,874.47,,,,,,,per diem,874.47,874.47,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92210651,CDM,250,RC,,,,,,Inpatient,1,EA,874.47,874.47,HUMANA CHOICE PLUS,MGD,874.47,,,,,,,case rate,874.47,874.47,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 200MG T12        ,92210652,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 10MG TAB       ,92210653,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,AETNA,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,BCBS,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,CIGNA,COM,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,TRICARE,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,UNITED HEALTHCARE,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,UNITED HEALTHCARE,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,VA,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,VA TRICARE,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,WELLMED,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,HUMANA,MGD,104.77,,,,,,,per diem,104.77,104.77,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92210654,CDM,250,RC,,,,,,Inpatient,1,EA,104.77,104.77,HUMANA CHOICE PLUS,MGD,104.77,,,,,,,case rate,104.77,104.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210655,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,AETNA,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,BCBS,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,CIGNA,COM,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,TRICARE,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,UNITED HEALTHCARE,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,UNITED HEALTHCARE,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,VA,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,VA TRICARE,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,WELLMED,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,HUMANA,MGD,95.04,,,,,,,per diem,95.04,95.04,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92210656,CDM,250,RC,,,,,,Inpatient,1,EA,95.04,95.04,HUMANA CHOICE PLUS,MGD,95.04,,,,,,,case rate,95.04,95.04,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 5MG CAP  ,92210657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,AETNA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,CIGNA,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,WELLMED,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA,MGD,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92210658,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA CHOICE PLUS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,AETNA,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,BCBS,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,CIGNA,COM,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,TRICARE,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,UNITED HEALTHCARE,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,UNITED HEALTHCARE,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,VA,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,VA TRICARE,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,WELLMED,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,HUMANA,MGD,41.58,,,,,,,per diem,41.58,41.58,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 6% EYE SOL    ,92210659,CDM,250,RC,,,,,,Inpatient,1,EA,41.58,41.58,HUMANA CHOICE PLUS,MGD,41.58,,,,,,,case rate,41.58,41.58,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,AETNA,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,BCBS,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,CIGNA,COM,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,TRICARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,UNITED HEALTHCARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,UNITED HEALTHCARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,VA,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,VA TRICARE,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,WELLMED,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,HUMANA,MGD,36.89,,,,,,,per diem,36.89,36.89,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92210661,CDM,250,RC,,,,,,Inpatient,1,EA,36.89,36.89,HUMANA CHOICE PLUS,MGD,36.89,,,,,,,case rate,36.89,36.89,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210662,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 5MG TAB         ,92210663,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92210664,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,AETNA,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,BCBS,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,CIGNA,COM,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,TRICARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,UNITED HEALTHCARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,UNITED HEALTHCARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,VA,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,VA TRICARE,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,WELLMED,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,HUMANA,MGD,34.52,,,,,,,per diem,34.52,34.52,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.025% CRE          ,92210665,CDM,250,RC,,,,,,Inpatient,1,EA,34.52,34.52,HUMANA CHOICE PLUS,MGD,34.52,,,,,,,case rate,34.52,34.52,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,AETNA,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,BCBS,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,CIGNA,COM,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,TRICARE,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,UNITED HEALTHCARE,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,UNITED HEALTHCARE,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,VA,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,VA TRICARE,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,WELLMED,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,HUMANA,MGD,34.24,,,,,,,per diem,34.24,34.24,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 40MG/ML INJ     ,92210666,CDM,250,RC,,,,,,Inpatient,1,EA,34.24,34.24,HUMANA CHOICE PLUS,MGD,34.24,,,,,,,case rate,34.24,34.24,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC CHELATED 50MG TAB        ,92210667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,AETNA,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,BCBS,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,CIGNA,COM,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,TRICARE,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,UNITED HEALTHCARE,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,UNITED HEALTHCARE,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,VA,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,VA TRICARE,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,WELLMED,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,HUMANA,MGD,793.8,,,,,,,per diem,793.8,793.8,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210668,CDM,250,RC,,,,,,Inpatient,1,EA,793.8,793.8,HUMANA CHOICE PLUS,MGD,793.8,,,,,,,case rate,793.8,793.8,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210669,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.6MG TAB       ,92210670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,AETNA,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,BCBS,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,CIGNA,COM,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,TRICARE,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,UNITED HEALTHCARE,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,UNITED HEALTHCARE,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,VA,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,VA TRICARE,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,WELLMED,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,HUMANA,MGD,70.97,,,,,,,per diem,70.97,70.97,"Per diem rate, code is bundled with other services"
ATROPINE SULF 1% EYE SOL      ,92210671,CDM,250,RC,,,,,,Inpatient,1,EA,70.97,70.97,HUMANA CHOICE PLUS,MGD,70.97,,,,,,,case rate,70.97,70.97,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92210672,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CER       ,92210673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,AETNA,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,BCBS,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,CIGNA,COM,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,TRICARE,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,UNITED HEALTHCARE,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,UNITED HEALTHCARE,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,VA,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,VA TRICARE,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,WELLMED,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,HUMANA,MGD,15.31,,,,,,,per diem,15.31,15.31,"Per diem rate, code is bundled with other services"
SELENIUM SULFIDE 1% SHA       ,92210674,CDM,250,RC,,,,,,Inpatient,1,EA,15.31,15.31,HUMANA CHOICE PLUS,MGD,15.31,,,,,,,case rate,15.31,15.31,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,AETNA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,BCBS,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,CIGNA,COM,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,UNITED HEALTHCARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,VA TRICARE,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,WELLMED,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA,MGD,6.8,,,,,,,per diem,6.8,6.8,"Per diem rate, code is bundled with other services"
KETOROLAC 10MG TAB            ,92210675,CDM,250,RC,,,,,,Inpatient,1,EA,6.8,6.8,HUMANA CHOICE PLUS,MGD,6.8,,,,,,,case rate,6.8,6.8,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE COD 6.25-10/5ML S,92210676,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,AETNA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,CIGNA,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,WELLMED,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA,MGD,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CARBAMIDE PEROXIDE 6.5% EAR SO,92210677,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA CHOICE PLUS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,AETNA,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,BCBS,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,CIGNA,COM,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,TRICARE,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,UNITED HEALTHCARE,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,UNITED HEALTHCARE,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,VA,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,VA TRICARE,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,WELLMED,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,HUMANA,MGD,13.61,,,,,,,per diem,13.61,13.61,"Per diem rate, code is bundled with other services"
ANTIBACTERIAL/ANESTHETIC OIN  ,92210678,CDM,250,RC,,,,,,Inpatient,1,EA,13.61,13.61,HUMANA CHOICE PLUS,MGD,13.61,,,,,,,case rate,13.61,13.61,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,AETNA,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,BCBS,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,CIGNA,COM,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,TRICARE,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,UNITED HEALTHCARE,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,UNITED HEALTHCARE,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,VA,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,VA TRICARE,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,WELLMED,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,HUMANA,MGD,54.75,,,,,,,per diem,54.75,54.75,"Per diem rate, code is bundled with other services"
UREA HC 20% CRE               ,92210679,CDM,250,RC,,,,,,Inpatient,1,EA,54.75,54.75,HUMANA CHOICE PLUS,MGD,54.75,,,,,,,case rate,54.75,54.75,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210680,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,AETNA,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,BCBS,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,CIGNA,COM,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,TRICARE,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,UNITED HEALTHCARE,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,UNITED HEALTHCARE,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,VA,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,VA TRICARE,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,WELLMED,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,HUMANA,MGD,33.93,,,,,,,per diem,33.93,33.93,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210681,CDM,250,RC,,,,,,Inpatient,1,EA,33.93,33.93,HUMANA CHOICE PLUS,MGD,33.93,,,,,,,case rate,33.93,33.93,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 250MG SGL         ,92210682,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,AETNA,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,BCBS,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,CIGNA,COM,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,TRICARE,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,UNITED HEALTHCARE,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,UNITED HEALTHCARE,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,VA,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,VA TRICARE,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,WELLMED,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,HUMANA,MGD,88.11,,,,,,,per diem,88.11,88.11,"Per diem rate, code is bundled with other services"
BETAMETHASONE VA 0.1% CRE     ,92210683,CDM,250,RC,,,,,,Inpatient,1,EA,88.11,88.11,HUMANA CHOICE PLUS,MGD,88.11,,,,,,,case rate,88.11,88.11,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ZINC GLUCONATE 50MG TAB       ,92210684,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE APAP 25-500 TA,92210685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92210687,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92210688,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 150MCG TAB   ,92210689,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"ASCORBIC ACID 1,000MG TER     ",92210690,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,AETNA,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,BCBS,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,CIGNA,COM,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,TRICARE,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,UNITED HEALTHCARE,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,UNITED HEALTHCARE,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,VA,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,VA TRICARE,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,WELLMED,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,HUMANA,MGD,216.78,,,,,,,per diem,216.78,216.78,"Per diem rate, code is bundled with other services"
DEXAMETHASONE-NEOMYCIN-POLYMYX,92210691,CDM,250,RC,,,,,,Inpatient,1,EA,216.78,216.78,HUMANA CHOICE PLUS,MGD,216.78,,,,,,,case rate,216.78,216.78,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG CTB       ,92210692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,AETNA,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,BCBS,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,CIGNA,COM,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,TRICARE,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,UNITED HEALTHCARE,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,UNITED HEALTHCARE,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,VA,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,VA TRICARE,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,WELLMED,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,HUMANA,MGD,37.55,,,,,,,per diem,37.55,37.55,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210693,CDM,250,RC,,,,,,Inpatient,1,EA,37.55,37.55,HUMANA CHOICE PLUS,MGD,37.55,,,,,,,case rate,37.55,37.55,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,AETNA,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,BCBS,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,CIGNA,COM,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,TRICARE,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,UNITED HEALTHCARE,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,UNITED HEALTHCARE,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,VA,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,VA TRICARE,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,WELLMED,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,HUMANA,MGD,11.09,,,,,,,per diem,11.09,11.09,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92210694,CDM,250,RC,,,,,,Inpatient,1,EA,11.09,11.09,HUMANA CHOICE PLUS,MGD,11.09,,,,,,,case rate,11.09,11.09,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92210695,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,AETNA,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,BCBS,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,CIGNA,COM,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,TRICARE,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,UNITED HEALTHCARE,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,UNITED HEALTHCARE,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,VA,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,VA TRICARE,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,WELLMED,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,HUMANA,MGD,403.92,,,,,,,per diem,403.92,403.92,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92210696,CDM,250,RC,,,,,,Inpatient,1,EA,403.92,403.92,HUMANA CHOICE PLUS,MGD,403.92,,,,,,,case rate,403.92,403.92,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 300MCG TAB   ,92210697,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92210698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,AETNA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,BCBS,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,CIGNA,COM,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,UNITED HEALTHCARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,VA,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,VA TRICARE,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,WELLMED,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,HUMANA,MGD,126,,,,,,,per diem,126,126,"Per diem rate, code is bundled with other services"
CEPHALEXIN 125MG/5ML SUS      ,92210699,CDM,250,RC,,,,,,Inpatient,1,EA,126,126,HUMANA CHOICE PLUS,MGD,126,,,,,,,case rate,126,126,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,AETNA,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,BCBS,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,CIGNA,COM,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,TRICARE,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,UNITED HEALTHCARE,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,UNITED HEALTHCARE,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,VA,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,VA TRICARE,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,WELLMED,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,HUMANA,MGD,50.31,,,,,,,per diem,50.31,50.31,"Per diem rate, code is bundled with other services"
TROPICAMIDE 0.5% EYE SOL      ,92210701,CDM,250,RC,,,,,,Inpatient,1,EA,50.31,50.31,HUMANA CHOICE PLUS,MGD,50.31,,,,,,,case rate,50.31,50.31,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENOXYLATE HCL ATROPINE TAB,92210702,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92210703,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 5MG TAB   ,92210704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,AETNA,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,BCBS,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,CIGNA,COM,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,TRICARE,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,UNITED HEALTHCARE,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,UNITED HEALTHCARE,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,VA,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,VA TRICARE,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,WELLMED,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,HUMANA,MGD,191.74,,,,,,,per diem,191.74,191.74,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92210705,CDM,250,RC,,,,,,Inpatient,1,EA,191.74,191.74,HUMANA CHOICE PLUS,MGD,191.74,,,,,,,case rate,191.74,191.74,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92210706,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,AETNA,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,BCBS,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,CIGNA,COM,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,TRICARE,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,UNITED HEALTHCARE,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,UNITED HEALTHCARE,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,VA,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,VA TRICARE,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,WELLMED,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,HUMANA,MGD,252.91,,,,,,,per diem,252.91,252.91,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210707,CDM,250,RC,,,,,,Inpatient,1,EA,252.91,252.91,HUMANA CHOICE PLUS,MGD,252.91,,,,,,,case rate,252.91,252.91,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG TAB         ,92210708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210709,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,AETNA,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,BCBS,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,CIGNA,COM,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,TRICARE,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,UNITED HEALTHCARE,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,UNITED HEALTHCARE,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,VA,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,VA TRICARE,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,WELLMED,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,HUMANA,MGD,17.89,,,,,,,per diem,17.89,17.89,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92210710,CDM,250,RC,,,,,,Inpatient,1,EA,17.89,17.89,HUMANA CHOICE PLUS,MGD,17.89,,,,,,,case rate,17.89,17.89,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 300MG CAP            ,92210711,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210712,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92210713,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,AETNA,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,BCBS,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,CIGNA,COM,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,TRICARE,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,UNITED HEALTHCARE,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,UNITED HEALTHCARE,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,VA,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,VA TRICARE,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,WELLMED,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,HUMANA,MGD,19.81,,,,,,,per diem,19.81,19.81,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.25%/0.0005 I,92210714,CDM,250,RC,,,,,,Inpatient,1,EA,19.81,19.81,HUMANA CHOICE PLUS,MGD,19.81,,,,,,,case rate,19.81,19.81,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210715,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210717,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,AETNA,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,BCBS,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,CIGNA,COM,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,TRICARE,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,UNITED HEALTHCARE,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,UNITED HEALTHCARE,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,VA,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,VA TRICARE,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,WELLMED,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,HUMANA,MGD,101.27,,,,,,,per diem,101.27,101.27,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210718,CDM,250,RC,,,,,,Inpatient,1,EA,101.27,101.27,HUMANA CHOICE PLUS,MGD,101.27,,,,,,,case rate,101.27,101.27,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92210719,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-60MG T,92210720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 10-2 TAB      ,92210721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,AETNA,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,BCBS,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,CIGNA,COM,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,TRICARE,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,UNITED HEALTHCARE,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,UNITED HEALTHCARE,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,VA,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,VA TRICARE,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,WELLMED,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,HUMANA,MGD,76.39,,,,,,,per diem,76.39,76.39,"Per diem rate, code is bundled with other services"
POTASSIUM CL 2MEQ/ML INJ      ,92210722,CDM,250,RC,,,,,,Inpatient,1,EA,76.39,76.39,HUMANA CHOICE PLUS,MGD,76.39,,,,,,,case rate,76.39,76.39,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,AETNA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,CIGNA,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,VA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,VA TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,WELLMED,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,HUMANA,MGD,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 750MG INJ       ,92210723,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,HUMANA CHOICE PLUS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,AETNA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,CIGNA,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,WELLMED,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA,MGD,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
DIGOXIN 0.25MG/ML INJ         ,92210724,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA CHOICE PLUS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92210725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,AETNA,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,BCBS,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,CIGNA,COM,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,TRICARE,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,UNITED HEALTHCARE,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,UNITED HEALTHCARE,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,VA,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,VA TRICARE,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,WELLMED,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,HUMANA,MGD,59.06,,,,,,,per diem,59.06,59.06,"Per diem rate, code is bundled with other services"
SULF-PRED 0.25-10% EYE SOL    ,92210726,CDM,250,RC,,,,,,Inpatient,1,EA,59.06,59.06,HUMANA CHOICE PLUS,MGD,59.06,,,,,,,case rate,59.06,59.06,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,AETNA,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,CIGNA,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,TRICARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,UNITED HEALTHCARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,UNITED HEALTHCARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,VA,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,VA TRICARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,WELLMED,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,HUMANA,MGD,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
"BACITRACIN 50,000U INJ        ",92210727,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,HUMANA CHOICE PLUS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92210728,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,AETNA,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,BCBS,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,CIGNA,COM,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,TRICARE,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,UNITED HEALTHCARE,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,UNITED HEALTHCARE,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,VA,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,VA TRICARE,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,WELLMED,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,HUMANA,MGD,58.28,,,,,,,per diem,58.28,58.28,"Per diem rate, code is bundled with other services"
TICARCILLIN CLV K 3.1GM INJ   ,92210730,CDM,250,RC,,,,,,Inpatient,1,EA,58.28,58.28,HUMANA CHOICE PLUS,MGD,58.28,,,,,,,case rate,58.28,58.28,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,AETNA,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,BCBS,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,CIGNA,COM,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,TRICARE,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,UNITED HEALTHCARE,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,UNITED HEALTHCARE,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,VA,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,VA TRICARE,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,WELLMED,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,HUMANA,MGD,218.8,,,,,,,per diem,218.8,218.8,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92210731,CDM,250,RC,,,,,,Inpatient,1,EA,218.8,218.8,HUMANA CHOICE PLUS,MGD,218.8,,,,,,,case rate,218.8,218.8,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL/HCTZ 10-25MG TAB    ,92210732,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROBENECID 500MG TAB          ,92210733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 1.5MG TAB     ,92210734,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92210735,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,AETNA,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,BCBS,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,CIGNA,COM,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,TRICARE,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,UNITED HEALTHCARE,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,UNITED HEALTHCARE,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,VA,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,VA TRICARE,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,WELLMED,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,HUMANA,MGD,27.72,,,,,,,per diem,27.72,27.72,"Per diem rate, code is bundled with other services"
REFRESH PM                    ,92210736,CDM,250,RC,,,,,,Inpatient,1,EA,27.72,27.72,HUMANA CHOICE PLUS,MGD,27.72,,,,,,,case rate,27.72,27.72,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210737,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,AETNA,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,BCBS,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,CIGNA,COM,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,TRICARE,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,UNITED HEALTHCARE,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,UNITED HEALTHCARE,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,VA,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,VA TRICARE,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,WELLMED,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,HUMANA,MGD,20.19,,,,,,,per diem,20.19,20.19,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92210738,CDM,250,RC,,,,,,Inpatient,1,EA,20.19,20.19,HUMANA CHOICE PLUS,MGD,20.19,,,,,,,case rate,20.19,20.19,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,AETNA,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,CIGNA,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,TRICARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UNITED HEALTHCARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UNITED HEALTHCARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,VA,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,VA TRICARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,WELLMED,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,HUMANA,MGD,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG/5ML SUS       ,92210739,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,HUMANA CHOICE PLUS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,AETNA,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,BCBS,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,CIGNA,COM,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,TRICARE,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,UNITED HEALTHCARE,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,UNITED HEALTHCARE,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,VA,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,VA TRICARE,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,WELLMED,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,HUMANA,MGD,216.56,,,,,,,per diem,216.56,216.56,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.025MG SPR       ,92210740,CDM,250,RC,,,,,,Inpatient,1,EA,216.56,216.56,HUMANA CHOICE PLUS,MGD,216.56,,,,,,,case rate,216.56,216.56,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,AETNA,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,BCBS,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,CIGNA,COM,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,TRICARE,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,UNITED HEALTHCARE,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,UNITED HEALTHCARE,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,VA,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,VA TRICARE,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,WELLMED,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,HUMANA,MGD,115.48,,,,,,,per diem,115.48,115.48,"Per diem rate, code is bundled with other services"
CABERGOLINE 0.5MG TAB         ,92210741,CDM,250,RC,,,,,,Inpatient,1,EA,115.48,115.48,HUMANA CHOICE PLUS,MGD,115.48,,,,,,,case rate,115.48,115.48,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92210742,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,AETNA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,CIGNA,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,WELLMED,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA,MGD,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
ACETIC ACID ALUMINUM 2-0.79% S,92210743,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA CHOICE PLUS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,AETNA,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,BCBS,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,CIGNA,COM,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,TRICARE,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,UNITED HEALTHCARE,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,UNITED HEALTHCARE,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,VA,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,VA TRICARE,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,WELLMED,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,HUMANA,MGD,339.48,,,,,,,per diem,339.48,339.48,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 10GM INJ        ,92210744,CDM,250,RC,,,,,,Inpatient,1,EA,339.48,339.48,HUMANA CHOICE PLUS,MGD,339.48,,,,,,,case rate,339.48,339.48,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92210745,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,AETNA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,CIGNA,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,WELLMED,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA,MGD,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG CER       ,92210746,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA CHOICE PLUS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,AETNA,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,BCBS,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,CIGNA,COM,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,TRICARE,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,UNITED HEALTHCARE,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,UNITED HEALTHCARE,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,VA,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,VA TRICARE,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,WELLMED,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,HUMANA,MGD,42.9,,,,,,,per diem,42.9,42.9,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210747,CDM,250,RC,,,,,,Inpatient,1,EA,42.9,42.9,HUMANA CHOICE PLUS,MGD,42.9,,,,,,,case rate,42.9,42.9,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,AETNA,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,BCBS,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,CIGNA,COM,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,TRICARE,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,UNITED HEALTHCARE,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,UNITED HEALTHCARE,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,VA,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,VA TRICARE,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,WELLMED,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,HUMANA,MGD,62.31,,,,,,,per diem,62.31,62.31,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92210748,CDM,250,RC,,,,,,Inpatient,1,EA,62.31,62.31,HUMANA CHOICE PLUS,MGD,62.31,,,,,,,case rate,62.31,62.31,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 25MG TAB           ,92210749,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92210750,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92210752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92210753,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,AETNA,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,BCBS,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,CIGNA,COM,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,TRICARE,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,UNITED HEALTHCARE,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,UNITED HEALTHCARE,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,VA,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,VA TRICARE,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,WELLMED,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,HUMANA,MGD,1011.59,,,,,,,per diem,1011.59,1011.59,"Per diem rate, code is bundled with other services"
DESONIDE 0.05% CRE            ,92210754,CDM,250,RC,,,,,,Inpatient,1,EA,1011.59,1011.59,HUMANA CHOICE PLUS,MGD,1011.59,,,,,,,case rate,1011.59,1011.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,AETNA,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,BCBS,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,CIGNA,COM,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,TRICARE,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,UNITED HEALTHCARE,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,UNITED HEALTHCARE,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,VA,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,VA TRICARE,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,WELLMED,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,HUMANA,MGD,133.62,,,,,,,per diem,133.62,133.62,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% LOT        ,92210755,CDM,250,RC,,,,,,Inpatient,1,EA,133.62,133.62,HUMANA CHOICE PLUS,MGD,133.62,,,,,,,case rate,133.62,133.62,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92210756,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92210757,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210758,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,AETNA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,CIGNA,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,WELLMED,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA,MGD,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92210759,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA CHOICE PLUS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,AETNA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,BCBS,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,CIGNA,COM,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,UNITED HEALTHCARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,VA,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,VA TRICARE,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,WELLMED,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,HUMANA,MGD,132.3,,,,,,,per diem,132.3,132.3,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210760,CDM,250,RC,,,,,,Inpatient,1,EA,132.3,132.3,HUMANA CHOICE PLUS,MGD,132.3,,,,,,,case rate,132.3,132.3,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,AETNA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,BCBS,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,CIGNA,COM,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,UNITED HEALTHCARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,VA,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,VA TRICARE,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,WELLMED,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,HUMANA,MGD,39.66,,,,,,,per diem,39.66,39.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 0.5% INJ        ,92210761,CDM,250,RC,,,,,,Inpatient,1,EA,39.66,39.66,HUMANA CHOICE PLUS,MGD,39.66,,,,,,,case rate,39.66,39.66,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 75MCG TAB    ,92210762,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,AETNA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,CIGNA,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,WELLMED,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,HUMANA,MGD,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92210763,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,HUMANA CHOICE PLUS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,AETNA,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,BCBS,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,CIGNA,COM,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,TRICARE,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,UNITED HEALTHCARE,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,UNITED HEALTHCARE,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,VA,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,VA TRICARE,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,WELLMED,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,HUMANA,MGD,25.83,,,,,,,per diem,25.83,25.83,"Per diem rate, code is bundled with other services"
IRBESARTAN 300MG TAB          ,92210764,CDM,250,RC,,,,,,Inpatient,1,EA,25.83,25.83,HUMANA CHOICE PLUS,MGD,25.83,,,,,,,case rate,25.83,25.83,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210765,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,AETNA,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,BCBS,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,CIGNA,COM,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,TRICARE,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,UNITED HEALTHCARE,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,UNITED HEALTHCARE,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,VA,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,VA TRICARE,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,WELLMED,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,HUMANA,MGD,422.98,,,,,,,per diem,422.98,422.98,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML SOL    ,92210766,CDM,250,RC,,,,,,Inpatient,1,EA,422.98,422.98,HUMANA CHOICE PLUS,MGD,422.98,,,,,,,case rate,422.98,422.98,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92210767,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 750MG CTB        ,92210768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,AETNA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,CIGNA,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,WELLMED,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA,MGD,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL OIN    ,92210769,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA CHOICE PLUS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTROPIPATE 0.75MG TAB        ,92210770,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92210771,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,AETNA,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,BCBS,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,CIGNA,COM,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,TRICARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,UNITED HEALTHCARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,UNITED HEALTHCARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,VA,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,VA TRICARE,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,WELLMED,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,HUMANA,MGD,356.36,,,,,,,per diem,356.36,356.36,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92210772,CDM,250,RC,,,,,,Inpatient,1,EA,356.36,356.36,HUMANA CHOICE PLUS,MGD,356.36,,,,,,,case rate,356.36,356.36,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92210773,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG CAP       ,92210774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,AETNA,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,BCBS,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,CIGNA,COM,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,TRICARE,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,UNITED HEALTHCARE,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,UNITED HEALTHCARE,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,VA,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,VA TRICARE,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,WELLMED,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,HUMANA,MGD,489.57,,,,,,,per diem,489.57,489.57,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 2% GEL           ,92210775,CDM,250,RC,,,,,,Inpatient,1,EA,489.57,489.57,HUMANA CHOICE PLUS,MGD,489.57,,,,,,,case rate,489.57,489.57,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,AETNA,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,BCBS,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,CIGNA,COM,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,TRICARE,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,UNITED HEALTHCARE,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,UNITED HEALTHCARE,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,VA,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,VA TRICARE,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,WELLMED,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,HUMANA,MGD,421.06,,,,,,,per diem,421.06,421.06,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.01% CRE   ,92210776,CDM,250,RC,,,,,,Inpatient,1,EA,421.06,421.06,HUMANA CHOICE PLUS,MGD,421.06,,,,,,,case rate,421.06,421.06,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS 0.625MG TA,92210777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,AETNA,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,BCBS,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,CIGNA,COM,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,TRICARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,UNITED HEALTHCARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,UNITED HEALTHCARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,VA,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,VA TRICARE,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,WELLMED,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,HUMANA,MGD,12.25,,,,,,,per diem,12.25,12.25,"Per diem rate, code is bundled with other services"
CEFOTAXIME NA 1GM INJ         ,92210778,CDM,250,RC,,,,,,Inpatient,1,EA,12.25,12.25,HUMANA CHOICE PLUS,MGD,12.25,,,,,,,case rate,12.25,12.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,AETNA,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,BCBS,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,CIGNA,COM,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,TRICARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,UNITED HEALTHCARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,UNITED HEALTHCARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,VA,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,VA TRICARE,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,WELLMED,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,HUMANA,MGD,10.87,,,,,,,per diem,10.87,10.87,"Per diem rate, code is bundled with other services"
TOPIRAMATE 25MG TAB           ,92210780,CDM,250,RC,,,,,,Inpatient,1,EA,10.87,10.87,HUMANA CHOICE PLUS,MGD,10.87,,,,,,,case rate,10.87,10.87,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92210781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92210782,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,AETNA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,CIGNA,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,WELLMED,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA,MGD,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 20MG TAB        ,92210783,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA CHOICE PLUS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL VC/COD SYR   ,92210784,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 600MG TER         ,92210785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,AETNA,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,BCBS,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,CIGNA,COM,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,TRICARE,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,UNITED HEALTHCARE,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,UNITED HEALTHCARE,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,VA,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,VA TRICARE,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,WELLMED,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,HUMANA,MGD,39.06,,,,,,,per diem,39.06,39.06,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 2MG TAB            ,92210786,CDM,250,RC,,,,,,Inpatient,1,EA,39.06,39.06,HUMANA CHOICE PLUS,MGD,39.06,,,,,,,case rate,39.06,39.06,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 30MG SGL         ,92210787,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92210788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 500MG TAB   ,92210789,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,AETNA,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,BCBS,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,CIGNA,COM,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,TRICARE,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,UNITED HEALTHCARE,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,UNITED HEALTHCARE,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,VA,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,VA TRICARE,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,WELLMED,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,HUMANA,MGD,528.76,,,,,,,per diem,528.76,528.76,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210790,CDM,250,RC,,,,,,Inpatient,1,EA,528.76,528.76,HUMANA CHOICE PLUS,MGD,528.76,,,,,,,case rate,528.76,528.76,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92210791,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92210792,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 20MG TAB    ,92210793,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,AETNA,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,BCBS,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,CIGNA,COM,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,TRICARE,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,UNITED HEALTHCARE,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,UNITED HEALTHCARE,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,VA,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,VA TRICARE,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,WELLMED,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,HUMANA,MGD,86,,,,,,,per diem,86,86,"Per diem rate, code is bundled with other services"
CREAM MULTI INGREDIENT CRE    ,92210794,CDM,250,RC,,,,,,Inpatient,1,EA,86,86,HUMANA CHOICE PLUS,MGD,86,,,,,,,case rate,86,86,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"CYANOCABALAMIN 1,000MCG TAB   ",92210795,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92210796,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA-LEVODOPA            ,92210797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 50MG TAB           ,92210798,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,AETNA,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,BCBS,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,CIGNA,COM,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,TRICARE,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,UNITED HEALTHCARE,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,UNITED HEALTHCARE,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,VA,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,VA TRICARE,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,WELLMED,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,HUMANA,MGD,546.9,,,,,,,per diem,546.9,546.9,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG C,92210799,CDM,250,RC,,,,,,Inpatient,1,EA,546.9,546.9,HUMANA CHOICE PLUS,MGD,546.9,,,,,,,case rate,546.9,546.9,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92210801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,AETNA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,CIGNA,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,WELLMED,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA,MGD,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
NIFEDIPINE 60MG TER           ,92210802,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA CHOICE PLUS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.5MG/ML LIQ ,92210803,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,AETNA,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,BCBS,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,CIGNA,COM,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,TRICARE,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UNITED HEALTHCARE,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,UNITED HEALTHCARE,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,VA TRICARE,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,WELLMED,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,HUMANA,MGD,8.79,,,,,,,per diem,8.79,8.79,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE EDI 5MG/ML IN,92210804,CDM,250,RC,,,,,,Inpatient,1,EA,8.79,8.79,HUMANA CHOICE PLUS,MGD,8.79,,,,,,,case rate,8.79,8.79,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,AETNA,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,BCBS,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,CIGNA,COM,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,TRICARE,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,UNITED HEALTHCARE,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,UNITED HEALTHCARE,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,VA,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,VA TRICARE,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,WELLMED,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,HUMANA,MGD,267.72,,,,,,,per diem,267.72,267.72,"Per diem rate, code is bundled with other services"
CROMOLYN NA 0.8MG ARO         ,92210805,CDM,250,RC,,,,,,Inpatient,1,EA,267.72,267.72,HUMANA CHOICE PLUS,MGD,267.72,,,,,,,case rate,267.72,267.72,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,AETNA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,CIGNA,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,WELLMED,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA,MGD,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210806,CDM,258,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA CHOICE PLUS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 1MG TAB   ,92210807,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 1MG/ML INJ      ,92210809,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,AETNA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,BCBS,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,CIGNA,COM,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,UNITED HEALTHCARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,VA,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,VA TRICARE,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,WELLMED,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,HUMANA,MGD,32.07,,,,,,,per diem,32.07,32.07,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92210810,CDM,250,RC,,,,,,Inpatient,1,EA,32.07,32.07,HUMANA CHOICE PLUS,MGD,32.07,,,,,,,case rate,32.07,32.07,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,AETNA,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,BCBS,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,CIGNA,COM,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,TRICARE,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,UNITED HEALTHCARE,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,UNITED HEALTHCARE,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,VA,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,VA TRICARE,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,WELLMED,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,HUMANA,MGD,2177.28,,,,,,,per diem,2177.28,2177.28,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 6GM INJ       ,92210811,CDM,250,RC,,,,,,Inpatient,1,EA,2177.28,2177.28,HUMANA CHOICE PLUS,MGD,2177.28,,,,,,,case rate,2177.28,2177.28,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92210812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,AETNA,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,BCBS,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,CIGNA,COM,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,TRICARE,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,UNITED HEALTHCARE,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,UNITED HEALTHCARE,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,VA,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,VA TRICARE,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,WELLMED,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,HUMANA,MGD,1137.15,,,,,,,per diem,1137.15,1137.15,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92210813,CDM,250,RC,,,,,,Inpatient,1,EA,1137.15,1137.15,HUMANA CHOICE PLUS,MGD,1137.15,,,,,,,case rate,1137.15,1137.15,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML LI,92210814,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210815,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,AETNA,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,BCBS,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,CIGNA,COM,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,TRICARE,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,UNITED HEALTHCARE,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,UNITED HEALTHCARE,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,VA,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,VA TRICARE,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,WELLMED,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,HUMANA,MGD,32.29,,,,,,,per diem,32.29,32.29,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 2.25GM INJ ,92210816,CDM,250,RC,,,,,,Inpatient,1,EA,32.29,32.29,HUMANA CHOICE PLUS,MGD,32.29,,,,,,,case rate,32.29,32.29,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,AETNA,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,BCBS,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,CIGNA,COM,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,TRICARE,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UNITED HEALTHCARE,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,UNITED HEALTHCARE,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,VA TRICARE,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,WELLMED,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,HUMANA,MGD,5.61,,,,,,,per diem,5.61,5.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92210817,CDM,250,RC,,,,,,Inpatient,1,EA,5.61,5.61,HUMANA CHOICE PLUS,MGD,5.61,,,,,,,case rate,5.61,5.61,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,AETNA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,CIGNA,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,WELLMED,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA,MGD,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.1MG/HR TDM    ,92210818,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA CHOICE PLUS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92210819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 50MG CAP      ,92210820,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-15MG T,92210821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,AETNA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,CIGNA,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,VA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,VA TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,WELLMED,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,HUMANA,MGD,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92210822,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,HUMANA CHOICE PLUS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92210823,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,AETNA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,CIGNA,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,WELLMED,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA,MGD,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210824,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA CHOICE PLUS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92210825,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOSINOPRIL NA 10MG TAB        ,92210826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,AETNA,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,BCBS,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,CIGNA,COM,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,TRICARE,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,UNITED HEALTHCARE,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,UNITED HEALTHCARE,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,VA,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,VA TRICARE,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,WELLMED,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,HUMANA,MGD,21.61,,,,,,,per diem,21.61,21.61,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92210827,CDM,250,RC,,,,,,Inpatient,1,EA,21.61,21.61,HUMANA CHOICE PLUS,MGD,21.61,,,,,,,case rate,21.61,21.61,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92210828,CDM,258,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,AETNA,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,BCBS,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,CIGNA,COM,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,TRICARE,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,UNITED HEALTHCARE,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,UNITED HEALTHCARE,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,VA,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,VA TRICARE,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,WELLMED,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,HUMANA,MGD,1150.16,,,,,,,per diem,1150.16,1150.16,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.375MG TER  ,92210829,CDM,250,RC,,,,,,Inpatient,1,EA,1150.16,1150.16,HUMANA CHOICE PLUS,MGD,1150.16,,,,,,,case rate,1150.16,1150.16,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIORIDAZINE HCL 10MG TAB     ,92210830,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92210831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCRIPTIN 325MG TAB           ,92210832,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"VITAMIN E 1,000U SGL          ",92210833,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,AETNA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,BCBS,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,CIGNA,COM,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,UNITED HEALTHCARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,VA TRICARE,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,WELLMED,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA,MGD,5.58,,,,,,,per diem,5.58,5.58,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92210834,CDM,250,RC,,,,,,Inpatient,1,EA,5.58,5.58,HUMANA CHOICE PLUS,MGD,5.58,,,,,,,case rate,5.58,5.58,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,AETNA,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,BCBS,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,CIGNA,COM,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,TRICARE,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,UNITED HEALTHCARE,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,UNITED HEALTHCARE,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,VA,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,VA TRICARE,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,WELLMED,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,HUMANA,MGD,48.73,,,,,,,per diem,48.73,48.73,"Per diem rate, code is bundled with other services"
SUCROSE SYR                   ,92210835,CDM,250,RC,,,,,,Inpatient,1,EA,48.73,48.73,HUMANA CHOICE PLUS,MGD,48.73,,,,,,,case rate,48.73,48.73,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 3MG TAB             ,92210836,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,AETNA,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,BCBS,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,CIGNA,COM,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,TRICARE,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,UNITED HEALTHCARE,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,UNITED HEALTHCARE,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,VA,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,VA TRICARE,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,WELLMED,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,HUMANA,MGD,20.6,,,,,,,per diem,20.6,20.6,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210837,CDM,250,RC,,,,,,Inpatient,1,EA,20.6,20.6,HUMANA CHOICE PLUS,MGD,20.6,,,,,,,case rate,20.6,20.6,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,AETNA,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,BCBS,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,CIGNA,COM,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,TRICARE,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,UNITED HEALTHCARE,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,UNITED HEALTHCARE,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,VA,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,VA TRICARE,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,WELLMED,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,HUMANA,MGD,308.79,,,,,,,per diem,308.79,308.79,"Per diem rate, code is bundled with other services"
FLUNISOLIDE 0.25MG ARO        ,92210838,CDM,250,RC,,,,,,Inpatient,1,EA,308.79,308.79,HUMANA CHOICE PLUS,MGD,308.79,,,,,,,case rate,308.79,308.79,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG T12        ,92210839,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92210840,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 5MG TAB   ,92210841,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/2 STRENGTH TAB     ,92210842,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BETHANECHOL CL 5MG TAB        ,92210843,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUPROPION HCL                 ,92210844,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,AETNA,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,BCBS,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,CIGNA,COM,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,TRICARE,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,UNITED HEALTHCARE,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,UNITED HEALTHCARE,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,VA,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,VA TRICARE,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,WELLMED,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,HUMANA,MGD,4879.98,,,,,,,per diem,4879.98,4879.98,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5% INJ        ,92210845,CDM,250,RC,,,,,,Inpatient,1,EA,4879.98,4879.98,HUMANA CHOICE PLUS,MGD,4879.98,,,,,,,case rate,4879.98,4879.98,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,AETNA,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,BCBS,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,CIGNA,COM,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,TRICARE,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,UNITED HEALTHCARE,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,UNITED HEALTHCARE,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,VA,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,VA TRICARE,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,WELLMED,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,HUMANA,MGD,67.41,,,,,,,per diem,67.41,67.41,"Per diem rate, code is bundled with other services"
SCOPOLAMINE 0.33MG/24HR TDM   ,92210847,CDM,250,RC,,,,,,Inpatient,1,EA,67.41,67.41,HUMANA CHOICE PLUS,MGD,67.41,,,,,,,case rate,67.41,67.41,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92210848,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,AETNA,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,CIGNA,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,TRICARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,UNITED HEALTHCARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,UNITED HEALTHCARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,VA,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,VA TRICARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,WELLMED,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,HUMANA,MGD,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92210849,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,HUMANA CHOICE PLUS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,AETNA,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,CIGNA,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,TRICARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,UNITED HEALTHCARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,UNITED HEALTHCARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,VA,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,VA TRICARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,WELLMED,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,HUMANA,MGD,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% CRE      ,92210850,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,HUMANA CHOICE PLUS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 30MG TAB        ,92210851,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92210852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,AETNA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,CIGNA,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,WELLMED,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA,MGD,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
TICLOPIDINE HCL 250MG TAB     ,92210853,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA CHOICE PLUS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,AETNA,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,BCBS,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,CIGNA,COM,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,TRICARE,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,UNITED HEALTHCARE,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,UNITED HEALTHCARE,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,VA,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,VA TRICARE,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,WELLMED,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,HUMANA,MGD,147.61,,,,,,,per diem,147.61,147.61,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.4% CRE          ,92210854,CDM,250,RC,,,,,,Inpatient,1,EA,147.61,147.61,HUMANA CHOICE PLUS,MGD,147.61,,,,,,,case rate,147.61,147.61,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92210856,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,AETNA,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,BCBS,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,CIGNA,COM,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,TRICARE,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,UNITED HEALTHCARE,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,UNITED HEALTHCARE,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,VA,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,VA TRICARE,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,WELLMED,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,HUMANA,MGD,266.87,,,,,,,per diem,266.87,266.87,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92210857,CDM,250,RC,,,,,,Inpatient,1,EA,266.87,266.87,HUMANA CHOICE PLUS,MGD,266.87,,,,,,,case rate,266.87,266.87,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92210858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92210859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,AETNA,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,BCBS,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,CIGNA,COM,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,TRICARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UNITED HEALTHCARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,UNITED HEALTHCARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,VA,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,VA TRICARE,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,WELLMED,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,HUMANA,MGD,11.31,,,,,,,per diem,11.31,11.31,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92210860,CDM,250,RC,,,,,,Inpatient,1,EA,11.31,11.31,HUMANA CHOICE PLUS,MGD,11.31,,,,,,,case rate,11.31,11.31,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210861,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,AETNA,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,BCBS,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,CIGNA,COM,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,TRICARE,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,UNITED HEALTHCARE,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,UNITED HEALTHCARE,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,VA,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,VA TRICARE,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,WELLMED,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,HUMANA,MGD,11.06,,,,,,,per diem,11.06,11.06,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 25MG/5ML INJ    ,92210862,CDM,250,RC,,,,,,Inpatient,1,EA,11.06,11.06,HUMANA CHOICE PLUS,MGD,11.06,,,,,,,case rate,11.06,11.06,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92210863,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500 W/D 125U TAB ,92210864,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG/5ML S,92210865,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 88MCG TAB    ,92210866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,AETNA,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,CIGNA,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,TRICARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,UNITED HEALTHCARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,UNITED HEALTHCARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,VA,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,VA TRICARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,WELLMED,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,HUMANA,MGD,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92210867,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,HUMANA CHOICE PLUS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210868,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,AETNA,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,BCBS,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,CIGNA,COM,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,TRICARE,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,UNITED HEALTHCARE,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,UNITED HEALTHCARE,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,VA,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,VA TRICARE,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,WELLMED,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,HUMANA,MGD,20.73,,,,,,,per diem,20.73,20.73,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92210869,CDM,250,RC,,,,,,Inpatient,1,EA,20.73,20.73,HUMANA CHOICE PLUS,MGD,20.73,,,,,,,case rate,20.73,20.73,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,AETNA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,CIGNA,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,WELLMED,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA,MGD,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
GRISEOFLUVIN 250MG TAB        ,92210870,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA CHOICE PLUS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA SENNO A B 50-8.6 T,92210871,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TAB            ,92210872,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,AETNA,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,BCBS,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,CIGNA,COM,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,TRICARE,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,UNITED HEALTHCARE,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,UNITED HEALTHCARE,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,VA,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,VA TRICARE,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,WELLMED,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,HUMANA,MGD,53.05,,,,,,,per diem,53.05,53.05,"Per diem rate, code is bundled with other services"
MEPIVACAINE HCL 1% INJ        ,92210873,CDM,250,RC,,,,,,Inpatient,1,EA,53.05,53.05,HUMANA CHOICE PLUS,MGD,53.05,,,,,,,case rate,53.05,53.05,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92210874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92210875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,AETNA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,BCBS,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,CIGNA,COM,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,UNITED HEALTHCARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,VA,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,VA TRICARE,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,WELLMED,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,HUMANA,MGD,51.38,,,,,,,per diem,51.38,51.38,"Per diem rate, code is bundled with other services"
TERCONAZOLE 80MG SUP          ,92210876,CDM,250,RC,,,,,,Inpatient,1,EA,51.38,51.38,HUMANA CHOICE PLUS,MGD,51.38,,,,,,,case rate,51.38,51.38,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,AETNA,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,BCBS,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,CIGNA,COM,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,TRICARE,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,UNITED HEALTHCARE,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,UNITED HEALTHCARE,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,VA,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,VA TRICARE,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,WELLMED,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,HUMANA,MGD,22.77,,,,,,,per diem,22.77,22.77,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210877,CDM,250,RC,,,,,,Inpatient,1,EA,22.77,22.77,HUMANA CHOICE PLUS,MGD,22.77,,,,,,,case rate,22.77,22.77,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92210878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,AETNA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,CIGNA,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,WELLMED,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA,MGD,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
CIMETIDINE HCL 300MG/5ML SOL  ,92210879,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA CHOICE PLUS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,AETNA,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,BCBS,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,CIGNA,COM,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,TRICARE,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,UNITED HEALTHCARE,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,UNITED HEALTHCARE,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,VA,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,VA TRICARE,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,WELLMED,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,HUMANA,MGD,498.36,,,,,,,per diem,498.36,498.36,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92210880,CDM,250,RC,,,,,,Inpatient,1,EA,498.36,498.36,HUMANA CHOICE PLUS,MGD,498.36,,,,,,,case rate,498.36,498.36,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 10MG TAB           ,92210881,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,AETNA,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,BCBS,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,CIGNA,COM,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,TRICARE,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,UNITED HEALTHCARE,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,UNITED HEALTHCARE,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,VA,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,VA TRICARE,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,WELLMED,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,HUMANA,MGD,16.29,,,,,,,per diem,16.29,16.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92210882,CDM,250,RC,,,,,,Inpatient,1,EA,16.29,16.29,HUMANA CHOICE PLUS,MGD,16.29,,,,,,,case rate,16.29,16.29,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,AETNA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,CIGNA,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,WELLMED,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA,MGD,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE 0.1-0.3 S,92210883,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA CHOICE PLUS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 100MG TAB            ,92210884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG TAB            ,92210886,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92210887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92210888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,AETNA,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,BCBS,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,CIGNA,COM,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,TRICARE,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,UNITED HEALTHCARE,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,UNITED HEALTHCARE,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,VA,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,VA TRICARE,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,WELLMED,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,HUMANA,MGD,12.47,,,,,,,per diem,12.47,12.47,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92210889,CDM,250,RC,,,,,,Inpatient,1,EA,12.47,12.47,HUMANA CHOICE PLUS,MGD,12.47,,,,,,,case rate,12.47,12.47,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,AETNA,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,BCBS,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,CIGNA,COM,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,TRICARE,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,UNITED HEALTHCARE,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,UNITED HEALTHCARE,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,VA,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,VA TRICARE,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,WELLMED,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,HUMANA,MGD,462.74,,,,,,,per diem,462.74,462.74,"Per diem rate, code is bundled with other services"
MENINGOCOCCAL POLY VACC  INJ  ,92210890,CDM,250,RC,,,,,,Inpatient,1,EA,462.74,462.74,HUMANA CHOICE PLUS,MGD,462.74,,,,,,,case rate,462.74,462.74,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,AETNA,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,BCBS,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,CIGNA,COM,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,TRICARE,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,UNITED HEALTHCARE,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,UNITED HEALTHCARE,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,VA,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,VA TRICARE,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,WELLMED,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,HUMANA,MGD,132.65,,,,,,,per diem,132.65,132.65,"Per diem rate, code is bundled with other services"
PROPARACAINE HCL 0.5% SOL     ,92210891,CDM,250,RC,,,,,,Inpatient,1,EA,132.65,132.65,HUMANA CHOICE PLUS,MGD,132.65,,,,,,,case rate,132.65,132.65,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,AETNA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,CIGNA,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,VA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,VA TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,WELLMED,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,HUMANA,MGD,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92210892,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,HUMANA CHOICE PLUS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LYSINE 500MG TAB              ,92210893,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,AETNA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,BCBS,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,CIGNA,COM,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,UNITED HEALTHCARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,VA,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,VA TRICARE,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,WELLMED,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,HUMANA,MGD,12.69,,,,,,,per diem,12.69,12.69,"Per diem rate, code is bundled with other services"
PHENOL 1.4% SPR               ,92210894,CDM,250,RC,,,,,,Inpatient,1,EA,12.69,12.69,HUMANA CHOICE PLUS,MGD,12.69,,,,,,,case rate,12.69,12.69,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,AETNA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,CIGNA,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,WELLMED,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA,MGD,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
ACYCLOVIR 800MG TAB           ,92210895,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA CHOICE PLUS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92210896,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92210897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,AETNA,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,BCBS,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,CIGNA,COM,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,TRICARE,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,UNITED HEALTHCARE,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,UNITED HEALTHCARE,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,VA,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,VA TRICARE,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,WELLMED,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,HUMANA,MGD,195.21,,,,,,,per diem,195.21,195.21,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.25% OIN      ,92210898,CDM,250,RC,,,,,,Inpatient,1,EA,195.21,195.21,HUMANA CHOICE PLUS,MGD,195.21,,,,,,,case rate,195.21,195.21,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,AETNA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,CIGNA,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,WELLMED,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA,MGD,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92210899,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA CHOICE PLUS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 150MG TAB            ,92210900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,AETNA,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,BCBS,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,CIGNA,COM,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,TRICARE,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,UNITED HEALTHCARE,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,UNITED HEALTHCARE,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,VA,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,VA TRICARE,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,WELLMED,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,HUMANA,MGD,88.96,,,,,,,per diem,88.96,88.96,"Per diem rate, code is bundled with other services"
CEFACLOR 250MG/5ML SUS        ,92210901,CDM,250,RC,,,,,,Inpatient,1,EA,88.96,88.96,HUMANA CHOICE PLUS,MGD,88.96,,,,,,,case rate,88.96,88.96,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92210902,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,AETNA,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,BCBS,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,CIGNA,COM,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,TRICARE,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,UNITED HEALTHCARE,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,UNITED HEALTHCARE,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,VA,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,VA TRICARE,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,WELLMED,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,HUMANA,MGD,323.88,,,,,,,per diem,323.88,323.88,"Per diem rate, code is bundled with other services"
DIMERCAPROL 100MG/ML OIL      ,92210903,CDM,250,RC,,,,,,Inpatient,1,EA,323.88,323.88,HUMANA CHOICE PLUS,MGD,323.88,,,,,,,case rate,323.88,323.88,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,AETNA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,CIGNA,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,WELLMED,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA,MGD,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92210904,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA CHOICE PLUS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92210905,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 5-500MG TAB  ,92210906,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92210907,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,AETNA,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,BCBS,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,CIGNA,COM,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,TRICARE,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,UNITED HEALTHCARE,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,UNITED HEALTHCARE,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,VA,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,VA TRICARE,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,WELLMED,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,HUMANA,MGD,55.28,,,,,,,per diem,55.28,55.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92210908,CDM,250,RC,,,,,,Inpatient,1,EA,55.28,55.28,HUMANA CHOICE PLUS,MGD,55.28,,,,,,,case rate,55.28,55.28,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,AETNA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,BCBS,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,CIGNA,COM,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,UNITED HEALTHCARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,VA TRICARE,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,WELLMED,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA,MGD,27.34,,,,,,,per diem,27.34,27.34,"Per diem rate, code is bundled with other services"
TOLNAFTATE 1% CRE             ,92210909,CDM,250,RC,,,,,,Inpatient,1,EA,27.34,27.34,HUMANA CHOICE PLUS,MGD,27.34,,,,,,,case rate,27.34,27.34,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,AETNA,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,BCBS,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,CIGNA,COM,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,TRICARE,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UNITED HEALTHCARE,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,UNITED HEALTHCARE,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,VA TRICARE,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,WELLMED,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,HUMANA,MGD,6.87,,,,,,,per diem,6.87,6.87,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 125MG TAB       ,92210910,CDM,250,RC,,,,,,Inpatient,1,EA,6.87,6.87,HUMANA CHOICE PLUS,MGD,6.87,,,,,,,case rate,6.87,6.87,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,AETNA,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,BCBS,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,CIGNA,COM,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,TRICARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,UNITED HEALTHCARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,UNITED HEALTHCARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,VA,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,VA TRICARE,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,WELLMED,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,HUMANA,MGD,8,,,,,,,per diem,8,8,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92210911,CDM,250,RC,,,,,,Inpatient,1,EA,8,8,HUMANA CHOICE PLUS,MGD,8,,,,,,,case rate,8,8,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL           ,92210912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ETODOLAC 200MG CAP            ,92210913,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,AETNA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,CIGNA,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,WELLMED,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA,MGD,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92210914,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA CHOICE PLUS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,AETNA,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,BCBS,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,CIGNA,COM,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,TRICARE,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,UNITED HEALTHCARE,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,UNITED HEALTHCARE,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,VA,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,VA TRICARE,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,WELLMED,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,HUMANA,MGD,818.21,,,,,,,per diem,818.21,818.21,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92210915,CDM,250,RC,,,,,,Inpatient,1,EA,818.21,818.21,HUMANA CHOICE PLUS,MGD,818.21,,,,,,,case rate,818.21,818.21,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,AETNA,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,BCBS,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,CIGNA,COM,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,TRICARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UNITED HEALTHCARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,UNITED HEALTHCARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,VA TRICARE,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,WELLMED,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,HUMANA,MGD,45.36,,,,,,,per diem,45.36,45.36,"Per diem rate, code is bundled with other services"
PIPERACIL TAZOBACT 3.375GM INJ,92210916,CDM,250,RC,,,,,,Inpatient,1,EA,45.36,45.36,HUMANA CHOICE PLUS,MGD,45.36,,,,,,,case rate,45.36,45.36,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,AETNA,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,BCBS,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,CIGNA,COM,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,TRICARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,UNITED HEALTHCARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,UNITED HEALTHCARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,VA,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,VA TRICARE,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,WELLMED,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,HUMANA,MGD,41.61,,,,,,,per diem,41.61,41.61,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92210917,CDM,250,RC,,,,,,Inpatient,1,EA,41.61,41.61,HUMANA CHOICE PLUS,MGD,41.61,,,,,,,case rate,41.61,41.61,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92210918,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,AETNA,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,BCBS,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,CIGNA,COM,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,TRICARE,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,UNITED HEALTHCARE,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,UNITED HEALTHCARE,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,VA,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,VA TRICARE,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,WELLMED,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,HUMANA,MGD,28.63,,,,,,,per diem,28.63,28.63,"Per diem rate, code is bundled with other services"
SUFENTANIL CITRATE 50MCG/ML IN,92210919,CDM,250,RC,,,,,,Inpatient,1,EA,28.63,28.63,HUMANA CHOICE PLUS,MGD,28.63,,,,,,,case rate,28.63,28.63,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG CAP          ,92210920,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,AETNA,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,BCBS,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,CIGNA,COM,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,TRICARE,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,UNITED HEALTHCARE,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,UNITED HEALTHCARE,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,VA,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,VA TRICARE,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,WELLMED,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,HUMANA,MGD,278.96,,,,,,,per diem,278.96,278.96,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.7GM PDR  ,92210921,CDM,250,RC,,,,,,Inpatient,1,EA,278.96,278.96,HUMANA CHOICE PLUS,MGD,278.96,,,,,,,case rate,278.96,278.96,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92210922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92210923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,AETNA,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,BCBS,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,CIGNA,COM,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,TRICARE,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,UNITED HEALTHCARE,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,UNITED HEALTHCARE,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,VA,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,VA TRICARE,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,WELLMED,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,HUMANA,MGD,282.05,,,,,,,per diem,282.05,282.05,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92210924,CDM,250,RC,,,,,,Inpatient,1,EA,282.05,282.05,HUMANA CHOICE PLUS,MGD,282.05,,,,,,,case rate,282.05,282.05,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,AETNA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,BCBS,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,CIGNA,COM,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,UNITED HEALTHCARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,VA TRICARE,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,WELLMED,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA,MGD,6.27,,,,,,,per diem,6.27,6.27,"Per diem rate, code is bundled with other services"
SODIUM CL NASAL SPR           ,92210925,CDM,250,RC,,,,,,Inpatient,1,EA,6.27,6.27,HUMANA CHOICE PLUS,MGD,6.27,,,,,,,case rate,6.27,6.27,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG TAB        ,92210926,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,AETNA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,BCBS,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,CIGNA,COM,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,UNITED HEALTHCARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,VA TRICARE,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,WELLMED,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,HUMANA,MGD,8.88,,,,,,,per diem,8.88,8.88,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92210927,CDM,250,RC,,,,,,Inpatient,1,EA,8.88,8.88,HUMANA CHOICE PLUS,MGD,8.88,,,,,,,case rate,8.88,8.88,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-650MG TAB,92210928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,AETNA,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,CIGNA,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,TRICARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,UNITED HEALTHCARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,UNITED HEALTHCARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,VA,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,VA TRICARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,WELLMED,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,HUMANA,MGD,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 CTB,92210929,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,HUMANA CHOICE PLUS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PYRIDOXINE 100MG TAB          ,92210930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,AETNA,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,BCBS,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,CIGNA,COM,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,TRICARE,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,UNITED HEALTHCARE,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,UNITED HEALTHCARE,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,VA,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,VA TRICARE,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,WELLMED,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,HUMANA,MGD,18.59,,,,,,,per diem,18.59,18.59,"Per diem rate, code is bundled with other services"
SODIUM CL 3% IVS              ,92210931,CDM,258,RC,,,,,,Inpatient,1,EA,18.59,18.59,HUMANA CHOICE PLUS,MGD,18.59,,,,,,,case rate,18.59,18.59,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG CAP      ,92210932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,AETNA,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,BCBS,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,CIGNA,COM,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,TRICARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,UNITED HEALTHCARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,UNITED HEALTHCARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,VA,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,VA TRICARE,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,WELLMED,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,HUMANA,MGD,35.91,,,,,,,per diem,35.91,35.91,"Per diem rate, code is bundled with other services"
TOPIRAMATE 100MG TAB          ,92210933,CDM,250,RC,,,,,,Inpatient,1,EA,35.91,35.91,HUMANA CHOICE PLUS,MGD,35.91,,,,,,,case rate,35.91,35.91,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 50/200 TER     ,92210934,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,AETNA,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,CIGNA,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,TRICARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UNITED HEALTHCARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UNITED HEALTHCARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA TRICARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,WELLMED,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,HUMANA,MGD,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92210935,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,HUMANA CHOICE PLUS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,AETNA,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,BCBS,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,CIGNA,COM,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,TRICARE,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,UNITED HEALTHCARE,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,UNITED HEALTHCARE,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,VA,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,VA TRICARE,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,WELLMED,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,HUMANA,MGD,46.78,,,,,,,per diem,46.78,46.78,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92210936,CDM,250,RC,,,,,,Inpatient,1,EA,46.78,46.78,HUMANA CHOICE PLUS,MGD,46.78,,,,,,,case rate,46.78,46.78,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DYPHYLLINE GG 200-200 TAB     ,92210937,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92210938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92210939,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,AETNA,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,BCBS,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,CIGNA,COM,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,TRICARE,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,UNITED HEALTHCARE,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,UNITED HEALTHCARE,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,VA,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,VA TRICARE,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,WELLMED,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,HUMANA,MGD,180.46,,,,,,,per diem,180.46,180.46,"Per diem rate, code is bundled with other services"
NITROPRUSSIDE 50MG INJ        ,92210940,CDM,250,RC,,,,,,Inpatient,1,EA,180.46,180.46,HUMANA CHOICE PLUS,MGD,180.46,,,,,,,case rate,180.46,180.46,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,AETNA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,CIGNA,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,WELLMED,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA,MGD,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92210941,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA CHOICE PLUS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZONATATE                   ,92210942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,AETNA,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,CIGNA,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,TRICARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,UNITED HEALTHCARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,UNITED HEALTHCARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,VA,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,VA TRICARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,WELLMED,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,HUMANA,MGD,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
SEVELAMER HCL 800MG TAB       ,92210943,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,HUMANA CHOICE PLUS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,AETNA,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,BCBS,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,CIGNA,COM,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,TRICARE,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,UNITED HEALTHCARE,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,UNITED HEALTHCARE,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,VA,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,VA TRICARE,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,WELLMED,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,HUMANA,MGD,71.73,,,,,,,per diem,71.73,71.73,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92210944,CDM,250,RC,,,,,,Inpatient,1,EA,71.73,71.73,HUMANA CHOICE PLUS,MGD,71.73,,,,,,,case rate,71.73,71.73,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92210945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,AETNA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,CIGNA,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,WELLMED,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA,MGD,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 200MG TAB     ,92210946,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA CHOICE PLUS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,AETNA,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,BCBS,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,CIGNA,COM,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,TRICARE,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,UNITED HEALTHCARE,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,UNITED HEALTHCARE,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,VA,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,VA TRICARE,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,WELLMED,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,HUMANA,MGD,13.58,,,,,,,per diem,13.58,13.58,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 5MG CAP          ,92210947,CDM,250,RC,,,,,,Inpatient,1,EA,13.58,13.58,HUMANA CHOICE PLUS,MGD,13.58,,,,,,,case rate,13.58,13.58,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,AETNA,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,BCBS,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,CIGNA,COM,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,TRICARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,UNITED HEALTHCARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,UNITED HEALTHCARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,VA,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,VA TRICARE,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,WELLMED,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,HUMANA,MGD,16.79,,,,,,,per diem,16.79,16.79,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92210948,CDM,250,RC,,,,,,Inpatient,1,EA,16.79,16.79,HUMANA CHOICE PLUS,MGD,16.79,,,,,,,case rate,16.79,16.79,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,AETNA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,CIGNA,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,VA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,VA TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,WELLMED,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,HUMANA,MGD,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
BACITRACIN/POLYMYXIN B OIN    ,92210949,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,HUMANA CHOICE PLUS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92210950,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG TAB        ,92210951,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,AETNA,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,BCBS,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,CIGNA,COM,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,TRICARE,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,UNITED HEALTHCARE,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,UNITED HEALTHCARE,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,VA,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,VA TRICARE,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,WELLMED,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,HUMANA,MGD,31.44,,,,,,,per diem,31.44,31.44,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM/10ML SUS       ,92210952,CDM,250,RC,,,,,,Inpatient,1,EA,31.44,31.44,HUMANA CHOICE PLUS,MGD,31.44,,,,,,,case rate,31.44,31.44,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,AETNA,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,BCBS,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,CIGNA,COM,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,TRICARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,UNITED HEALTHCARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,UNITED HEALTHCARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,VA,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,VA TRICARE,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,WELLMED,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,HUMANA,MGD,39.85,,,,,,,per diem,39.85,39.85,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 100MG/60ML NMA ,92210953,CDM,250,RC,,,,,,Inpatient,1,EA,39.85,39.85,HUMANA CHOICE PLUS,MGD,39.85,,,,,,,case rate,39.85,39.85,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92210954,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,AETNA,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,BCBS,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,CIGNA,COM,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,TRICARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,UNITED HEALTHCARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,UNITED HEALTHCARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,VA,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,VA TRICARE,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,WELLMED,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,HUMANA,MGD,47.44,,,,,,,per diem,47.44,47.44,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 20% SOL        ,92210955,CDM,250,RC,,,,,,Inpatient,1,EA,47.44,47.44,HUMANA CHOICE PLUS,MGD,47.44,,,,,,,case rate,47.44,47.44,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92210956,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 500MCG TAB     ,92210957,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,AETNA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,CIGNA,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,WELLMED,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA,MGD,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 1MG CAP          ,92210958,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA CHOICE PLUS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,AETNA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,CIGNA,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,WELLMED,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA,MGD,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92210959,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA CHOICE PLUS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,AETNA,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,BCBS,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,CIGNA,COM,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,TRICARE,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,UNITED HEALTHCARE,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,UNITED HEALTHCARE,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,VA,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,VA TRICARE,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,WELLMED,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,HUMANA,MGD,26.15,,,,,,,per diem,26.15,26.15,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 10MG INJ   ,92210960,CDM,250,RC,,,,,,Inpatient,1,EA,26.15,26.15,HUMANA CHOICE PLUS,MGD,26.15,,,,,,,case rate,26.15,26.15,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,AETNA,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,CIGNA,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,TRICARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,UNITED HEALTHCARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,UNITED HEALTHCARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,VA,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,VA TRICARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,WELLMED,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,HUMANA,MGD,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 50MG CAP     ,92210961,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,HUMANA CHOICE PLUS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210962,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,AETNA,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,BCBS,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,CIGNA,COM,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,TRICARE,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,UNITED HEALTHCARE,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,UNITED HEALTHCARE,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,VA,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,VA TRICARE,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,WELLMED,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,HUMANA,MGD,174.26,,,,,,,per diem,174.26,174.26,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92210963,CDM,250,RC,,,,,,Inpatient,1,EA,174.26,174.26,HUMANA CHOICE PLUS,MGD,174.26,,,,,,,case rate,174.26,174.26,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,AETNA,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,BCBS,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,CIGNA,COM,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,TRICARE,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,UNITED HEALTHCARE,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,UNITED HEALTHCARE,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,VA,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,VA TRICARE,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,WELLMED,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,HUMANA,MGD,38.62,,,,,,,per diem,38.62,38.62,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 25MG SUP ,92210964,CDM,250,RC,,,,,,Inpatient,1,EA,38.62,38.62,HUMANA CHOICE PLUS,MGD,38.62,,,,,,,case rate,38.62,38.62,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92210966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92210967,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 100MCG TAB   ,92210968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,AETNA,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,BCBS,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,CIGNA,COM,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,TRICARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,UNITED HEALTHCARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,UNITED HEALTHCARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,VA,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,VA TRICARE,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,WELLMED,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,HUMANA,MGD,319,,,,,,,per diem,319,319,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92210969,CDM,250,RC,,,,,,Inpatient,1,EA,319,319,HUMANA CHOICE PLUS,MGD,319,,,,,,,case rate,319,319,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92210970,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,AETNA,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,BCBS,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,CIGNA,COM,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,TRICARE,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,UNITED HEALTHCARE,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,UNITED HEALTHCARE,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,VA,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,VA TRICARE,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,WELLMED,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,HUMANA,MGD,123.13,,,,,,,per diem,123.13,123.13,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG/5ML SUS       ,92210971,CDM,250,RC,,,,,,Inpatient,1,EA,123.13,123.13,HUMANA CHOICE PLUS,MGD,123.13,,,,,,,case rate,123.13,123.13,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 10MG TAB      ,92210972,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,AETNA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,CIGNA,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,WELLMED,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA,MGD,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
ACYCLOVIR 500MG INJ           ,92210973,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA CHOICE PLUS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LACTASE 30MG TAB              ,92210974,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92210975,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,AETNA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,BCBS,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,CIGNA,COM,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,UNITED HEALTHCARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,VA TRICARE,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,WELLMED,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA,MGD,23.63,,,,,,,per diem,23.63,23.63,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92210976,CDM,250,RC,,,,,,Inpatient,1,EA,23.63,23.63,HUMANA CHOICE PLUS,MGD,23.63,,,,,,,case rate,23.63,23.63,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92210977,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,AETNA,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,BCBS,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,CIGNA,COM,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,TRICARE,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,UNITED HEALTHCARE,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,UNITED HEALTHCARE,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,VA,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,VA TRICARE,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,WELLMED,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,HUMANA,MGD,36.35,,,,,,,per diem,36.35,36.35,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 80MG/0.9% NACL INJ ,92210978,CDM,250,RC,,,,,,Inpatient,1,EA,36.35,36.35,HUMANA CHOICE PLUS,MGD,36.35,,,,,,,case rate,36.35,36.35,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92210979,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,AETNA,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,BCBS,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,CIGNA,COM,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,TRICARE,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,UNITED HEALTHCARE,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,UNITED HEALTHCARE,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,VA,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,VA TRICARE,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,WELLMED,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,HUMANA,MGD,651.01,,,,,,,per diem,651.01,651.01,"Per diem rate, code is bundled with other services"
LATANOPROST 0.005% SOL        ,92210980,CDM,250,RC,,,,,,Inpatient,1,EA,651.01,651.01,HUMANA CHOICE PLUS,MGD,651.01,,,,,,,case rate,651.01,651.01,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92210981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,AETNA,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,BCBS,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,CIGNA,COM,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,TRICARE,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UNITED HEALTHCARE,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,UNITED HEALTHCARE,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,VA,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,VA TRICARE,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,WELLMED,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,HUMANA,MGD,12.51,,,,,,,per diem,12.51,12.51,"Per diem rate, code is bundled with other services"
NADOLOL 40MG TAB              ,92210982,CDM,250,RC,,,,,,Inpatient,1,EA,12.51,12.51,HUMANA CHOICE PLUS,MGD,12.51,,,,,,,case rate,12.51,12.51,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP 800/160 T,92210983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92210984,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,AETNA,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,BCBS,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,CIGNA,COM,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,TRICARE,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,UNITED HEALTHCARE,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,UNITED HEALTHCARE,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,VA,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,VA TRICARE,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,WELLMED,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,HUMANA,MGD,312.86,,,,,,,per diem,312.86,312.86,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SOL,92210985,CDM,250,RC,,,,,,Inpatient,1,EA,312.86,312.86,HUMANA CHOICE PLUS,MGD,312.86,,,,,,,case rate,312.86,312.86,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92210986,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,AETNA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,CIGNA,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,WELLMED,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA,MGD,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92210987,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA CHOICE PLUS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92210988,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92210989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92210990,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,AETNA,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,BCBS,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,CIGNA,COM,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,TRICARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,UNITED HEALTHCARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,UNITED HEALTHCARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,VA,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,VA TRICARE,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,WELLMED,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,HUMANA,MGD,62.69,,,,,,,per diem,62.69,62.69,"Per diem rate, code is bundled with other services"
UREA 20% CRE                  ,92210991,CDM,250,RC,,,,,,Inpatient,1,EA,62.69,62.69,HUMANA CHOICE PLUS,MGD,62.69,,,,,,,case rate,62.69,62.69,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92210992,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,AETNA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,BCBS,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,CIGNA,COM,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,UNITED HEALTHCARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,VA TRICARE,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,WELLMED,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA,MGD,18.9,,,,,,,per diem,18.9,18.9,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 30MG ECC         ,92210993,CDM,250,RC,,,,,,Inpatient,1,EA,18.9,18.9,HUMANA CHOICE PLUS,MGD,18.9,,,,,,,case rate,18.9,18.9,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,AETNA,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,BCBS,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,CIGNA,COM,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,TRICARE,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,UNITED HEALTHCARE,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,UNITED HEALTHCARE,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,VA,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,VA TRICARE,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,WELLMED,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,HUMANA,MGD,39.91,,,,,,,per diem,39.91,39.91,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% OIN        ,92210994,CDM,250,RC,,,,,,Inpatient,1,EA,39.91,39.91,HUMANA CHOICE PLUS,MGD,39.91,,,,,,,case rate,39.91,39.91,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 100MG SUP  ,92210995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,AETNA,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,BCBS,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,CIGNA,COM,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,TRICARE,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,UNITED HEALTHCARE,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,UNITED HEALTHCARE,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,VA,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,VA TRICARE,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,WELLMED,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,HUMANA,MGD,17.96,,,,,,,per diem,17.96,17.96,"Per diem rate, code is bundled with other services"
ZIND OXIDE MENTHOL POW        ,92210996,CDM,250,RC,,,,,,Inpatient,1,EA,17.96,17.96,HUMANA CHOICE PLUS,MGD,17.96,,,,,,,case rate,17.96,17.96,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,AETNA,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,BCBS,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,CIGNA,COM,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,TRICARE,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,UNITED HEALTHCARE,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,UNITED HEALTHCARE,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,VA,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,VA TRICARE,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,WELLMED,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,HUMANA,MGD,209.22,,,,,,,per diem,209.22,209.22,"Per diem rate, code is bundled with other services"
GRAMICIDIN NEOMYCIN POLY SOL  ,92210997,CDM,250,RC,,,,,,Inpatient,1,EA,209.22,209.22,HUMANA CHOICE PLUS,MGD,209.22,,,,,,,case rate,209.22,209.22,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACINAMIDE 500MG TAB         ,92210998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,AETNA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,BCBS,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,CIGNA,COM,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,UNITED HEALTHCARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,VA,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,VA TRICARE,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,WELLMED,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,HUMANA,MGD,306.31,,,,,,,per diem,306.31,306.31,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92210999,CDM,250,RC,,,,,,Inpatient,1,EA,306.31,306.31,HUMANA CHOICE PLUS,MGD,306.31,,,,,,,case rate,306.31,306.31,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,AETNA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,CIGNA,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,WELLMED,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA,MGD,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211000,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA CHOICE PLUS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 10MG TAB       ,92211001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,AETNA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,CIGNA,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,WELLMED,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,HUMANA,MGD,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92211003,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,HUMANA CHOICE PLUS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TOLMETIN NA 200MG TAB         ,92211004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 40MG TAB           ,92211005,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN                   ,92211006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,AETNA,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,BCBS,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,CIGNA,COM,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,TRICARE,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,UNITED HEALTHCARE,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,UNITED HEALTHCARE,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,VA,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,VA TRICARE,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,WELLMED,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,HUMANA,MGD,60.89,,,,,,,per diem,60.89,60.89,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 40MG TAB        ,92211007,CDM,250,RC,,,,,,Inpatient,1,EA,60.89,60.89,HUMANA CHOICE PLUS,MGD,60.89,,,,,,,case rate,60.89,60.89,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,AETNA,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,BCBS,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,CIGNA,COM,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,TRICARE,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,UNITED HEALTHCARE,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,UNITED HEALTHCARE,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,VA,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,VA TRICARE,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,WELLMED,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,HUMANA,MGD,36.73,,,,,,,per diem,36.73,36.73,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.5% INJ      ,92211008,CDM,250,RC,,,,,,Inpatient,1,EA,36.73,36.73,HUMANA CHOICE PLUS,MGD,36.73,,,,,,,case rate,36.73,36.73,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211009,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92211010,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,AETNA,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,BCBS,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,CIGNA,COM,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,TRICARE,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,UNITED HEALTHCARE,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,UNITED HEALTHCARE,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,VA,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,VA TRICARE,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,WELLMED,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,HUMANA,MGD,222.83,,,,,,,per diem,222.83,222.83,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/ML SUS ,92211011,CDM,250,RC,,,,,,Inpatient,1,EA,222.83,222.83,HUMANA CHOICE PLUS,MGD,222.83,,,,,,,case rate,222.83,222.83,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,AETNA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,CIGNA,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,WELLMED,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA,MGD,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 50MG CAP  ,92211012,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA CHOICE PLUS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,AETNA,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,CIGNA,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,TRICARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UNITED HEALTHCARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UNITED HEALTHCARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA TRICARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,WELLMED,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,HUMANA,MGD,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211013,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,HUMANA CHOICE PLUS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,AETNA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,BCBS,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,CIGNA,COM,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,UNITED HEALTHCARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,VA,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,VA TRICARE,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,WELLMED,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,HUMANA,MGD,236.25,,,,,,,per diem,236.25,236.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211014,CDM,250,RC,,,,,,Inpatient,1,EA,236.25,236.25,HUMANA CHOICE PLUS,MGD,236.25,,,,,,,case rate,236.25,236.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211016,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,AETNA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,CIGNA,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,WELLMED,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA,MGD,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211017,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA CHOICE PLUS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211018,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,AETNA,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,BCBS,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,CIGNA,COM,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,TRICARE,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,UNITED HEALTHCARE,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,UNITED HEALTHCARE,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,VA,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,VA TRICARE,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,WELLMED,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,HUMANA,MGD,19.03,,,,,,,per diem,19.03,19.03,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211019,CDM,250,RC,,,,,,Inpatient,1,EA,19.03,19.03,HUMANA CHOICE PLUS,MGD,19.03,,,,,,,case rate,19.03,19.03,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,AETNA,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,BCBS,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,CIGNA,COM,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,TRICARE,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,UNITED HEALTHCARE,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,UNITED HEALTHCARE,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,VA,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,VA TRICARE,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,WELLMED,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,HUMANA,MGD,15.44,,,,,,,per diem,15.44,15.44,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211020,CDM,250,RC,,,,,,Inpatient,1,EA,15.44,15.44,HUMANA CHOICE PLUS,MGD,15.44,,,,,,,case rate,15.44,15.44,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,AETNA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,CIGNA,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,WELLMED,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA,MGD,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211021,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA CHOICE PLUS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,AETNA,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,BCBS,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,CIGNA,COM,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,TRICARE,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,UNITED HEALTHCARE,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,UNITED HEALTHCARE,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,VA,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,VA TRICARE,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,WELLMED,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,HUMANA,MGD,131.67,,,,,,,per diem,131.67,131.67,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211022,CDM,250,RC,,,,,,Inpatient,1,EA,131.67,131.67,HUMANA CHOICE PLUS,MGD,131.67,,,,,,,case rate,131.67,131.67,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,AETNA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,BCBS,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,CIGNA,COM,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,UNITED HEALTHCARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,VA TRICARE,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,WELLMED,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA,MGD,6.36,,,,,,,per diem,6.36,6.36,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211023,CDM,250,RC,,,,,,Inpatient,1,EA,6.36,6.36,HUMANA CHOICE PLUS,MGD,6.36,,,,,,,case rate,6.36,6.36,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,AETNA,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,BCBS,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,CIGNA,COM,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,TRICARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UNITED HEALTHCARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,UNITED HEALTHCARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,VA,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,VA TRICARE,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,WELLMED,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,HUMANA,MGD,45.9,,,,,,,per diem,45.9,45.9,"Per diem rate, code is bundled with other services"
NAFCILLIN 1GM INJ             ,92211024,CDM,250,RC,,,,,,Inpatient,1,EA,45.9,45.9,HUMANA CHOICE PLUS,MGD,45.9,,,,,,,case rate,45.9,45.9,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,AETNA,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,BCBS,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,CIGNA,COM,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,TRICARE,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,UNITED HEALTHCARE,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,UNITED HEALTHCARE,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,VA,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,VA TRICARE,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,WELLMED,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,HUMANA,MGD,2691.33,,,,,,,per diem,2691.33,2691.33,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 7.5MG KIT SUS ,92211027,CDM,250,RC,,,,,,Inpatient,1,EA,2691.33,2691.33,HUMANA CHOICE PLUS,MGD,2691.33,,,,,,,case rate,2691.33,2691.33,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,AETNA,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,CIGNA,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,TRICARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UNITED HEALTHCARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UNITED HEALTHCARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,VA,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,VA TRICARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,WELLMED,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,HUMANA,MGD,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92211028,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,HUMANA CHOICE PLUS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG/5ML LIQ    ,92211030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 10/100 TAB     ,92211031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 50MG TAB                 ,92211032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,AETNA,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,BCBS,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,CIGNA,COM,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,TRICARE,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,UNITED HEALTHCARE,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,UNITED HEALTHCARE,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,VA,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,VA TRICARE,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,WELLMED,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,HUMANA,MGD,15.06,,,,,,,per diem,15.06,15.06,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG TAB      ,92211033,CDM,250,RC,,,,,,Inpatient,1,EA,15.06,15.06,HUMANA CHOICE PLUS,MGD,15.06,,,,,,,case rate,15.06,15.06,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211034,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92211035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,AETNA,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,BCBS,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,CIGNA,COM,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,TRICARE,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,UNITED HEALTHCARE,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,UNITED HEALTHCARE,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,VA,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,VA TRICARE,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,WELLMED,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,HUMANA,MGD,31.66,,,,,,,per diem,31.66,31.66,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211036,CDM,250,RC,,,,,,Inpatient,1,EA,31.66,31.66,HUMANA CHOICE PLUS,MGD,31.66,,,,,,,case rate,31.66,31.66,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,AETNA,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,CIGNA,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,TRICARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,UNITED HEALTHCARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,UNITED HEALTHCARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,VA,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,VA TRICARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,WELLMED,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,HUMANA,MGD,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
FLUPHENAZINE DEC 25MG/ML INJ  ,92211037,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,HUMANA CHOICE PLUS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,AETNA,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,BCBS,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,CIGNA,COM,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,TRICARE,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,UNITED HEALTHCARE,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,UNITED HEALTHCARE,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,VA,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,VA TRICARE,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,WELLMED,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,HUMANA,MGD,489.67,,,,,,,per diem,489.67,489.67,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211040,CDM,250,RC,,,,,,Inpatient,1,EA,489.67,489.67,HUMANA CHOICE PLUS,MGD,489.67,,,,,,,case rate,489.67,489.67,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92211041,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211042,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,AETNA,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,BCBS,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,CIGNA,COM,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,TRICARE,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,UNITED HEALTHCARE,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,UNITED HEALTHCARE,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,VA,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,VA TRICARE,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,WELLMED,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,HUMANA,MGD,16.07,,,,,,,per diem,16.07,16.07,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211043,CDM,250,RC,,,,,,Inpatient,1,EA,16.07,16.07,HUMANA CHOICE PLUS,MGD,16.07,,,,,,,case rate,16.07,16.07,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIAMTERENE/HYDROCHLOROTHIAZID,92211044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,AETNA,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,BCBS,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,CIGNA,COM,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,TRICARE,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,UNITED HEALTHCARE,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,UNITED HEALTHCARE,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,VA,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,VA TRICARE,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,WELLMED,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,HUMANA,MGD,568.95,,,,,,,per diem,568.95,568.95,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 250MG/5ML SUS  ,92211045,CDM,250,RC,,,,,,Inpatient,1,EA,568.95,568.95,HUMANA CHOICE PLUS,MGD,568.95,,,,,,,case rate,568.95,568.95,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CITRATE 950MG TAB     ,92211046,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ TER        ,92211047,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,AETNA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,CIGNA,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,WELLMED,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA,MGD,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BUTORPHANOL 2MG/ML INJ        ,92211048,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA CHOICE PLUS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,AETNA,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,BCBS,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,CIGNA,COM,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,TRICARE,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,UNITED HEALTHCARE,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,UNITED HEALTHCARE,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,VA,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,VA TRICARE,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,WELLMED,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,HUMANA,MGD,135.64,,,,,,,per diem,135.64,135.64,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211049,CDM,250,RC,,,,,,Inpatient,1,EA,135.64,135.64,HUMANA CHOICE PLUS,MGD,135.64,,,,,,,case rate,135.64,135.64,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 120MG TAB             ,92211050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 400MG TAB           ,92211051,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 25MG CAP     ,92211052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULFASALAZINE 500MG TAB       ,92211053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIMENHYDRINATE 50MG TAB       ,92211054,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,AETNA,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,BCBS,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,CIGNA,COM,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,TRICARE,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,UNITED HEALTHCARE,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,UNITED HEALTHCARE,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,VA,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,VA TRICARE,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,WELLMED,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,HUMANA,MGD,125.06,,,,,,,per diem,125.06,125.06,"Per diem rate, code is bundled with other services"
ENOXAPARIN NA 40MG/0.4ML INJ  ,92211055,CDM,250,RC,,,,,,Inpatient,1,EA,125.06,125.06,HUMANA CHOICE PLUS,MGD,125.06,,,,,,,case rate,125.06,125.06,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,AETNA,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,BCBS,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,CIGNA,COM,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,TRICARE,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,UNITED HEALTHCARE,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,UNITED HEALTHCARE,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,VA,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,VA TRICARE,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,WELLMED,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,HUMANA,MGD,23.44,,,,,,,per diem,23.44,23.44,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% SOL     ,92211057,CDM,250,RC,,,,,,Inpatient,1,EA,23.44,23.44,HUMANA CHOICE PLUS,MGD,23.44,,,,,,,case rate,23.44,23.44,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 250MCG TAB     ,92211059,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,AETNA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,BCBS,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,CIGNA,COM,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,UNITED HEALTHCARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,VA,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,VA TRICARE,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,WELLMED,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,HUMANA,MGD,7.94,,,,,,,per diem,7.94,7.94,"Per diem rate, code is bundled with other services"
PRAZOSIN HCL 2MG CAP          ,92211060,CDM,250,RC,,,,,,Inpatient,1,EA,7.94,7.94,HUMANA CHOICE PLUS,MGD,7.94,,,,,,,case rate,7.94,7.94,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211061,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MISOPROSTOL 100MCG TAB        ,92211062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,AETNA,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,BCBS,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,CIGNA,COM,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,TRICARE,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,UNITED HEALTHCARE,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,UNITED HEALTHCARE,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,VA,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,VA TRICARE,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,WELLMED,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,HUMANA,MGD,43.12,,,,,,,per diem,43.12,43.12,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 100MG I,92211064,CDM,250,RC,,,,,,Inpatient,1,EA,43.12,43.12,HUMANA CHOICE PLUS,MGD,43.12,,,,,,,case rate,43.12,43.12,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92211065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,AETNA,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,BCBS,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,CIGNA,COM,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,TRICARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,UNITED HEALTHCARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,UNITED HEALTHCARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,VA,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,VA TRICARE,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,WELLMED,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,HUMANA,MGD,58.4,,,,,,,per diem,58.4,58.4,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211066,CDM,250,RC,,,,,,Inpatient,1,EA,58.4,58.4,HUMANA CHOICE PLUS,MGD,58.4,,,,,,,case rate,58.4,58.4,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,AETNA,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,CIGNA,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,TRICARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,UNITED HEALTHCARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,UNITED HEALTHCARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,VA,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,VA TRICARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,WELLMED,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,HUMANA,MGD,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 1.5GM INJ,92211067,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,HUMANA CHOICE PLUS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,AETNA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,CIGNA,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,WELLMED,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA,MGD,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211068,CDM,258,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA CHOICE PLUS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,AETNA,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,BCBS,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,CIGNA,COM,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,TRICARE,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,UNITED HEALTHCARE,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,UNITED HEALTHCARE,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,VA,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,VA TRICARE,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,WELLMED,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,HUMANA,MGD,512.32,,,,,,,per diem,512.32,512.32,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML SUS        ,92211069,CDM,250,RC,,,,,,Inpatient,1,EA,512.32,512.32,HUMANA CHOICE PLUS,MGD,512.32,,,,,,,case rate,512.32,512.32,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FISH OIL VITAMIN E  SGL       ,92211071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG TAB          ,92211072,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 50MG TAB       ,92211073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,AETNA,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,CIGNA,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,TRICARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,UNITED HEALTHCARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,UNITED HEALTHCARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,VA,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,VA TRICARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,WELLMED,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,HUMANA,MGD,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211074,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,HUMANA CHOICE PLUS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 50MG ECT        ,92211075,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211076,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 20MG TAB  ,92211077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG/ML INJ          ,92211078,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,AETNA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,BCBS,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,CIGNA,COM,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,UNITED HEALTHCARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,VA TRICARE,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,WELLMED,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA,MGD,19.69,,,,,,,per diem,19.69,19.69,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211079,CDM,250,RC,,,,,,Inpatient,1,EA,19.69,19.69,HUMANA CHOICE PLUS,MGD,19.69,,,,,,,case rate,19.69,19.69,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASCORBIC ACID 500MG TAB       ,92211080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,AETNA,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,BCBS,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,CIGNA,COM,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,TRICARE,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,UNITED HEALTHCARE,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,UNITED HEALTHCARE,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,VA,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,VA TRICARE,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,WELLMED,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,HUMANA,MGD,30.56,,,,,,,per diem,30.56,30.56,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92211081,CDM,250,RC,,,,,,Inpatient,1,EA,30.56,30.56,HUMANA CHOICE PLUS,MGD,30.56,,,,,,,case rate,30.56,30.56,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 250MG TAB          ,92211082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211083,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,AETNA,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,BCBS,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,CIGNA,COM,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,TRICARE,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,UNITED HEALTHCARE,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,UNITED HEALTHCARE,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,VA,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,VA TRICARE,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,WELLMED,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,HUMANA,MGD,36.19,,,,,,,per diem,36.19,36.19,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211084,CDM,250,RC,,,,,,Inpatient,1,EA,36.19,36.19,HUMANA CHOICE PLUS,MGD,36.19,,,,,,,case rate,36.19,36.19,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,AETNA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,CIGNA,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,VA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,VA TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,WELLMED,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,HUMANA,MGD,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 500MG INJ      ,92211085,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,HUMANA CHOICE PLUS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,AETNA,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,BCBS,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,CIGNA,COM,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,TRICARE,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,UNITED HEALTHCARE,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,UNITED HEALTHCARE,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,VA,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,VA TRICARE,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,WELLMED,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,HUMANA,MGD,10764.87,,,,,,,per diem,10764.87,10764.87,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 30MG KIT PI4  ,92211086,CDM,250,RC,,,,,,Inpatient,1,EA,10764.87,10764.87,HUMANA CHOICE PLUS,MGD,10764.87,,,,,,,case rate,10764.87,10764.87,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,AETNA,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,BCBS,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,CIGNA,COM,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,TRICARE,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,UNITED HEALTHCARE,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,UNITED HEALTHCARE,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,VA,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,VA TRICARE,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,WELLMED,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,HUMANA,MGD,161.44,,,,,,,per diem,161.44,161.44,"Per diem rate, code is bundled with other services"
CEPHALEXIN 250MG/5ML SUS      ,92211087,CDM,250,RC,,,,,,Inpatient,1,EA,161.44,161.44,HUMANA CHOICE PLUS,MGD,161.44,,,,,,,case rate,161.44,161.44,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,AETNA,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,BCBS,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,CIGNA,COM,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,TRICARE,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,UNITED HEALTHCARE,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,UNITED HEALTHCARE,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,VA,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,VA TRICARE,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,WELLMED,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,HUMANA,MGD,29.04,,,,,,,per diem,29.04,29.04,"Per diem rate, code is bundled with other services"
STAVIDOME 40MG CAP            ,92211088,CDM,250,RC,,,,,,Inpatient,1,EA,29.04,29.04,HUMANA CHOICE PLUS,MGD,29.04,,,,,,,case rate,29.04,29.04,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BREWERS YEAST 500MG TAB       ,92211089,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
KETOROLAC 30MG/ML INJ         ,92211090,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG TAB       ,92211091,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,AETNA,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,BCBS,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,CIGNA,COM,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,TRICARE,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,UNITED HEALTHCARE,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,UNITED HEALTHCARE,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,VA,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,VA TRICARE,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,WELLMED,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,HUMANA,MGD,24,,,,,,,per diem,24,24,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECT        ,92211092,CDM,250,RC,,,,,,Inpatient,1,EA,24,24,HUMANA CHOICE PLUS,MGD,24,,,,,,,case rate,24,24,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92211093,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
TROLAMINE SALICYLATE 10% CRE  ,92211094,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,AETNA,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,CIGNA,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,TRICARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,UNITED HEALTHCARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,UNITED HEALTHCARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,VA,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,VA TRICARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,WELLMED,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,HUMANA,MGD,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
GLYCERIN/PHENO/NA BIC/NA BOR S,92211095,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,HUMANA CHOICE PLUS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211096,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,AETNA,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,BCBS,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,CIGNA,COM,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,TRICARE,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,UNITED HEALTHCARE,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,UNITED HEALTHCARE,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,VA,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,VA TRICARE,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,WELLMED,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,HUMANA,MGD,56.92,,,,,,,per diem,56.92,56.92,"Per diem rate, code is bundled with other services"
HYDROCORTISONE ACET 25MG SUP  ,92211097,CDM,250,RC,,,,,,Inpatient,1,EA,56.92,56.92,HUMANA CHOICE PLUS,MGD,56.92,,,,,,,case rate,56.92,56.92,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SPIRONOLACTONE 25MG TAB       ,92211098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92211099,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,AETNA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,CIGNA,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,WELLMED,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA,MGD,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211100,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA CHOICE PLUS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,AETNA,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,BCBS,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,CIGNA,COM,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,TRICARE,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,UNITED HEALTHCARE,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,UNITED HEALTHCARE,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,VA,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,VA TRICARE,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,WELLMED,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,HUMANA,MGD,1211.77,,,,,,,per diem,1211.77,1211.77,"Per diem rate, code is bundled with other services"
CLOBETASOL PROPIONATE         ,92211101,CDM,250,RC,,,,,,Inpatient,1,EA,1211.77,1211.77,HUMANA CHOICE PLUS,MGD,1211.77,,,,,,,case rate,1211.77,1211.77,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,AETNA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,CIGNA,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,WELLMED,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA,MGD,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% OIN       ,92211102,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA CHOICE PLUS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 100MG TAB     ,92211103,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211104,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,AETNA,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,BCBS,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,CIGNA,COM,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,TRICARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,UNITED HEALTHCARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,UNITED HEALTHCARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,VA,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,VA TRICARE,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,WELLMED,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,HUMANA,MGD,28.54,,,,,,,per diem,28.54,28.54,"Per diem rate, code is bundled with other services"
MORPHINE 25MG/ML INJ          ,92211105,CDM,250,RC,,,,,,Inpatient,1,EA,28.54,28.54,HUMANA CHOICE PLUS,MGD,28.54,,,,,,,case rate,28.54,28.54,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 100MG TAB              ,92211106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,AETNA,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,BCBS,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,CIGNA,COM,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,TRICARE,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,UNITED HEALTHCARE,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,UNITED HEALTHCARE,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,VA,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,VA TRICARE,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,WELLMED,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,HUMANA,MGD,107.45,,,,,,,per diem,107.45,107.45,"Per diem rate, code is bundled with other services"
RIFABUTIN 150MG CAP           ,92211107,CDM,250,RC,,,,,,Inpatient,1,EA,107.45,107.45,HUMANA CHOICE PLUS,MGD,107.45,,,,,,,case rate,107.45,107.45,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,AETNA,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,BCBS,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,CIGNA,COM,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,TRICARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,UNITED HEALTHCARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,UNITED HEALTHCARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,VA,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,VA TRICARE,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,WELLMED,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,HUMANA,MGD,53.11,,,,,,,per diem,53.11,53.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92211108,CDM,250,RC,,,,,,Inpatient,1,EA,53.11,53.11,HUMANA CHOICE PLUS,MGD,53.11,,,,,,,case rate,53.11,53.11,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,AETNA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,BCBS,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,CIGNA,COM,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,UNITED HEALTHCARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,VA,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,VA TRICARE,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,WELLMED,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,HUMANA,MGD,18.65,,,,,,,per diem,18.65,18.65,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-125 TAB ,92211109,CDM,250,RC,,,,,,Inpatient,1,EA,18.65,18.65,HUMANA CHOICE PLUS,MGD,18.65,,,,,,,case rate,18.65,18.65,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURBIPROFEN 100MG TAB        ,92211110,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,AETNA,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,BCBS,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,CIGNA,COM,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,TRICARE,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,UNITED HEALTHCARE,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,UNITED HEALTHCARE,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,VA,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,VA TRICARE,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,WELLMED,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,HUMANA,MGD,8.95,,,,,,,per diem,8.95,8.95,"Per diem rate, code is bundled with other services"
CLORAZEPATE 7.5MG TAB         ,92211111,CDM,250,RC,,,,,,Inpatient,1,EA,8.95,8.95,HUMANA CHOICE PLUS,MGD,8.95,,,,,,,case rate,8.95,8.95,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,AETNA,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,BCBS,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,CIGNA,COM,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,TRICARE,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,UNITED HEALTHCARE,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,UNITED HEALTHCARE,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,VA,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,VA TRICARE,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,WELLMED,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,HUMANA,MGD,166.29,,,,,,,per diem,166.29,166.29,"Per diem rate, code is bundled with other services"
TERCONAZOLE 0.8% CRE          ,92211114,CDM,250,RC,,,,,,Inpatient,1,EA,166.29,166.29,HUMANA CHOICE PLUS,MGD,166.29,,,,,,,case rate,166.29,166.29,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,AETNA,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,BCBS,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,CIGNA,COM,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,TRICARE,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,UNITED HEALTHCARE,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,UNITED HEALTHCARE,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,VA,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,VA TRICARE,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,WELLMED,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,HUMANA,MGD,10.52,,,,,,,per diem,10.52,10.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 300MG C24        ,92211115,CDM,250,RC,,,,,,Inpatient,1,EA,10.52,10.52,HUMANA CHOICE PLUS,MGD,10.52,,,,,,,case rate,10.52,10.52,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 125MCG/5ML EL,92211116,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211117,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,AETNA,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,BCBS,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,CIGNA,COM,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,TRICARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,UNITED HEALTHCARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,UNITED HEALTHCARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,VA,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,VA TRICARE,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,WELLMED,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,HUMANA,MGD,32.45,,,,,,,per diem,32.45,32.45,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211118,CDM,250,RC,,,,,,Inpatient,1,EA,32.45,32.45,HUMANA CHOICE PLUS,MGD,32.45,,,,,,,case rate,32.45,32.45,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,AETNA,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,BCBS,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,CIGNA,COM,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,TRICARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UNITED HEALTHCARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,UNITED HEALTHCARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,VA,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,VA TRICARE,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,WELLMED,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,HUMANA,MGD,15.66,,,,,,,per diem,15.66,15.66,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 1% INJ          ,92211119,CDM,250,RC,,,,,,Inpatient,1,EA,15.66,15.66,HUMANA CHOICE PLUS,MGD,15.66,,,,,,,case rate,15.66,15.66,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211120,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,AETNA,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,BCBS,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,CIGNA,COM,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,TRICARE,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,UNITED HEALTHCARE,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,UNITED HEALTHCARE,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,VA,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,VA TRICARE,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,WELLMED,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,HUMANA,MGD,313.14,,,,,,,per diem,313.14,313.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211121,CDM,250,RC,,,,,,Inpatient,1,EA,313.14,313.14,HUMANA CHOICE PLUS,MGD,313.14,,,,,,,case rate,313.14,313.14,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 40MG TAB        ,92211122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211123,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,AETNA,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,CIGNA,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,TRICARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,UNITED HEALTHCARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,UNITED HEALTHCARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,VA,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,VA TRICARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,WELLMED,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,HUMANA,MGD,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
ZIDOVUDINE 300MG TAB          ,92211124,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,HUMANA CHOICE PLUS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 5MG TAB       ,92211125,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,AETNA,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,BCBS,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,CIGNA,COM,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,TRICARE,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,UNITED HEALTHCARE,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,UNITED HEALTHCARE,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,VA,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,VA TRICARE,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,WELLMED,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,HUMANA,MGD,384.96,,,,,,,per diem,384.96,384.96,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/HC SUS,92211127,CDM,250,RC,,,,,,Inpatient,1,EA,384.96,384.96,HUMANA CHOICE PLUS,MGD,384.96,,,,,,,case rate,384.96,384.96,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 325MG TAB       ,92211128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211130,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-325MG TAB    ,92211131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,AETNA,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,BCBS,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,CIGNA,COM,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,TRICARE,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,UNITED HEALTHCARE,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,UNITED HEALTHCARE,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,VA,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,VA TRICARE,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,WELLMED,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,HUMANA,MGD,84.29,,,,,,,per diem,84.29,84.29,"Per diem rate, code is bundled with other services"
HEPATITIS B VACC 10MCG/0.5ML S,92211132,CDM,250,RC,,,,,,Inpatient,1,EA,84.29,84.29,HUMANA CHOICE PLUS,MGD,84.29,,,,,,,case rate,84.29,84.29,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,AETNA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,BCBS,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,CIGNA,COM,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,UNITED HEALTHCARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,VA TRICARE,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,WELLMED,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA,MGD,10.02,,,,,,,per diem,10.02,10.02,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 30MG TAB       ,92211133,CDM,250,RC,,,,,,Inpatient,1,EA,10.02,10.02,HUMANA CHOICE PLUS,MGD,10.02,,,,,,,case rate,10.02,10.02,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92211134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,AETNA,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,BCBS,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,CIGNA,COM,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,TRICARE,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,UNITED HEALTHCARE,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,UNITED HEALTHCARE,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,VA,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,VA TRICARE,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,WELLMED,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,HUMANA,MGD,27.44,,,,,,,per diem,27.44,27.44,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 40MG TAB ,92211135,CDM,250,RC,,,,,,Inpatient,1,EA,27.44,27.44,HUMANA CHOICE PLUS,MGD,27.44,,,,,,,case rate,27.44,27.44,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,AETNA,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,BCBS,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,CIGNA,COM,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,TRICARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,UNITED HEALTHCARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,UNITED HEALTHCARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,VA,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,VA TRICARE,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,WELLMED,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,HUMANA,MGD,264.6,,,,,,,per diem,264.6,264.6,"Per diem rate, code is bundled with other services"
GRANISETRON HCL 1MG/ML INJ    ,92211136,CDM,250,RC,,,,,,Inpatient,1,EA,264.6,264.6,HUMANA CHOICE PLUS,MGD,264.6,,,,,,,case rate,264.6,264.6,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211137,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,AETNA,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,BCBS,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,CIGNA,COM,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,TRICARE,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,UNITED HEALTHCARE,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,UNITED HEALTHCARE,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,VA,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,VA TRICARE,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,WELLMED,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,HUMANA,MGD,537.8,,,,,,,per diem,537.8,537.8,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211138,CDM,250,RC,,,,,,Inpatient,1,EA,537.8,537.8,HUMANA CHOICE PLUS,MGD,537.8,,,,,,,case rate,537.8,537.8,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,AETNA,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,BCBS,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,CIGNA,COM,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,TRICARE,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,UNITED HEALTHCARE,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,UNITED HEALTHCARE,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,VA,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,VA TRICARE,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,WELLMED,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,HUMANA,MGD,57.11,,,,,,,per diem,57.11,57.11,"Per diem rate, code is bundled with other services"
ALCLOMETASONE DIPRO 0.05% CRE ,92211139,CDM,250,RC,,,,,,Inpatient,1,EA,57.11,57.11,HUMANA CHOICE PLUS,MGD,57.11,,,,,,,case rate,57.11,57.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 80MG TAB        ,92211140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 375MG ECT            ,92211141,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.3MG TAB       ,92211143,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"FISH OIL 1,000MG SGL          ",92211144,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,AETNA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,BCBS,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,CIGNA,COM,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,UNITED HEALTHCARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,VA,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,VA TRICARE,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,WELLMED,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,HUMANA,MGD,20.35,,,,,,,per diem,20.35,20.35,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 12.5MG/ML INJ  ,92211145,CDM,250,RC,,,,,,Inpatient,1,EA,20.35,20.35,HUMANA CHOICE PLUS,MGD,20.35,,,,,,,case rate,20.35,20.35,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,AETNA,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,BCBS,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,CIGNA,COM,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,TRICARE,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,UNITED HEALTHCARE,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,UNITED HEALTHCARE,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,VA,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,VA TRICARE,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,WELLMED,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,HUMANA,MGD,59.6,,,,,,,per diem,59.6,59.6,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211146,CDM,250,RC,,,,,,Inpatient,1,EA,59.6,59.6,HUMANA CHOICE PLUS,MGD,59.6,,,,,,,case rate,59.6,59.6,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,AETNA,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,BCBS,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,CIGNA,COM,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,TRICARE,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,UNITED HEALTHCARE,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,UNITED HEALTHCARE,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,VA,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,VA TRICARE,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,WELLMED,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,HUMANA,MGD,15.25,,,,,,,per diem,15.25,15.25,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% SPR     ,92211147,CDM,250,RC,,,,,,Inpatient,1,EA,15.25,15.25,HUMANA CHOICE PLUS,MGD,15.25,,,,,,,case rate,15.25,15.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,AETNA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,CIGNA,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,WELLMED,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA,MGD,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211148,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA CHOICE PLUS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML SYR     ,92211149,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIGOXIN 250MCG TAB            ,92211150,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,AETNA,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,BCBS,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,CIGNA,COM,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,TRICARE,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,UNITED HEALTHCARE,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,UNITED HEALTHCARE,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,VA,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,VA TRICARE,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,WELLMED,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,HUMANA,MGD,413.69,,,,,,,per diem,413.69,413.69,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92211151,CDM,250,RC,,,,,,Inpatient,1,EA,413.69,413.69,HUMANA CHOICE PLUS,MGD,413.69,,,,,,,case rate,413.69,413.69,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211152,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,AETNA,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,BCBS,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,CIGNA,COM,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,TRICARE,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,UNITED HEALTHCARE,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,UNITED HEALTHCARE,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,VA,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,VA TRICARE,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,WELLMED,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,HUMANA,MGD,32.26,,,,,,,per diem,32.26,32.26,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 10% INJ     ,92211153,CDM,250,RC,,,,,,Inpatient,1,EA,32.26,32.26,HUMANA CHOICE PLUS,MGD,32.26,,,,,,,case rate,32.26,32.26,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,AETNA,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,CIGNA,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,TRICARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,UNITED HEALTHCARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,UNITED HEALTHCARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,VA,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,VA TRICARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,WELLMED,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,HUMANA,MGD,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
CHLORHEXIDINE GLUC 0.12% LIQ  ,92211154,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,HUMANA CHOICE PLUS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS LIQ     ,92211156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 0.83MG/ML SOL  ,92211157,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE TAB   ,92211158,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,AETNA,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,BCBS,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,CIGNA,COM,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,TRICARE,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,UNITED HEALTHCARE,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,UNITED HEALTHCARE,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,VA,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,VA TRICARE,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,WELLMED,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,HUMANA,MGD,62.56,,,,,,,per diem,62.56,62.56,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/GM OIN    ,92211159,CDM,250,RC,,,,,,Inpatient,1,EA,62.56,62.56,HUMANA CHOICE PLUS,MGD,62.56,,,,,,,case rate,62.56,62.56,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211161,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,AETNA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,BCBS,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,CIGNA,COM,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,UNITED HEALTHCARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,VA TRICARE,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,WELLMED,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA,MGD,5.83,,,,,,,per diem,5.83,5.83,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211162,CDM,250,RC,,,,,,Inpatient,1,EA,5.83,5.83,HUMANA CHOICE PLUS,MGD,5.83,,,,,,,case rate,5.83,5.83,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 160MG/5ML SUS   ,92211163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,AETNA,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,BCBS,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,CIGNA,COM,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,TRICARE,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,UNITED HEALTHCARE,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,UNITED HEALTHCARE,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,VA,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,VA TRICARE,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,WELLMED,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,HUMANA,MGD,34.93,,,,,,,per diem,34.93,34.93,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211164,CDM,250,RC,,,,,,Inpatient,1,EA,34.93,34.93,HUMANA CHOICE PLUS,MGD,34.93,,,,,,,case rate,34.93,34.93,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,AETNA,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,BCBS,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,CIGNA,COM,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,TRICARE,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,UNITED HEALTHCARE,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,UNITED HEALTHCARE,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,VA,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,VA TRICARE,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,WELLMED,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,HUMANA,MGD,121.91,,,,,,,per diem,121.91,121.91,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% CRE   ,92211165,CDM,250,RC,,,,,,Inpatient,1,EA,121.91,121.91,HUMANA CHOICE PLUS,MGD,121.91,,,,,,,case rate,121.91,121.91,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLINDAMYCIN HCL 150MG CAP     ,92211166,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG TAB  ,92211167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,AETNA,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,CIGNA,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,TRICARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UNITED HEALTHCARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UNITED HEALTHCARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,VA,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,VA TRICARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,WELLMED,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,HUMANA,MGD,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
GABAPENTIN 300MG CAP          ,92211168,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,HUMANA CHOICE PLUS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,AETNA,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,BCBS,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,CIGNA,COM,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,TRICARE,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,UNITED HEALTHCARE,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,UNITED HEALTHCARE,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,VA,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,VA TRICARE,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,WELLMED,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,HUMANA,MGD,502.9,,,,,,,per diem,502.9,502.9,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 1% SUS   ,92211169,CDM,250,RC,,,,,,Inpatient,1,EA,502.9,502.9,HUMANA CHOICE PLUS,MGD,502.9,,,,,,,case rate,502.9,502.9,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,AETNA,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,BCBS,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,CIGNA,COM,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,TRICARE,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,UNITED HEALTHCARE,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,UNITED HEALTHCARE,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,VA,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,VA TRICARE,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,WELLMED,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,HUMANA,MGD,166.64,,,,,,,per diem,166.64,166.64,"Per diem rate, code is bundled with other services"
PHYTONADIONE 10MG/ML INJ      ,92211170,CDM,250,RC,,,,,,Inpatient,1,EA,166.64,166.64,HUMANA CHOICE PLUS,MGD,166.64,,,,,,,case rate,166.64,166.64,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,AETNA,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,BCBS,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,CIGNA,COM,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,TRICARE,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,UNITED HEALTHCARE,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,UNITED HEALTHCARE,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,VA,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,VA TRICARE,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,WELLMED,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,HUMANA,MGD,163.49,,,,,,,per diem,163.49,163.49,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92211171,CDM,250,RC,,,,,,Inpatient,1,EA,163.49,163.49,HUMANA CHOICE PLUS,MGD,163.49,,,,,,,case rate,163.49,163.49,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,AETNA,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,BCBS,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,CIGNA,COM,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,TRICARE,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,UNITED HEALTHCARE,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,UNITED HEALTHCARE,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,VA,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,VA TRICARE,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,WELLMED,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,HUMANA,MGD,56.26,,,,,,,per diem,56.26,56.26,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92211172,CDM,250,RC,,,,,,Inpatient,1,EA,56.26,56.26,HUMANA CHOICE PLUS,MGD,56.26,,,,,,,case rate,56.26,56.26,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COENZYME Q10 60MG CAP         ,92211173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,AETNA,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,BCBS,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,CIGNA,COM,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,TRICARE,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,UNITED HEALTHCARE,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,UNITED HEALTHCARE,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,VA,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,VA TRICARE,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,WELLMED,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,HUMANA,MGD,28.51,,,,,,,per diem,28.51,28.51,"Per diem rate, code is bundled with other services"
STAVIDOME 30MG CAP            ,92211174,CDM,250,RC,,,,,,Inpatient,1,EA,28.51,28.51,HUMANA CHOICE PLUS,MGD,28.51,,,,,,,case rate,28.51,28.51,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,AETNA,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,BCBS,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,CIGNA,COM,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,TRICARE,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,UNITED HEALTHCARE,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,UNITED HEALTHCARE,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,VA,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,VA TRICARE,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,WELLMED,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,HUMANA,MGD,14.08,,,,,,,per diem,14.08,14.08,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 250MG TAB       ,92211175,CDM,250,RC,,,,,,Inpatient,1,EA,14.08,14.08,HUMANA CHOICE PLUS,MGD,14.08,,,,,,,case rate,14.08,14.08,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,AETNA,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,BCBS,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,CIGNA,COM,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,TRICARE,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,UNITED HEALTHCARE,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,UNITED HEALTHCARE,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,VA,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,VA TRICARE,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,WELLMED,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,HUMANA,MGD,61.83,,,,,,,per diem,61.83,61.83,"Per diem rate, code is bundled with other services"
MYCOPHENOLATE 500MG TAB       ,92211176,CDM,250,RC,,,,,,Inpatient,1,EA,61.83,61.83,HUMANA CHOICE PLUS,MGD,61.83,,,,,,,case rate,61.83,61.83,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,AETNA,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,BCBS,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,CIGNA,COM,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,TRICARE,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,UNITED HEALTHCARE,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,UNITED HEALTHCARE,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,VA,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,VA TRICARE,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,WELLMED,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,HUMANA,MGD,19.94,,,,,,,per diem,19.94,19.94,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92211177,CDM,250,RC,,,,,,Inpatient,1,EA,19.94,19.94,HUMANA CHOICE PLUS,MGD,19.94,,,,,,,case rate,19.94,19.94,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,AETNA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,CIGNA,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,WELLMED,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA,MGD,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
TAMOXIFEN 10MG TAB            ,92211178,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA CHOICE PLUS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DEXTROSE 4GM CTB              ,92211179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,AETNA,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,CIGNA,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,TRICARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,UNITED HEALTHCARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,UNITED HEALTHCARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,VA,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,VA TRICARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,WELLMED,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,HUMANA,MGD,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
DANAZOL 200MG CAP             ,92211180,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,HUMANA CHOICE PLUS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211181,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TROPICAMIDE 1% EYE SOL        ,92211182,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG/10.15ML SO,92211183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 50MG TER      ,92211184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,AETNA,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,BCBS,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,CIGNA,COM,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,TRICARE,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,UNITED HEALTHCARE,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,UNITED HEALTHCARE,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,VA,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,VA TRICARE,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,WELLMED,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,HUMANA,MGD,12.63,,,,,,,per diem,12.63,12.63,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 25MG TAB  ,92211185,CDM,250,RC,,,,,,Inpatient,1,EA,12.63,12.63,HUMANA CHOICE PLUS,MGD,12.63,,,,,,,case rate,12.63,12.63,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,AETNA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,CIGNA,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,WELLMED,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA,MGD,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
SALSALATE 500MG TAB           ,92211186,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA CHOICE PLUS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211187,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,AETNA,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,CIGNA,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,TRICARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,UNITED HEALTHCARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,UNITED HEALTHCARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,VA,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,VA TRICARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,WELLMED,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,HUMANA,MGD,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
PRILOCAINE LIDOCAINE 2.5-2.5 C,92211188,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,HUMANA CHOICE PLUS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,AETNA,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,BCBS,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,CIGNA,COM,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,TRICARE,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,UNITED HEALTHCARE,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,UNITED HEALTHCARE,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,VA,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,VA TRICARE,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,WELLMED,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,HUMANA,MGD,60.29,,,,,,,per diem,60.29,60.29,"Per diem rate, code is bundled with other services"
HYDROCORTISONE NA SUCC 250MG I,92211189,CDM,250,RC,,,,,,Inpatient,1,EA,60.29,60.29,HUMANA CHOICE PLUS,MGD,60.29,,,,,,,case rate,60.29,60.29,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML INJ       ,92211190,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,AETNA,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,BCBS,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,CIGNA,COM,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,TRICARE,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,UNITED HEALTHCARE,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,UNITED HEALTHCARE,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,VA,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,VA TRICARE,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,WELLMED,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,HUMANA,MGD,206.83,,,,,,,per diem,206.83,206.83,"Per diem rate, code is bundled with other services"
PROCAINAMIDE HCL 500MG/ML INJ ,92211191,CDM,250,RC,,,,,,Inpatient,1,EA,206.83,206.83,HUMANA CHOICE PLUS,MGD,206.83,,,,,,,case rate,206.83,206.83,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,AETNA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,CIGNA,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,WELLMED,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA,MGD,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
ISOXSUPRINE HCL 20MG TAB      ,92211193,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA CHOICE PLUS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211195,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,AETNA,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,BCBS,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,CIGNA,COM,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,TRICARE,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,UNITED HEALTHCARE,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,UNITED HEALTHCARE,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,VA,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,VA TRICARE,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,WELLMED,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,HUMANA,MGD,319.91,,,,,,,per diem,319.91,319.91,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 2GM INJ        ,92211196,CDM,250,RC,,,,,,Inpatient,1,EA,319.91,319.91,HUMANA CHOICE PLUS,MGD,319.91,,,,,,,case rate,319.91,319.91,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92211197,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD 300MG-30MG T,92211198,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,AETNA,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,BCBS,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,CIGNA,COM,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,TRICARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,UNITED HEALTHCARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,UNITED HEALTHCARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,VA,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,VA TRICARE,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,WELLMED,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,HUMANA,MGD,20.98,,,,,,,per diem,20.98,20.98,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211200,CDM,250,RC,,,,,,Inpatient,1,EA,20.98,20.98,HUMANA CHOICE PLUS,MGD,20.98,,,,,,,case rate,20.98,20.98,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,AETNA,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,BCBS,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,CIGNA,COM,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,TRICARE,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,UNITED HEALTHCARE,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,UNITED HEALTHCARE,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,VA,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,VA TRICARE,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,WELLMED,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,HUMANA,MGD,119.7,,,,,,,per diem,119.7,119.7,"Per diem rate, code is bundled with other services"
AK-PENTOLATE 1% EYE SOL       ,92211201,CDM,250,RC,,,,,,Inpatient,1,EA,119.7,119.7,HUMANA CHOICE PLUS,MGD,119.7,,,,,,,case rate,119.7,119.7,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,AETNA,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,BCBS,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,CIGNA,COM,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,TRICARE,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,UNITED HEALTHCARE,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,UNITED HEALTHCARE,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,VA,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,VA TRICARE,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,WELLMED,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,HUMANA,MGD,26.02,,,,,,,per diem,26.02,26.02,"Per diem rate, code is bundled with other services"
BSS EYE SOL                   ,92211202,CDM,250,RC,,,,,,Inpatient,1,EA,26.02,26.02,HUMANA CHOICE PLUS,MGD,26.02,,,,,,,case rate,26.02,26.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,AETNA,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,BCBS,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,CIGNA,COM,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,TRICARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UNITED HEALTHCARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,UNITED HEALTHCARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,VA TRICARE,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,WELLMED,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,HUMANA,MGD,5.64,,,,,,,per diem,5.64,5.64,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211203,CDM,250,RC,,,,,,Inpatient,1,EA,5.64,5.64,HUMANA CHOICE PLUS,MGD,5.64,,,,,,,case rate,5.64,5.64,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,AETNA,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,BCBS,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,CIGNA,COM,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,TRICARE,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UNITED HEALTHCARE,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,UNITED HEALTHCARE,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,VA,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,VA TRICARE,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,WELLMED,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,HUMANA,MGD,18.45,,,,,,,per diem,18.45,18.45,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211204,CDM,250,RC,,,,,,Inpatient,1,EA,18.45,18.45,HUMANA CHOICE PLUS,MGD,18.45,,,,,,,case rate,18.45,18.45,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,AETNA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,CIGNA,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,WELLMED,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA,MGD,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
AMANTADINE HCL 50MG/5ML LIQ   ,92211205,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA CHOICE PLUS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,AETNA,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,BCBS,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,CIGNA,COM,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,TRICARE,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,UNITED HEALTHCARE,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,UNITED HEALTHCARE,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,VA,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,VA TRICARE,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,WELLMED,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,HUMANA,MGD,14.14,,,,,,,per diem,14.14,14.14,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25% SPR   ,92211206,CDM,250,RC,,,,,,Inpatient,1,EA,14.14,14.14,HUMANA CHOICE PLUS,MGD,14.14,,,,,,,case rate,14.14,14.14,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,AETNA,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,BCBS,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,CIGNA,COM,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,TRICARE,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,UNITED HEALTHCARE,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,UNITED HEALTHCARE,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,VA,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,VA TRICARE,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,WELLMED,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,HUMANA,MGD,7657.93,,,,,,,per diem,7657.93,7657.93,"Per diem rate, code is bundled with other services"
CALCITONIN 200U/ML INJ        ,92211207,CDM,250,RC,,,,,,Inpatient,1,EA,7657.93,7657.93,HUMANA CHOICE PLUS,MGD,7657.93,,,,,,,case rate,7657.93,7657.93,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 500MG CAP    ,92211208,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,AETNA,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,BCBS,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,CIGNA,COM,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,TRICARE,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,UNITED HEALTHCARE,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,UNITED HEALTHCARE,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,VA,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,VA TRICARE,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,WELLMED,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,HUMANA,MGD,20,,,,,,,per diem,20,20,"Per diem rate, code is bundled with other services"
PYRAZINAMIDE 500MG TAB        ,92211209,CDM,250,RC,,,,,,Inpatient,1,EA,20,20,HUMANA CHOICE PLUS,MGD,20,,,,,,,case rate,20,20,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,AETNA,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,BCBS,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,CIGNA,COM,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,TRICARE,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,UNITED HEALTHCARE,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,UNITED HEALTHCARE,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,VA,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,VA TRICARE,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,WELLMED,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,HUMANA,MGD,116.2,,,,,,,per diem,116.2,116.2,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 50MG TAB     ,92211210,CDM,250,RC,,,,,,Inpatient,1,EA,116.2,116.2,HUMANA CHOICE PLUS,MGD,116.2,,,,,,,case rate,116.2,116.2,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,AETNA,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,BCBS,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,CIGNA,COM,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,TRICARE,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,UNITED HEALTHCARE,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,UNITED HEALTHCARE,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,VA,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,VA TRICARE,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,WELLMED,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,HUMANA,MGD,322.25,,,,,,,per diem,322.25,322.25,"Per diem rate, code is bundled with other services"
RIMEXOLONE 1% SUS             ,92211211,CDM,250,RC,,,,,,Inpatient,1,EA,322.25,322.25,HUMANA CHOICE PLUS,MGD,322.25,,,,,,,case rate,322.25,322.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/250 TAB     ,92211212,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,AETNA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,CIGNA,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,WELLMED,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA,MGD,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 25MG SGL         ,92211213,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA CHOICE PLUS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,AETNA,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,BCBS,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,CIGNA,COM,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,TRICARE,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,UNITED HEALTHCARE,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,UNITED HEALTHCARE,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,VA,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,VA TRICARE,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,WELLMED,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,HUMANA,MGD,7.4,,,,,,,per diem,7.4,7.4,"Per diem rate, code is bundled with other services"
DEXTROSE FRUCTOSE PHOS ACID SO,92211214,CDM,250,RC,,,,,,Inpatient,1,EA,7.4,7.4,HUMANA CHOICE PLUS,MGD,7.4,,,,,,,case rate,7.4,7.4,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 2.5MG TAB ,92211215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,AETNA,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,BCBS,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,CIGNA,COM,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,TRICARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,UNITED HEALTHCARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,UNITED HEALTHCARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,VA,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,VA TRICARE,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,WELLMED,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,HUMANA,MGD,12.19,,,,,,,per diem,12.19,12.19,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211216,CDM,250,RC,,,,,,Inpatient,1,EA,12.19,12.19,HUMANA CHOICE PLUS,MGD,12.19,,,,,,,case rate,12.19,12.19,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211217,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,AETNA,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,BCBS,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,CIGNA,COM,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,TRICARE,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,UNITED HEALTHCARE,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,UNITED HEALTHCARE,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,VA,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,VA TRICARE,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,WELLMED,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,HUMANA,MGD,327.98,,,,,,,per diem,327.98,327.98,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211218,CDM,250,RC,,,,,,Inpatient,1,EA,327.98,327.98,HUMANA CHOICE PLUS,MGD,327.98,,,,,,,case rate,327.98,327.98,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
CAFFEINE SOD BENZOATE 500MG IN,92211219,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,AETNA,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,BCBS,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,CIGNA,COM,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,TRICARE,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,UNITED HEALTHCARE,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,UNITED HEALTHCARE,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,VA,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,VA TRICARE,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,WELLMED,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,HUMANA,MGD,34.21,,,,,,,per diem,34.21,34.21,"Per diem rate, code is bundled with other services"
SODIUM PHOSPHATE 3MM/ML INJ   ,92211220,CDM,250,RC,,,,,,Inpatient,1,EA,34.21,34.21,HUMANA CHOICE PLUS,MGD,34.21,,,,,,,case rate,34.21,34.21,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,AETNA,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,BCBS,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,CIGNA,COM,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,TRICARE,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,UNITED HEALTHCARE,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,UNITED HEALTHCARE,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,VA,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,VA TRICARE,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,WELLMED,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,HUMANA,MGD,289.86,,,,,,,per diem,289.86,289.86,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211221,CDM,250,RC,,,,,,Inpatient,1,EA,289.86,289.86,HUMANA CHOICE PLUS,MGD,289.86,,,,,,,case rate,289.86,289.86,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 50MG TAB             ,92211222,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG CT,92211223,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,AETNA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,BCBS,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,CIGNA,COM,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,UNITED HEALTHCARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,VA TRICARE,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,WELLMED,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,HUMANA,MGD,10.71,,,,,,,per diem,10.71,10.71,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 150MG CAP         ,92211224,CDM,250,RC,,,,,,Inpatient,1,EA,10.71,10.71,HUMANA CHOICE PLUS,MGD,10.71,,,,,,,case rate,10.71,10.71,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,AETNA,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,BCBS,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,CIGNA,COM,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,TRICARE,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,UNITED HEALTHCARE,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,UNITED HEALTHCARE,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,VA,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,VA TRICARE,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,WELLMED,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,HUMANA,MGD,172.27,,,,,,,per diem,172.27,172.27,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211225,CDM,250,RC,,,,,,Inpatient,1,EA,172.27,172.27,HUMANA CHOICE PLUS,MGD,172.27,,,,,,,case rate,172.27,172.27,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211226,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,AETNA,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,BCBS,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,CIGNA,COM,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,TRICARE,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,UNITED HEALTHCARE,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,UNITED HEALTHCARE,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,VA,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,VA TRICARE,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,WELLMED,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,HUMANA,MGD,14.81,,,,,,,per diem,14.81,14.81,"Per diem rate, code is bundled with other services"
BACLOFEN 20MG TAB             ,92211227,CDM,250,RC,,,,,,Inpatient,1,EA,14.81,14.81,HUMANA CHOICE PLUS,MGD,14.81,,,,,,,case rate,14.81,14.81,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYCERIN SUP                  ,92211228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 500MG INJ           ,92211230,CDM,250,RC,J2185,HCPCS,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-750MG TAB,92211231,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211232,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR                     ,92211233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,AETNA,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,BCBS,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,CIGNA,COM,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,TRICARE,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,UNITED HEALTHCARE,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,UNITED HEALTHCARE,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,VA,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,VA TRICARE,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,WELLMED,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,HUMANA,MGD,18.02,,,,,,,per diem,18.02,18.02,"Per diem rate, code is bundled with other services"
DIBUCAINE 1% OIN              ,92211234,CDM,250,RC,,,,,,Inpatient,1,EA,18.02,18.02,HUMANA CHOICE PLUS,MGD,18.02,,,,,,,case rate,18.02,18.02,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,AETNA,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,CIGNA,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,TRICARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UNITED HEALTHCARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UNITED HEALTHCARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA TRICARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,WELLMED,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,HUMANA,MGD,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG INJ   ,92211235,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,HUMANA CHOICE PLUS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,AETNA,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,BCBS,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,CIGNA,COM,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,TRICARE,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,UNITED HEALTHCARE,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,UNITED HEALTHCARE,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,VA,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,VA TRICARE,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,WELLMED,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,HUMANA,MGD,36.29,,,,,,,per diem,36.29,36.29,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 100MG TAB  ,92211237,CDM,250,RC,,,,,,Inpatient,1,EA,36.29,36.29,HUMANA CHOICE PLUS,MGD,36.29,,,,,,,case rate,36.29,36.29,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,AETNA,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,BCBS,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,CIGNA,COM,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,TRICARE,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,UNITED HEALTHCARE,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,UNITED HEALTHCARE,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,VA,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,VA TRICARE,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,WELLMED,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,HUMANA,MGD,1030.62,,,,,,,per diem,1030.62,1030.62,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211238,CDM,250,RC,,,,,,Inpatient,1,EA,1030.62,1030.62,HUMANA CHOICE PLUS,MGD,1030.62,,,,,,,case rate,1030.62,1030.62,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211239,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,AETNA,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,BCBS,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,CIGNA,COM,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,TRICARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,UNITED HEALTHCARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,UNITED HEALTHCARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,VA,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,VA TRICARE,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,WELLMED,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,HUMANA,MGD,14.05,,,,,,,per diem,14.05,14.05,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211240,CDM,250,RC,,,,,,Inpatient,1,EA,14.05,14.05,HUMANA CHOICE PLUS,MGD,14.05,,,,,,,case rate,14.05,14.05,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,AETNA,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,BCBS,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,CIGNA,COM,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,TRICARE,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,UNITED HEALTHCARE,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,UNITED HEALTHCARE,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,VA,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,VA TRICARE,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,WELLMED,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,HUMANA,MGD,16.09,,,,,,,per diem,16.09,16.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92211241,CDM,250,RC,,,,,,Inpatient,1,EA,16.09,16.09,HUMANA CHOICE PLUS,MGD,16.09,,,,,,,case rate,16.09,16.09,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,AETNA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,CIGNA,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,WELLMED,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA,MGD,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
VANCOMYCIN HCL 500MG INJ      ,92211242,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA CHOICE PLUS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,AETNA,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,BCBS,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,CIGNA,COM,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,TRICARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,UNITED HEALTHCARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,UNITED HEALTHCARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,VA,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,VA TRICARE,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,WELLMED,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,HUMANA,MGD,15.09,,,,,,,per diem,15.09,15.09,"Per diem rate, code is bundled with other services"
BUTORPHANOL 1MG/ML INJ        ,92211244,CDM,250,RC,,,,,,Inpatient,1,EA,15.09,15.09,HUMANA CHOICE PLUS,MGD,15.09,,,,,,,case rate,15.09,15.09,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92211245,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,AETNA,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,CIGNA,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,TRICARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,UNITED HEALTHCARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,UNITED HEALTHCARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,VA,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,VA TRICARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,WELLMED,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,HUMANA,MGD,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
VITAMIN A/D OIN               ,92211246,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,HUMANA CHOICE PLUS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211247,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,AETNA,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,BCBS,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,CIGNA,COM,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,TRICARE,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,UNITED HEALTHCARE,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,UNITED HEALTHCARE,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,VA,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,VA TRICARE,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,WELLMED,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,HUMANA,MGD,5.8,,,,,,,per diem,5.8,5.8,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-650MG TAB ,92211248,CDM,250,RC,,,,,,Inpatient,1,EA,5.8,5.8,HUMANA CHOICE PLUS,MGD,5.8,,,,,,,case rate,5.8,5.8,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,AETNA,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,BCBS,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,CIGNA,COM,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,TRICARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,UNITED HEALTHCARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,UNITED HEALTHCARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,VA,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,VA TRICARE,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,WELLMED,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,HUMANA,MGD,170.1,,,,,,,per diem,170.1,170.1,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211249,CDM,250,RC,,,,,,Inpatient,1,EA,170.1,170.1,HUMANA CHOICE PLUS,MGD,170.1,,,,,,,case rate,170.1,170.1,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,AETNA,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,BCBS,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,CIGNA,COM,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,TRICARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,UNITED HEALTHCARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,UNITED HEALTHCARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,VA,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,VA TRICARE,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,WELLMED,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,HUMANA,MGD,11.12,,,,,,,per diem,11.12,11.12,"Per diem rate, code is bundled with other services"
OXCARBAZEPINE 300MG TAB       ,92211250,CDM,250,RC,,,,,,Inpatient,1,EA,11.12,11.12,HUMANA CHOICE PLUS,MGD,11.12,,,,,,,case rate,11.12,11.12,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,AETNA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,BCBS,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,CIGNA,COM,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,UNITED HEALTHCARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,VA TRICARE,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,WELLMED,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA,MGD,13.86,,,,,,,per diem,13.86,13.86,"Per diem rate, code is bundled with other services"
NORFLOXACIN 400MG TAB         ,92211251,CDM,250,RC,,,,,,Inpatient,1,EA,13.86,13.86,HUMANA CHOICE PLUS,MGD,13.86,,,,,,,case rate,13.86,13.86,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,AETNA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,CIGNA,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,WELLMED,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA,MGD,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211252,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA CHOICE PLUS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 0.5MG TAB         ,92211253,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 5MG ECT             ,92211254,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 100MG/5ML LIQ     ,92211255,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211256,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,AETNA,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,BCBS,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,CIGNA,COM,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,TRICARE,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,UNITED HEALTHCARE,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,UNITED HEALTHCARE,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,VA,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,VA TRICARE,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,WELLMED,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,HUMANA,MGD,531.94,,,,,,,per diem,531.94,531.94,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211257,CDM,250,RC,,,,,,Inpatient,1,EA,531.94,531.94,HUMANA CHOICE PLUS,MGD,531.94,,,,,,,case rate,531.94,531.94,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,AETNA,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,BCBS,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,CIGNA,COM,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,TRICARE,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,UNITED HEALTHCARE,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,UNITED HEALTHCARE,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,VA,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,VA TRICARE,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,WELLMED,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,HUMANA,MGD,27.53,,,,,,,per diem,27.53,27.53,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211258,CDM,250,RC,,,,,,Inpatient,1,EA,27.53,27.53,HUMANA CHOICE PLUS,MGD,27.53,,,,,,,case rate,27.53,27.53,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 50MG TAB               ,92211259,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG CAP,92211260,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211261,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,AETNA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,BCBS,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,CIGNA,COM,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,UNITED HEALTHCARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,VA,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,VA TRICARE,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,WELLMED,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,HUMANA,MGD,8.47,,,,,,,per diem,8.47,8.47,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211262,CDM,250,RC,,,,,,Inpatient,1,EA,8.47,8.47,HUMANA CHOICE PLUS,MGD,8.47,,,,,,,case rate,8.47,8.47,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,AETNA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,BCBS,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,CIGNA,COM,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,UNITED HEALTHCARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,VA TRICARE,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,WELLMED,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA,MGD,7.5,,,,,,,per diem,7.5,7.5,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211263,CDM,250,RC,,,,,,Inpatient,1,EA,7.5,7.5,HUMANA CHOICE PLUS,MGD,7.5,,,,,,,case rate,7.5,7.5,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211264,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,AETNA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,BCBS,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,CIGNA,COM,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,UNITED HEALTHCARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,VA,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,VA TRICARE,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,WELLMED,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,HUMANA,MGD,45.68,,,,,,,per diem,45.68,45.68,"Per diem rate, code is bundled with other services"
OXACILLIN NA 1GM INJ          ,92211265,CDM,250,RC,,,,,,Inpatient,1,EA,45.68,45.68,HUMANA CHOICE PLUS,MGD,45.68,,,,,,,case rate,45.68,45.68,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,AETNA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,CIGNA,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,WELLMED,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA,MGD,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
CLORAZEPATE 15MG TAB          ,92211266,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA CHOICE PLUS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,AETNA,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,CIGNA,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,TRICARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,UNITED HEALTHCARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,UNITED HEALTHCARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,VA,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,VA TRICARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,WELLMED,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,HUMANA,MGD,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211267,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,HUMANA CHOICE PLUS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 S,92211268,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,AETNA,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,BCBS,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,CIGNA,COM,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,TRICARE,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,UNITED HEALTHCARE,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,UNITED HEALTHCARE,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,VA,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,VA TRICARE,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,WELLMED,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,HUMANA,MGD,294.68,,,,,,,per diem,294.68,294.68,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211269,CDM,250,RC,,,,,,Inpatient,1,EA,294.68,294.68,HUMANA CHOICE PLUS,MGD,294.68,,,,,,,case rate,294.68,294.68,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,AETNA,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,BCBS,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,CIGNA,COM,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,TRICARE,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,UNITED HEALTHCARE,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,UNITED HEALTHCARE,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,VA,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,VA TRICARE,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,WELLMED,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,HUMANA,MGD,37.11,,,,,,,per diem,37.11,37.11,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92211270,CDM,250,RC,,,,,,Inpatient,1,EA,37.11,37.11,HUMANA CHOICE PLUS,MGD,37.11,,,,,,,case rate,37.11,37.11,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211271,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIAMINE 50MG TAB             ,92211272,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG TAB      ,92211273,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,AETNA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,CIGNA,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,WELLMED,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA,MGD,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
WARFARIN NA 3MG TAB           ,92211274,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA CHOICE PLUS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,AETNA,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,BCBS,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,CIGNA,COM,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,TRICARE,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,UNITED HEALTHCARE,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,UNITED HEALTHCARE,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,VA,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,VA TRICARE,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,WELLMED,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,HUMANA,MGD,206.01,,,,,,,per diem,206.01,206.01,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211275,CDM,250,RC,,,,,,Inpatient,1,EA,206.01,206.01,HUMANA CHOICE PLUS,MGD,206.01,,,,,,,case rate,206.01,206.01,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOXACILLIN NA 250MG CAP    ,92211276,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SULINDAC 200MG TAB            ,92211277,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211278,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,AETNA,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,BCBS,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,CIGNA,COM,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,TRICARE,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UNITED HEALTHCARE,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,UNITED HEALTHCARE,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,VA,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,VA TRICARE,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,WELLMED,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,HUMANA,MGD,29.7,,,,,,,per diem,29.7,29.7,"Per diem rate, code is bundled with other services"
ACETYLCYSTEINE 10% SOL        ,92211279,CDM,250,RC,,,,,,Inpatient,1,EA,29.7,29.7,HUMANA CHOICE PLUS,MGD,29.7,,,,,,,case rate,29.7,29.7,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROID 90MG TAB              ,92211280,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,AETNA,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,BCBS,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,CIGNA,COM,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,TRICARE,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,UNITED HEALTHCARE,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,UNITED HEALTHCARE,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,VA,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,VA TRICARE,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,WELLMED,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,HUMANA,MGD,17.23,,,,,,,per diem,17.23,17.23,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211281,CDM,250,RC,,,,,,Inpatient,1,EA,17.23,17.23,HUMANA CHOICE PLUS,MGD,17.23,,,,,,,case rate,17.23,17.23,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,AETNA,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,BCBS,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,CIGNA,COM,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,TRICARE,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,UNITED HEALTHCARE,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,UNITED HEALTHCARE,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,VA,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,VA TRICARE,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,WELLMED,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,HUMANA,MGD,12.32,,,,,,,per diem,12.32,12.32,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 150MG TAB      ,92211282,CDM,250,RC,,,,,,Inpatient,1,EA,12.32,12.32,HUMANA CHOICE PLUS,MGD,12.32,,,,,,,case rate,12.32,12.32,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 2MG TAB  ,92211283,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL-ACETAMINOPHEN   ,92211284,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,AETNA,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,CIGNA,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,TRICARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,UNITED HEALTHCARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,UNITED HEALTHCARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,VA,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,VA TRICARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,WELLMED,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,HUMANA,MGD,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
GEMFIBROZIL 600MG TAB         ,92211285,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,HUMANA CHOICE PLUS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,AETNA,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,BCBS,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,CIGNA,COM,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,TRICARE,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,UNITED HEALTHCARE,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,UNITED HEALTHCARE,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,VA,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,VA TRICARE,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,WELLMED,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,HUMANA,MGD,6.21,,,,,,,per diem,6.21,6.21,"Per diem rate, code is bundled with other services"
MULTIVITAMIN FE/F 0.25MG/ML LI,92211286,CDM,250,RC,,,,,,Inpatient,1,EA,6.21,6.21,HUMANA CHOICE PLUS,MGD,6.21,,,,,,,case rate,6.21,6.21,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG/5ML SOL,92211287,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG LI,92211288,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 10MG CAP          ,92211289,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211290,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211291,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211292,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211293,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,AETNA,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,BCBS,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,CIGNA,COM,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,TRICARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,UNITED HEALTHCARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,UNITED HEALTHCARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,VA,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,VA TRICARE,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,WELLMED,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,HUMANA,MGD,17.45,,,,,,,per diem,17.45,17.45,"Per diem rate, code is bundled with other services"
SIMVASTATIN 10MG TAB          ,92211294,CDM,250,RC,,,,,,Inpatient,1,EA,17.45,17.45,HUMANA CHOICE PLUS,MGD,17.45,,,,,,,case rate,17.45,17.45,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ SPIRONOLACT 25-25MG TAB  ,92211295,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,AETNA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,BCBS,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,CIGNA,COM,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,UNITED HEALTHCARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,VA TRICARE,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,WELLMED,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA,MGD,5.29,,,,,,,per diem,5.29,5.29,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 200MG TAB       ,92211296,CDM,250,RC,,,,,,Inpatient,1,EA,5.29,5.29,HUMANA CHOICE PLUS,MGD,5.29,,,,,,,case rate,5.29,5.29,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,AETNA,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,BCBS,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,CIGNA,COM,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,TRICARE,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,UNITED HEALTHCARE,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,UNITED HEALTHCARE,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,VA,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,VA TRICARE,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,WELLMED,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,HUMANA,MGD,146.41,,,,,,,per diem,146.41,146.41,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 1GM INJ    ,92211297,CDM,250,RC,,,,,,Inpatient,1,EA,146.41,146.41,HUMANA CHOICE PLUS,MGD,146.41,,,,,,,case rate,146.41,146.41,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,AETNA,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,BCBS,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,CIGNA,COM,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,TRICARE,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,UNITED HEALTHCARE,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,UNITED HEALTHCARE,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,VA,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,VA TRICARE,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,WELLMED,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,HUMANA,MGD,7.25,,,,,,,per diem,7.25,7.25,"Per diem rate, code is bundled with other services"
NIFEDIPINE 20MG SGL           ,92211298,CDM,250,RC,,,,,,Inpatient,1,EA,7.25,7.25,HUMANA CHOICE PLUS,MGD,7.25,,,,,,,case rate,7.25,7.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LECITHIN 19GR SGL             ,92211299,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,AETNA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,CIGNA,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,VA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,VA TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,WELLMED,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,HUMANA,MGD,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
TRIAZOLAM 0.25MG TAB          ,92211300,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,HUMANA CHOICE PLUS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,AETNA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,CIGNA,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,WELLMED,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA,MGD,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
AMIKACIN SULF 50MG/ML INJ     ,92211301,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA CHOICE PLUS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,AETNA,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,BCBS,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,CIGNA,COM,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,TRICARE,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,UNITED HEALTHCARE,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,UNITED HEALTHCARE,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,VA,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,VA TRICARE,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,WELLMED,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,HUMANA,MGD,91.73,,,,,,,per diem,91.73,91.73,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG/ML INJ           ,92211302,CDM,250,RC,,,,,,Inpatient,1,EA,91.73,91.73,HUMANA CHOICE PLUS,MGD,91.73,,,,,,,case rate,91.73,91.73,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,AETNA,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,BCBS,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,CIGNA,COM,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,TRICARE,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,UNITED HEALTHCARE,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,UNITED HEALTHCARE,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,VA,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,VA TRICARE,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,WELLMED,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,HUMANA,MGD,573.8,,,,,,,per diem,573.8,573.8,"Per diem rate, code is bundled with other services"
METRONIDAZOLE                 ,92211303,CDM,250,RC,,,,,,Inpatient,1,EA,573.8,573.8,HUMANA CHOICE PLUS,MGD,573.8,,,,,,,case rate,573.8,573.8,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 10MG CAP ,92211304,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211305,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,AETNA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,CIGNA,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,WELLMED,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA,MGD,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92211306,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA CHOICE PLUS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,AETNA,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,CIGNA,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,TRICARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,UNITED HEALTHCARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,UNITED HEALTHCARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,VA,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,VA TRICARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,WELLMED,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,HUMANA,MGD,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
PERPHENAZINE 8MG TAB          ,92211307,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,HUMANA CHOICE PLUS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211308,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,AETNA,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,BCBS,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,CIGNA,COM,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,TRICARE,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,UNITED HEALTHCARE,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,UNITED HEALTHCARE,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,VA,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,VA TRICARE,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,WELLMED,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,HUMANA,MGD,26.71,,,,,,,per diem,26.71,26.71,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211309,CDM,250,RC,,,,,,Inpatient,1,EA,26.71,26.71,HUMANA CHOICE PLUS,MGD,26.71,,,,,,,case rate,26.71,26.71,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,AETNA,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,BCBS,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,CIGNA,COM,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,TRICARE,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,UNITED HEALTHCARE,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,UNITED HEALTHCARE,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,VA,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,VA TRICARE,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,WELLMED,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,HUMANA,MGD,30.62,,,,,,,per diem,30.62,30.62,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92211310,CDM,250,RC,,,,,,Inpatient,1,EA,30.62,30.62,HUMANA CHOICE PLUS,MGD,30.62,,,,,,,case rate,30.62,30.62,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,AETNA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,BCBS,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,CIGNA,COM,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,UNITED HEALTHCARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,VA,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,VA TRICARE,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,WELLMED,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,HUMANA,MGD,109.24,,,,,,,per diem,109.24,109.24,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX 100 INJ     ,92211311,CDM,250,RC,,,,,,Inpatient,1,EA,109.24,109.24,HUMANA CHOICE PLUS,MGD,109.24,,,,,,,case rate,109.24,109.24,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN 200MG TAB         ,92211312,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 10MG TAB      ,92211313,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 1MG TAB             ,92211314,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,AETNA,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,BCBS,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,CIGNA,COM,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,TRICARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,UNITED HEALTHCARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,UNITED HEALTHCARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,VA,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,VA TRICARE,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,WELLMED,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,HUMANA,MGD,28.85,,,,,,,per diem,28.85,28.85,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.1MG/ML INJ    ,92211315,CDM,250,RC,,,,,,Inpatient,1,EA,28.85,28.85,HUMANA CHOICE PLUS,MGD,28.85,,,,,,,case rate,28.85,28.85,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,AETNA,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,CIGNA,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,TRICARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,UNITED HEALTHCARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,UNITED HEALTHCARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,VA,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,VA TRICARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,WELLMED,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,HUMANA,MGD,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
MINOCYCLINE HCL 100MG CAP     ,92211316,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,HUMANA CHOICE PLUS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,AETNA,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,BCBS,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,CIGNA,COM,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,TRICARE,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,UNITED HEALTHCARE,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,UNITED HEALTHCARE,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,VA,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,VA TRICARE,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,WELLMED,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,HUMANA,MGD,154.73,,,,,,,per diem,154.73,154.73,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 0.1%  SOL       ,92211317,CDM,250,RC,,,,,,Inpatient,1,EA,154.73,154.73,HUMANA CHOICE PLUS,MGD,154.73,,,,,,,case rate,154.73,154.73,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG TAB           ,92211318,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE CAL 240MG SGL        ,92211319,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,AETNA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,CIGNA,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,WELLMED,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA,MGD,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 200MG TAB,92211320,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA CHOICE PLUS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211321,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,AETNA,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,CIGNA,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,TRICARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UNITED HEALTHCARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UNITED HEALTHCARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA TRICARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,WELLMED,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,HUMANA,MGD,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MORPHINE 4MG/ML INJ           ,92211322,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,HUMANA CHOICE PLUS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211323,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CHLORIDE           ,92211324,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211325,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 125MG CTB         ,92211326,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,AETNA,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,BCBS,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,CIGNA,COM,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,TRICARE,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,UNITED HEALTHCARE,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,UNITED HEALTHCARE,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,VA,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,VA TRICARE,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,WELLMED,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,HUMANA,MGD,9.58,,,,,,,per diem,9.58,9.58,"Per diem rate, code is bundled with other services"
CLORAZEPATE 3.75MG TAB        ,92211327,CDM,250,RC,,,,,,Inpatient,1,EA,9.58,9.58,HUMANA CHOICE PLUS,MGD,9.58,,,,,,,case rate,9.58,9.58,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,AETNA,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,BCBS,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,CIGNA,COM,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,TRICARE,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,UNITED HEALTHCARE,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,UNITED HEALTHCARE,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,VA,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,VA TRICARE,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,WELLMED,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,HUMANA,MGD,142.03,,,,,,,per diem,142.03,142.03,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211328,CDM,250,RC,,,,,,Inpatient,1,EA,142.03,142.03,HUMANA CHOICE PLUS,MGD,142.03,,,,,,,case rate,142.03,142.03,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,AETNA,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,BCBS,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,CIGNA,COM,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,TRICARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UNITED HEALTHCARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,UNITED HEALTHCARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,VA TRICARE,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,WELLMED,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,HUMANA,MGD,20.88,,,,,,,per diem,20.88,20.88,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 10MG TAB   ,92211329,CDM,250,RC,,,,,,Inpatient,1,EA,20.88,20.88,HUMANA CHOICE PLUS,MGD,20.88,,,,,,,case rate,20.88,20.88,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 1MG TAB           ,92211330,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,AETNA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,CIGNA,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,WELLMED,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA,MGD,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
CARVEDILOL 25MG TAB           ,92211331,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA CHOICE PLUS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211332,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,AETNA,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,BCBS,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,CIGNA,COM,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,TRICARE,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,UNITED HEALTHCARE,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,UNITED HEALTHCARE,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,VA,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,VA TRICARE,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,WELLMED,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,HUMANA,MGD,8.41,,,,,,,per diem,8.41,8.41,"Per diem rate, code is bundled with other services"
HYOSCYAMINE SULF 0.125MG/ML LI,92211333,CDM,250,RC,,,,,,Inpatient,1,EA,8.41,8.41,HUMANA CHOICE PLUS,MGD,8.41,,,,,,,case rate,8.41,8.41,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SELENIUM 50MCG TAB            ,92211334,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 10MG CAP        ,92211335,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211336,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211337,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211338,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG CAP      ,92211339,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,AETNA,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,BCBS,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,CIGNA,COM,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,TRICARE,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,UNITED HEALTHCARE,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,UNITED HEALTHCARE,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,VA,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,VA TRICARE,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,WELLMED,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,HUMANA,MGD,20.63,,,,,,,per diem,20.63,20.63,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.75% INJ     ,92211340,CDM,250,RC,,,,,,Inpatient,1,EA,20.63,20.63,HUMANA CHOICE PLUS,MGD,20.63,,,,,,,case rate,20.63,20.63,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,AETNA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,CIGNA,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,WELLMED,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA,MGD,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211341,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA CHOICE PLUS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,AETNA,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,BCBS,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,CIGNA,COM,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,TRICARE,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,UNITED HEALTHCARE,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,UNITED HEALTHCARE,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,VA,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,VA TRICARE,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,WELLMED,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,HUMANA,MGD,35.28,,,,,,,per diem,35.28,35.28,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211342,CDM,250,RC,,,,,,Inpatient,1,EA,35.28,35.28,HUMANA CHOICE PLUS,MGD,35.28,,,,,,,case rate,35.28,35.28,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211343,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 50-75MG TAB  ,92211344,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,AETNA,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,BCBS,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,CIGNA,COM,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,TRICARE,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,UNITED HEALTHCARE,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,UNITED HEALTHCARE,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,VA,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,VA TRICARE,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,WELLMED,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,HUMANA,MGD,221.32,,,,,,,per diem,221.32,221.32,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% CRE    ,92211345,CDM,250,RC,,,,,,Inpatient,1,EA,221.32,221.32,HUMANA CHOICE PLUS,MGD,221.32,,,,,,,case rate,221.32,221.32,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211346,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.2MG TAB       ,92211347,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,AETNA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,BCBS,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,CIGNA,COM,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,UNITED HEALTHCARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,VA,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,VA TRICARE,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,WELLMED,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,HUMANA,MGD,38.4,,,,,,,per diem,38.4,38.4,"Per diem rate, code is bundled with other services"
KETOTIFEN FUMARATE 0.025% SOL ,92211348,CDM,250,RC,,,,,,Inpatient,1,EA,38.4,38.4,HUMANA CHOICE PLUS,MGD,38.4,,,,,,,case rate,38.4,38.4,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,AETNA,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,BCBS,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,CIGNA,COM,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,TRICARE,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,UNITED HEALTHCARE,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,UNITED HEALTHCARE,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,VA,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,VA TRICARE,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,WELLMED,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,HUMANA,MGD,478.77,,,,,,,per diem,478.77,478.77,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA 10% SOL      ,92211349,CDM,250,RC,,,,,,Inpatient,1,EA,478.77,478.77,HUMANA CHOICE PLUS,MGD,478.77,,,,,,,case rate,478.77,478.77,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,AETNA,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,CIGNA,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,TRICARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,UNITED HEALTHCARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,UNITED HEALTHCARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,VA,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,VA TRICARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,WELLMED,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,HUMANA,MGD,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 20MG ECC           ,92211350,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,HUMANA CHOICE PLUS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,AETNA,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,CIGNA,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,TRICARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,UNITED HEALTHCARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,UNITED HEALTHCARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,VA,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,VA TRICARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,WELLMED,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,HUMANA,MGD,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 25MG TAB     ,92211351,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,HUMANA CHOICE PLUS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,AETNA,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,CIGNA,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,TRICARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,UNITED HEALTHCARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,UNITED HEALTHCARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,VA,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,VA TRICARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,WELLMED,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,HUMANA,MGD,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211352,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,HUMANA CHOICE PLUS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92211353,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 10MG TAB       ,92211354,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,AETNA,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,BCBS,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,CIGNA,COM,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,TRICARE,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,UNITED HEALTHCARE,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,UNITED HEALTHCARE,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,VA,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,VA TRICARE,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,WELLMED,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,HUMANA,MGD,23.06,,,,,,,per diem,23.06,23.06,"Per diem rate, code is bundled with other services"
"HEPARIN 1,000U/ML INJ         ",92211355,CDM,250,RC,,,,,,Inpatient,1,EA,23.06,23.06,HUMANA CHOICE PLUS,MGD,23.06,,,,,,,case rate,23.06,23.06,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,AETNA,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,BCBS,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,CIGNA,COM,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,TRICARE,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,UNITED HEALTHCARE,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,UNITED HEALTHCARE,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,VA,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,VA TRICARE,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,WELLMED,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,HUMANA,MGD,10.21,,,,,,,per diem,10.21,10.21,"Per diem rate, code is bundled with other services"
PAROXETINE HCL 20MG TAB       ,92211356,CDM,250,RC,,,,,,Inpatient,1,EA,10.21,10.21,HUMANA CHOICE PLUS,MGD,10.21,,,,,,,case rate,10.21,10.21,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUCONATE 975MG TAB   ,92211357,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,AETNA,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,BCBS,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,CIGNA,COM,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,TRICARE,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,UNITED HEALTHCARE,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,UNITED HEALTHCARE,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,VA,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,VA TRICARE,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,WELLMED,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,HUMANA,MGD,984.66,,,,,,,per diem,984.66,984.66,"Per diem rate, code is bundled with other services"
OLOPATADINE HCL 0.1% SOL      ,92211358,CDM,250,RC,,,,,,Inpatient,1,EA,984.66,984.66,HUMANA CHOICE PLUS,MGD,984.66,,,,,,,case rate,984.66,984.66,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211359,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE 10MG/ML INJ          ,92211360,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENAZEPRIL HCL 10MG TAB       ,92211361,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,AETNA,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,BCBS,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,CIGNA,COM,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,TRICARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,UNITED HEALTHCARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,UNITED HEALTHCARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,VA,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,VA TRICARE,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,WELLMED,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,HUMANA,MGD,20.16,,,,,,,per diem,20.16,20.16,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% OIN         ,92211362,CDM,250,RC,,,,,,Inpatient,1,EA,20.16,20.16,HUMANA CHOICE PLUS,MGD,20.16,,,,,,,case rate,20.16,20.16,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,AETNA,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,BCBS,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,CIGNA,COM,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,TRICARE,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,UNITED HEALTHCARE,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,UNITED HEALTHCARE,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,VA,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,VA TRICARE,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,WELLMED,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,HUMANA,MGD,50.24,,,,,,,per diem,50.24,50.24,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.05MG/ML INJ   ,92211363,CDM,250,RC,,,,,,Inpatient,1,EA,50.24,50.24,HUMANA CHOICE PLUS,MGD,50.24,,,,,,,case rate,50.24,50.24,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211364,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CIMETIDINE 300MG TAB          ,92211365,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211366,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,AETNA,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,BCBS,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,CIGNA,COM,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,TRICARE,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,UNITED HEALTHCARE,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,UNITED HEALTHCARE,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,VA,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,VA TRICARE,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,WELLMED,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,HUMANA,MGD,8.6,,,,,,,per diem,8.6,8.6,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 50MG CAP    ,92211367,CDM,250,RC,,,,,,Inpatient,1,EA,8.6,8.6,HUMANA CHOICE PLUS,MGD,8.6,,,,,,,case rate,8.6,8.6,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 2MG CAP         ,92211368,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211369,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE APAP 5-500MG CAP    ,92211370,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211371,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,AETNA,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,BCBS,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,CIGNA,COM,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,TRICARE,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,UNITED HEALTHCARE,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,UNITED HEALTHCARE,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,VA,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,VA TRICARE,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,WELLMED,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,HUMANA,MGD,521.64,,,,,,,per diem,521.64,521.64,"Per diem rate, code is bundled with other services"
INSULIN HUM REGULAR 100U/ML IN,92211372,CDM,250,RC,,,,,,Inpatient,1,EA,521.64,521.64,HUMANA CHOICE PLUS,MGD,521.64,,,,,,,case rate,521.64,521.64,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SENNOSIDES A B 8.6MG TAB      ,92211373,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 1MG TAB  ,92211374,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG TAB      ,92211375,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 4MG TAB    ,92211376,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,AETNA,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,BCBS,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,CIGNA,COM,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,TRICARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,UNITED HEALTHCARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,UNITED HEALTHCARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,VA,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,VA TRICARE,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,WELLMED,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,HUMANA,MGD,64.95,,,,,,,per diem,64.95,64.95,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL 20MG/ML INJ   ,92211377,CDM,250,RC,,,,,,Inpatient,1,EA,64.95,64.95,HUMANA CHOICE PLUS,MGD,64.95,,,,,,,case rate,64.95,64.95,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 100-10MG/5ML SY,92211378,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIHEXYPHENIDYL HCL 2MG/5ML EL,92211379,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,AETNA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,CIGNA,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,VA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,VA TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,WELLMED,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,HUMANA,MGD,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
SULFAMETHOXAZOLE/TMP  SUS     ,92211380,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,HUMANA CHOICE PLUS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211381,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MULTIMINERAL LIQ ,92211382,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,AETNA,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,BCBS,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,CIGNA,COM,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,TRICARE,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,UNITED HEALTHCARE,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,UNITED HEALTHCARE,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,VA,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,VA TRICARE,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,WELLMED,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,HUMANA,MGD,76.58,,,,,,,per diem,76.58,76.58,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ES 200MG/5ML SUS ,92211383,CDM,250,RC,,,,,,Inpatient,1,EA,76.58,76.58,HUMANA CHOICE PLUS,MGD,76.58,,,,,,,case rate,76.58,76.58,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,AETNA,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,CIGNA,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,TRICARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,UNITED HEALTHCARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,UNITED HEALTHCARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,VA,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,VA TRICARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,WELLMED,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,HUMANA,MGD,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
SODIUM ACETATE 2MEQ/ML INJ    ,92211384,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,HUMANA CHOICE PLUS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,AETNA,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,BCBS,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,CIGNA,COM,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,TRICARE,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,UNITED HEALTHCARE,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,UNITED HEALTHCARE,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,VA,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,VA TRICARE,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,WELLMED,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,HUMANA,MGD,59.66,,,,,,,per diem,59.66,59.66,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211385,CDM,250,RC,,,,,,Inpatient,1,EA,59.66,59.66,HUMANA CHOICE PLUS,MGD,59.66,,,,,,,case rate,59.66,59.66,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211386,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,AETNA,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,BCBS,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,CIGNA,COM,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,TRICARE,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,UNITED HEALTHCARE,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,UNITED HEALTHCARE,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,VA,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,VA TRICARE,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,WELLMED,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,HUMANA,MGD,164.4,,,,,,,per diem,164.4,164.4,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.1% CRE        ,92211387,CDM,250,RC,,,,,,Inpatient,1,EA,164.4,164.4,HUMANA CHOICE PLUS,MGD,164.4,,,,,,,case rate,164.4,164.4,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SIMETHICONE 80MG CTB          ,92211388,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,AETNA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,BCBS,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,CIGNA,COM,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,UNITED HEALTHCARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,VA TRICARE,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,WELLMED,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA,MGD,5.86,,,,,,,per diem,5.86,5.86,"Per diem rate, code is bundled with other services"
CAPTOPRIL 25MG TAB            ,92211389,CDM,250,RC,,,,,,Inpatient,1,EA,5.86,5.86,HUMANA CHOICE PLUS,MGD,5.86,,,,,,,case rate,5.86,5.86,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,AETNA,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,BCBS,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,CIGNA,COM,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,TRICARE,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,UNITED HEALTHCARE,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,UNITED HEALTHCARE,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,VA,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,VA TRICARE,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,WELLMED,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,HUMANA,MGD,130.47,,,,,,,per diem,130.47,130.47,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 500MG INJ  ,92211390,CDM,250,RC,,,,,,Inpatient,1,EA,130.47,130.47,HUMANA CHOICE PLUS,MGD,130.47,,,,,,,case rate,130.47,130.47,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,AETNA,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,BCBS,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,CIGNA,COM,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,TRICARE,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,UNITED HEALTHCARE,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,UNITED HEALTHCARE,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,VA,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,VA TRICARE,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,WELLMED,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,HUMANA,MGD,19.53,,,,,,,per diem,19.53,19.53,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% INJ          ,92211391,CDM,250,RC,,,,,,Inpatient,1,EA,19.53,19.53,HUMANA CHOICE PLUS,MGD,19.53,,,,,,,case rate,19.53,19.53,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2.5MG TAB         ,92211392,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,AETNA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,CIGNA,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,WELLMED,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA,MGD,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211393,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA CHOICE PLUS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 200MG TAB           ,92211394,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG TAB  ,92211395,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,AETNA,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,BCBS,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,CIGNA,COM,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,TRICARE,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,UNITED HEALTHCARE,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,UNITED HEALTHCARE,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,VA,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,VA TRICARE,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,WELLMED,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,HUMANA,MGD,2139.29,,,,,,,per diem,2139.29,2139.29,"Per diem rate, code is bundled with other services"
IMMUNE GLOBULIN 5GM INJ       ,92211396,CDM,250,RC,,,,,,Inpatient,1,EA,2139.29,2139.29,HUMANA CHOICE PLUS,MGD,2139.29,,,,,,,case rate,2139.29,2139.29,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,AETNA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,CIGNA,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,VA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,VA TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,WELLMED,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,HUMANA,MGD,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
SODIUM BICARB 4.2% INJ        ,92211397,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,HUMANA CHOICE PLUS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,AETNA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,BCBS,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,CIGNA,COM,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,UNITED HEALTHCARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,VA,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,VA TRICARE,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,WELLMED,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,HUMANA,MGD,6.02,,,,,,,per diem,6.02,6.02,"Per diem rate, code is bundled with other services"
ACYCLOVIR 400MG TAB           ,92211398,CDM,250,RC,,,,,,Inpatient,1,EA,6.02,6.02,HUMANA CHOICE PLUS,MGD,6.02,,,,,,,case rate,6.02,6.02,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,AETNA,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,BCBS,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,CIGNA,COM,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,TRICARE,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,UNITED HEALTHCARE,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,UNITED HEALTHCARE,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,VA,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,VA TRICARE,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,WELLMED,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,HUMANA,MGD,1352.26,,,,,,,per diem,1352.26,1352.26,"Per diem rate, code is bundled with other services"
CYANIDE ANTIDOTE INJ          ,92211399,CDM,250,RC,,,,,,Inpatient,1,EA,1352.26,1352.26,HUMANA CHOICE PLUS,MGD,1352.26,,,,,,,case rate,1352.26,1352.26,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211400,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,AETNA,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,BCBS,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,CIGNA,COM,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,TRICARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,UNITED HEALTHCARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,UNITED HEALTHCARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,VA,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,VA TRICARE,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,WELLMED,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,HUMANA,MGD,31.75,,,,,,,per diem,31.75,31.75,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211401,CDM,250,RC,,,,,,Inpatient,1,EA,31.75,31.75,HUMANA CHOICE PLUS,MGD,31.75,,,,,,,case rate,31.75,31.75,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THIOTHIXENE 5MG CAP           ,92211402,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,AETNA,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,BCBS,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,CIGNA,COM,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,TRICARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,UNITED HEALTHCARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,UNITED HEALTHCARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,VA,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,VA TRICARE,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,WELLMED,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,HUMANA,MGD,17.8,,,,,,,per diem,17.8,17.8,"Per diem rate, code is bundled with other services"
BIOTENE DRY MOUTH MOUTHWASH   ,92211403,CDM,250,RC,,,,,,Inpatient,1,EA,17.8,17.8,HUMANA CHOICE PLUS,MGD,17.8,,,,,,,case rate,17.8,17.8,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211404,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NABUMETONE 750MG TAB          ,92211405,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,AETNA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,BCBS,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,CIGNA,COM,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,UNITED HEALTHCARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,VA TRICARE,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,WELLMED,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA,MGD,5.48,,,,,,,per diem,5.48,5.48,"Per diem rate, code is bundled with other services"
PERPHENAZINE 4MG TAB          ,92211406,CDM,250,RC,,,,,,Inpatient,1,EA,5.48,5.48,HUMANA CHOICE PLUS,MGD,5.48,,,,,,,case rate,5.48,5.48,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92211407,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 12.5MG/5 E,92211408,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,AETNA,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,BCBS,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,CIGNA,COM,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,TRICARE,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,UNITED HEALTHCARE,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,UNITED HEALTHCARE,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,VA,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,VA TRICARE,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,WELLMED,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,HUMANA,MGD,21.64,,,,,,,per diem,21.64,21.64,"Per diem rate, code is bundled with other services"
TUBERCULIN 5TU/0.1ML SOL      ,92211409,CDM,250,RC,,,,,,Inpatient,1,EA,21.64,21.64,HUMANA CHOICE PLUS,MGD,21.64,,,,,,,case rate,21.64,21.64,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 5MG TAB         ,92211410,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,AETNA,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,BCBS,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,CIGNA,COM,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,TRICARE,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,UNITED HEALTHCARE,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,UNITED HEALTHCARE,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,VA,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,VA TRICARE,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,WELLMED,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,HUMANA,MGD,1545.83,,,,,,,per diem,1545.83,1545.83,"Per diem rate, code is bundled with other services"
BETAXOLOL HCL 0.25% EYE SUS   ,92211411,CDM,250,RC,,,,,,Inpatient,1,EA,1545.83,1545.83,HUMANA CHOICE PLUS,MGD,1545.83,,,,,,,case rate,1545.83,1545.83,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 1MG TAB      ,92211412,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,AETNA,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,BCBS,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,CIGNA,COM,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,TRICARE,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,UNITED HEALTHCARE,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,UNITED HEALTHCARE,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,VA,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,VA TRICARE,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,WELLMED,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,HUMANA,MGD,129.06,,,,,,,per diem,129.06,129.06,"Per diem rate, code is bundled with other services"
BACITRACIN/HC/NEO/POLY B EYE O,92211413,CDM,250,RC,,,,,,Inpatient,1,EA,129.06,129.06,HUMANA CHOICE PLUS,MGD,129.06,,,,,,,case rate,129.06,129.06,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,AETNA,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,BCBS,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,CIGNA,COM,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,TRICARE,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,UNITED HEALTHCARE,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,UNITED HEALTHCARE,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,VA,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,VA TRICARE,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,WELLMED,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,HUMANA,MGD,18.46,,,,,,,per diem,18.46,18.46,"Per diem rate, code is bundled with other services"
DIACETAZONE CAP               ,92211414,CDM,250,RC,,,,,,Inpatient,1,EA,18.46,18.46,HUMANA CHOICE PLUS,MGD,18.46,,,,,,,case rate,18.46,18.46,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,AETNA,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,BCBS,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,CIGNA,COM,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,TRICARE,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,UNITED HEALTHCARE,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,UNITED HEALTHCARE,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,VA,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,VA TRICARE,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,WELLMED,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,HUMANA,MGD,172.37,,,,,,,per diem,172.37,172.37,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROSETIL 100MG SUS,92211415,CDM,250,RC,,,,,,Inpatient,1,EA,172.37,172.37,HUMANA CHOICE PLUS,MGD,172.37,,,,,,,case rate,172.37,172.37,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,AETNA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,CIGNA,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,WELLMED,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA,MGD,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211416,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA CHOICE PLUS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,AETNA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,CIGNA,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,WELLMED,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA,MGD,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
SODIUM CL 0.65% NASAL SOL     ,92211417,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA CHOICE PLUS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,AETNA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,BCBS,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,CIGNA,COM,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,UNITED HEALTHCARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,VA TRICARE,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,WELLMED,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA,MGD,26.65,,,,,,,per diem,26.65,26.65,"Per diem rate, code is bundled with other services"
MORPHINE  25MG/ML INJ         ,92211418,CDM,250,RC,,,,,,Inpatient,1,EA,26.65,26.65,HUMANA CHOICE PLUS,MGD,26.65,,,,,,,case rate,26.65,26.65,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,AETNA,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,BCBS,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,CIGNA,COM,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,TRICARE,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,UNITED HEALTHCARE,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,UNITED HEALTHCARE,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,VA,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,VA TRICARE,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,WELLMED,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,HUMANA,MGD,336.67,,,,,,,per diem,336.67,336.67,"Per diem rate, code is bundled with other services"
HYDROQUINONE 4% CRE           ,92211419,CDM,250,RC,,,,,,Inpatient,1,EA,336.67,336.67,HUMANA CHOICE PLUS,MGD,336.67,,,,,,,case rate,336.67,336.67,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,AETNA,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,BCBS,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,CIGNA,COM,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,TRICARE,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,UNITED HEALTHCARE,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,UNITED HEALTHCARE,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,VA,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,VA TRICARE,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,WELLMED,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,HUMANA,MGD,10.96,,,,,,,per diem,10.96,10.96,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211420,CDM,250,RC,,,,,,Inpatient,1,EA,10.96,10.96,HUMANA CHOICE PLUS,MGD,10.96,,,,,,,case rate,10.96,10.96,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,AETNA,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,BCBS,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,CIGNA,COM,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,TRICARE,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,UNITED HEALTHCARE,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,UNITED HEALTHCARE,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,VA,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,VA TRICARE,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,WELLMED,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,HUMANA,MGD,203.74,,,,,,,per diem,203.74,203.74,"Per diem rate, code is bundled with other services"
DEXAMETHASONE 0.1% SOL        ,92211421,CDM,250,RC,,,,,,Inpatient,1,EA,203.74,203.74,HUMANA CHOICE PLUS,MGD,203.74,,,,,,,case rate,203.74,203.74,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 250MG TAB       ,92211422,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,AETNA,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,BCBS,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,CIGNA,COM,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,TRICARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,UNITED HEALTHCARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,UNITED HEALTHCARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,VA,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,VA TRICARE,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,WELLMED,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,HUMANA,MGD,134.76,,,,,,,per diem,134.76,134.76,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 0.1% CRE   ,92211423,CDM,250,RC,,,,,,Inpatient,1,EA,134.76,134.76,HUMANA CHOICE PLUS,MGD,134.76,,,,,,,case rate,134.76,134.76,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,AETNA,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,BCBS,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,CIGNA,COM,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,TRICARE,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,UNITED HEALTHCARE,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,UNITED HEALTHCARE,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,VA,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,VA TRICARE,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,WELLMED,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,HUMANA,MGD,87.51,,,,,,,per diem,87.51,87.51,"Per diem rate, code is bundled with other services"
KETOCONAZOLE                  ,92211424,CDM,250,RC,,,,,,Inpatient,1,EA,87.51,87.51,HUMANA CHOICE PLUS,MGD,87.51,,,,,,,case rate,87.51,87.51,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,AETNA,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,BCBS,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,CIGNA,COM,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,TRICARE,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,UNITED HEALTHCARE,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,UNITED HEALTHCARE,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,VA,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,VA TRICARE,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,WELLMED,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,HUMANA,MGD,62.91,,,,,,,per diem,62.91,62.91,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% LOT      ,92211425,CDM,250,RC,,,,,,Inpatient,1,EA,62.91,62.91,HUMANA CHOICE PLUS,MGD,62.91,,,,,,,case rate,62.91,62.91,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,AETNA,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,BCBS,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,CIGNA,COM,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,TRICARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,UNITED HEALTHCARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,UNITED HEALTHCARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,VA,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,VA TRICARE,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,WELLMED,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,HUMANA,MGD,8.35,,,,,,,per diem,8.35,8.35,"Per diem rate, code is bundled with other services"
NORETHINDRONE ACET 5MG TAB    ,92211426,CDM,250,RC,,,,,,Inpatient,1,EA,8.35,8.35,HUMANA CHOICE PLUS,MGD,8.35,,,,,,,case rate,8.35,8.35,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,AETNA,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,BCBS,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,CIGNA,COM,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,TRICARE,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,UNITED HEALTHCARE,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,UNITED HEALTHCARE,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,VA,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,VA TRICARE,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,WELLMED,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,HUMANA,MGD,47.47,,,,,,,per diem,47.47,47.47,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92211427,CDM,250,RC,,,,,,Inpatient,1,EA,47.47,47.47,HUMANA CHOICE PLUS,MGD,47.47,,,,,,,case rate,47.47,47.47,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEDROXYPROGESTERONE 10MG TAB  ,92211428,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,AETNA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,CIGNA,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,WELLMED,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA,MGD,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 125-31.25 PD,92211429,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA CHOICE PLUS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,AETNA,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,CIGNA,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,TRICARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,UNITED HEALTHCARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,UNITED HEALTHCARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,VA,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,VA TRICARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,WELLMED,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,HUMANA,MGD,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211430,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,HUMANA CHOICE PLUS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,AETNA,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,BCBS,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,CIGNA,COM,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,TRICARE,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,UNITED HEALTHCARE,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,UNITED HEALTHCARE,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,VA,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,VA TRICARE,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,WELLMED,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,HUMANA,MGD,50.05,,,,,,,per diem,50.05,50.05,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% GEL       ,92211431,CDM,250,RC,,,,,,Inpatient,1,EA,50.05,50.05,HUMANA CHOICE PLUS,MGD,50.05,,,,,,,case rate,50.05,50.05,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,AETNA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,BCBS,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,CIGNA,COM,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,UNITED HEALTHCARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,VA TRICARE,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,WELLMED,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA,MGD,26.25,,,,,,,per diem,26.25,26.25,"Per diem rate, code is bundled with other services"
MEROPENEM 1GM INJ             ,92211432,CDM,250,RC,,,,,,Inpatient,1,EA,26.25,26.25,HUMANA CHOICE PLUS,MGD,26.25,,,,,,,case rate,26.25,26.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,AETNA,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,CIGNA,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,TRICARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,UNITED HEALTHCARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,UNITED HEALTHCARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,VA,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,VA TRICARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,WELLMED,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,HUMANA,MGD,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 5MG TAB   ,92211433,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,HUMANA CHOICE PLUS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211434,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92211435,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG CAP          ,92211436,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211437,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,AETNA,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,CIGNA,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,TRICARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,UNITED HEALTHCARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,UNITED HEALTHCARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,VA,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,VA TRICARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,WELLMED,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,HUMANA,MGD,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 5MG TAB     ,92211438,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,HUMANA CHOICE PLUS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG/5ML SYR   ,92211439,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,AETNA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,BCBS,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,CIGNA,COM,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,UNITED HEALTHCARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,VA,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,VA TRICARE,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,WELLMED,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,HUMANA,MGD,67.47,,,,,,,per diem,67.47,67.47,"Per diem rate, code is bundled with other services"
OLANZAPINE 10MG TAB           ,92211440,CDM,250,RC,,,,,,Inpatient,1,EA,67.47,67.47,HUMANA CHOICE PLUS,MGD,67.47,,,,,,,case rate,67.47,67.47,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPYLTHIOURACIL 50MG TAB     ,92211441,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,AETNA,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,BCBS,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,CIGNA,COM,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,TRICARE,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,UNITED HEALTHCARE,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,UNITED HEALTHCARE,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,VA,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,VA TRICARE,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,WELLMED,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,HUMANA,MGD,52.61,,,,,,,per diem,52.61,52.61,"Per diem rate, code is bundled with other services"
ACTIV CHARCOAL 25GM SUS       ,92211442,CDM,250,RC,,,,,,Inpatient,1,EA,52.61,52.61,HUMANA CHOICE PLUS,MGD,52.61,,,,,,,case rate,52.61,52.61,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,AETNA,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,BCBS,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,CIGNA,COM,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,TRICARE,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,UNITED HEALTHCARE,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,UNITED HEALTHCARE,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,VA,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,VA TRICARE,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,WELLMED,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,HUMANA,MGD,86.69,,,,,,,per diem,86.69,86.69,"Per diem rate, code is bundled with other services"
BELLADONNA OPIUM 16.2-30MG SUP,92211443,CDM,250,RC,,,,,,Inpatient,1,EA,86.69,86.69,HUMANA CHOICE PLUS,MGD,86.69,,,,,,,case rate,86.69,86.69,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,AETNA,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,BCBS,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,CIGNA,COM,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,TRICARE,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,UNITED HEALTHCARE,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,UNITED HEALTHCARE,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,VA,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,VA TRICARE,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,WELLMED,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,HUMANA,MGD,88.48,,,,,,,per diem,88.48,88.48,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM INJ          ,92211444,CDM,250,RC,,,,,,Inpatient,1,EA,88.48,88.48,HUMANA CHOICE PLUS,MGD,88.48,,,,,,,case rate,88.48,88.48,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,AETNA,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,BCBS,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,CIGNA,COM,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,TRICARE,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UNITED HEALTHCARE,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,UNITED HEALTHCARE,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,VA,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,VA TRICARE,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,WELLMED,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,HUMANA,MGD,54.72,,,,,,,per diem,54.72,54.72,"Per diem rate, code is bundled with other services"
BICALUTAMIDE 50MG TAB         ,92211445,CDM,250,RC,,,,,,Inpatient,1,EA,54.72,54.72,HUMANA CHOICE PLUS,MGD,54.72,,,,,,,case rate,54.72,54.72,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG CAP  ,92211446,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211447,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,AETNA,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,BCBS,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,CIGNA,COM,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,TRICARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,UNITED HEALTHCARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,UNITED HEALTHCARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,VA,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,VA TRICARE,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,WELLMED,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,HUMANA,MGD,21.26,,,,,,,per diem,21.26,21.26,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92211448,CDM,250,RC,,,,,,Inpatient,1,EA,21.26,21.26,HUMANA CHOICE PLUS,MGD,21.26,,,,,,,case rate,21.26,21.26,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,AETNA,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,BCBS,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,CIGNA,COM,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,TRICARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,UNITED HEALTHCARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,UNITED HEALTHCARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,VA,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,VA TRICARE,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,WELLMED,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,HUMANA,MGD,14.71,,,,,,,per diem,14.71,14.71,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211449,CDM,250,RC,,,,,,Inpatient,1,EA,14.71,14.71,HUMANA CHOICE PLUS,MGD,14.71,,,,,,,case rate,14.71,14.71,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 10MEQ CER        ,92211450,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLIPIZIDE 5MG TAB             ,92211451,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,AETNA,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,BCBS,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,CIGNA,COM,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,TRICARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,UNITED HEALTHCARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,UNITED HEALTHCARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,VA,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,VA TRICARE,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,WELLMED,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,HUMANA,MGD,10.55,,,,,,,per diem,10.55,10.55,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE LIGHT 4/5.7GM P,92211452,CDM,250,RC,,,,,,Inpatient,1,EA,10.55,10.55,HUMANA CHOICE PLUS,MGD,10.55,,,,,,,case rate,10.55,10.55,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211453,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,AETNA,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,BCBS,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,CIGNA,COM,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,TRICARE,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,UNITED HEALTHCARE,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,UNITED HEALTHCARE,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,VA,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,VA TRICARE,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,WELLMED,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,HUMANA,MGD,7.81,,,,,,,per diem,7.81,7.81,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211454,CDM,250,RC,,,,,,Inpatient,1,EA,7.81,7.81,HUMANA CHOICE PLUS,MGD,7.81,,,,,,,case rate,7.81,7.81,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92211455,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,AETNA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,CIGNA,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,WELLMED,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA,MGD,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211456,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA CHOICE PLUS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,AETNA,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,BCBS,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,CIGNA,COM,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,TRICARE,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,UNITED HEALTHCARE,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,UNITED HEALTHCARE,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,VA,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,VA TRICARE,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,WELLMED,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,HUMANA,MGD,12.06,,,,,,,per diem,12.06,12.06,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 500MG TAB       ,92211457,CDM,250,RC,,,,,,Inpatient,1,EA,12.06,12.06,HUMANA CHOICE PLUS,MGD,12.06,,,,,,,case rate,12.06,12.06,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,AETNA,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,BCBS,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,CIGNA,COM,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,TRICARE,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,UNITED HEALTHCARE,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,UNITED HEALTHCARE,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,VA,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,VA TRICARE,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,WELLMED,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,HUMANA,MGD,957.54,,,,,,,per diem,957.54,957.54,"Per diem rate, code is bundled with other services"
PREDNISOLONE ACETATE 0.12% SUS,92211458,CDM,250,RC,,,,,,Inpatient,1,EA,957.54,957.54,HUMANA CHOICE PLUS,MGD,957.54,,,,,,,case rate,957.54,957.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211459,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS CAP     ,92211460,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN MINERALS TAB     ,92211461,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 2MG TAB   ,92211462,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,AETNA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,CIGNA,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,WELLMED,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA,MGD,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211463,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA CHOICE PLUS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,AETNA,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,BCBS,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,CIGNA,COM,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,TRICARE,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,UNITED HEALTHCARE,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,UNITED HEALTHCARE,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,VA,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,VA TRICARE,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,WELLMED,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,HUMANA,MGD,162.48,,,,,,,per diem,162.48,162.48,"Per diem rate, code is bundled with other services"
OFLOXACIN 0.3% SOL            ,92211464,CDM,250,RC,,,,,,Inpatient,1,EA,162.48,162.48,HUMANA CHOICE PLUS,MGD,162.48,,,,,,,case rate,162.48,162.48,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211465,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,AETNA,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,BCBS,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,CIGNA,COM,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,TRICARE,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,UNITED HEALTHCARE,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,UNITED HEALTHCARE,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,VA,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,VA TRICARE,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,WELLMED,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,HUMANA,MGD,57.46,,,,,,,per diem,57.46,57.46,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211466,CDM,250,RC,,,,,,Inpatient,1,EA,57.46,57.46,HUMANA CHOICE PLUS,MGD,57.46,,,,,,,case rate,57.46,57.46,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,AETNA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,CIGNA,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,WELLMED,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA,MGD,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 240MG C24       ,92211467,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA CHOICE PLUS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 1MG CAP         ,92211468,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,AETNA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,CIGNA,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,WELLMED,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA,MGD,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211469,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA CHOICE PLUS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211470,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.5MG TAB           ,92211471,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,AETNA,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,BCBS,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,CIGNA,COM,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,TRICARE,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,UNITED HEALTHCARE,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,UNITED HEALTHCARE,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,VA,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,VA TRICARE,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,WELLMED,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,HUMANA,MGD,114.35,,,,,,,per diem,114.35,114.35,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% LOT      ,92211472,CDM,250,RC,,,,,,Inpatient,1,EA,114.35,114.35,HUMANA CHOICE PLUS,MGD,114.35,,,,,,,case rate,114.35,114.35,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,AETNA,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,BCBS,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,CIGNA,COM,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,TRICARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,UNITED HEALTHCARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,UNITED HEALTHCARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,VA,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,VA TRICARE,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,WELLMED,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,HUMANA,MGD,64.8,,,,,,,per diem,64.8,64.8,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 2GM INJ           ,92211473,CDM,250,RC,,,,,,Inpatient,1,EA,64.8,64.8,HUMANA CHOICE PLUS,MGD,64.8,,,,,,,case rate,64.8,64.8,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 12.5MG CAP               ,92211474,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92211475,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHONDROITIN GLUCOSAMINE CAP   ,92211476,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,AETNA,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,BCBS,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,CIGNA,COM,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,TRICARE,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,UNITED HEALTHCARE,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,UNITED HEALTHCARE,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,VA,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,VA TRICARE,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,WELLMED,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,HUMANA,MGD,212.63,,,,,,,per diem,212.63,212.63,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211477,CDM,250,RC,,,,,,Inpatient,1,EA,212.63,212.63,HUMANA CHOICE PLUS,MGD,212.63,,,,,,,case rate,212.63,212.63,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 160MG TER        ,92211478,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,AETNA,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,CIGNA,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,TRICARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,UNITED HEALTHCARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,UNITED HEALTHCARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,VA,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,VA TRICARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,WELLMED,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,HUMANA,MGD,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
PSYLLIUM 3.4GM PDR            ,92211479,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,HUMANA CHOICE PLUS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ TER         ,92211480,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 100MG TAB      ,92211481,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,AETNA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,BCBS,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,CIGNA,COM,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,UNITED HEALTHCARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,VA,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,VA TRICARE,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,WELLMED,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,HUMANA,MGD,9.64,,,,,,,per diem,9.64,9.64,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92211482,CDM,250,RC,,,,,,Inpatient,1,EA,9.64,9.64,HUMANA CHOICE PLUS,MGD,9.64,,,,,,,case rate,9.64,9.64,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/5ML SOL        ,92211483,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211484,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92211485,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SORBITOL 70% SOL              ,92211486,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,AETNA,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,BCBS,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,CIGNA,COM,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,TRICARE,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,UNITED HEALTHCARE,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,UNITED HEALTHCARE,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,VA,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,VA TRICARE,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,WELLMED,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,HUMANA,MGD,32.19,,,,,,,per diem,32.19,32.19,"Per diem rate, code is bundled with other services"
SODIUM BICARB 8.4% INJ        ,92211487,CDM,250,RC,,,,,,Inpatient,1,EA,32.19,32.19,HUMANA CHOICE PLUS,MGD,32.19,,,,,,,case rate,32.19,32.19,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211488,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,AETNA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,BCBS,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,CIGNA,COM,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,UNITED HEALTHCARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,VA TRICARE,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,WELLMED,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA,MGD,10.9,,,,,,,per diem,10.9,10.9,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92211489,CDM,250,RC,,,,,,Inpatient,1,EA,10.9,10.9,HUMANA CHOICE PLUS,MGD,10.9,,,,,,,case rate,10.9,10.9,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211490,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92211491,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,AETNA,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,CIGNA,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,TRICARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UNITED HEALTHCARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UNITED HEALTHCARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA TRICARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,WELLMED,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,HUMANA,MGD,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211492,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,HUMANA CHOICE PLUS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,AETNA,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,BCBS,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,CIGNA,COM,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,TRICARE,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,UNITED HEALTHCARE,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,UNITED HEALTHCARE,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,VA,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,VA TRICARE,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,WELLMED,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,HUMANA,MGD,165.5,,,,,,,per diem,165.5,165.5,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% GEL      ,92211493,CDM,250,RC,,,,,,Inpatient,1,EA,165.5,165.5,HUMANA CHOICE PLUS,MGD,165.5,,,,,,,case rate,165.5,165.5,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,AETNA,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,CIGNA,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,TRICARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,UNITED HEALTHCARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,UNITED HEALTHCARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,VA,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,VA TRICARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,WELLMED,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,HUMANA,MGD,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% SHA                ,92211494,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,HUMANA CHOICE PLUS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.5MG TAB          ,92211495,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,AETNA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,CIGNA,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,WELLMED,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA,MGD,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
METOPROLOL SUCC 100MG TAB     ,92211496,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA CHOICE PLUS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211497,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 650MG SUP       ,92211498,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERAZOSIN HCL 5MG CAP         ,92211499,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,AETNA,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,BCBS,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,CIGNA,COM,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,TRICARE,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,UNITED HEALTHCARE,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,UNITED HEALTHCARE,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,VA,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,VA TRICARE,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,WELLMED,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,HUMANA,MGD,120.61,,,,,,,per diem,120.61,120.61,"Per diem rate, code is bundled with other services"
TRIMETHOBENZAMIDE HCL 100MG IN,92211500,CDM,250,RC,,,,,,Inpatient,1,EA,120.61,120.61,HUMANA CHOICE PLUS,MGD,120.61,,,,,,,case rate,120.61,120.61,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,AETNA,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,BCBS,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,CIGNA,COM,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,TRICARE,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,UNITED HEALTHCARE,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,UNITED HEALTHCARE,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,VA,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,VA TRICARE,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,WELLMED,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,HUMANA,MGD,2860.2,,,,,,,per diem,2860.2,2860.2,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211501,CDM,250,RC,,,,,,Inpatient,1,EA,2860.2,2860.2,HUMANA CHOICE PLUS,MGD,2860.2,,,,,,,case rate,2860.2,2860.2,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 100MG CER        ,92211502,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN D 400U SGL            ,92211503,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,AETNA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,CIGNA,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,WELLMED,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA,MGD,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
NEFAZODONE HCL 100MG TAB      ,92211504,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA CHOICE PLUS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,AETNA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,CIGNA,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,WELLMED,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA,MGD,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211505,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA CHOICE PLUS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,AETNA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,CIGNA,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,WELLMED,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA,MGD,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211506,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA CHOICE PLUS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,AETNA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,BCBS,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,CIGNA,COM,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,UNITED HEALTHCARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,VA TRICARE,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,WELLMED,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA,MGD,7.91,,,,,,,per diem,7.91,7.91,"Per diem rate, code is bundled with other services"
ROPINIROLE HCL 0.5MG TAB      ,92211507,CDM,250,RC,,,,,,Inpatient,1,EA,7.91,7.91,HUMANA CHOICE PLUS,MGD,7.91,,,,,,,case rate,7.91,7.91,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOLOXAMINE CIT APAP TAB  ,92211508,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,AETNA,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,BCBS,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,CIGNA,COM,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,TRICARE,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,UNITED HEALTHCARE,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,UNITED HEALTHCARE,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,VA,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,VA TRICARE,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,WELLMED,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,HUMANA,MGD,18.49,,,,,,,per diem,18.49,18.49,"Per diem rate, code is bundled with other services"
TESTOSTERONE 2.5MG/24HR TDM   ,92211509,CDM,250,RC,,,,,,Inpatient,1,EA,18.49,18.49,HUMANA CHOICE PLUS,MGD,18.49,,,,,,,case rate,18.49,18.49,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,AETNA,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,BCBS,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,CIGNA,COM,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,TRICARE,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,UNITED HEALTHCARE,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,UNITED HEALTHCARE,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,VA,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,VA TRICARE,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,WELLMED,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,HUMANA,MGD,76.17,,,,,,,per diem,76.17,76.17,"Per diem rate, code is bundled with other services"
ROCURONIUM BROMIDE 10MG/ML INJ,92211510,CDM,250,RC,,,,,,Inpatient,1,EA,76.17,76.17,HUMANA CHOICE PLUS,MGD,76.17,,,,,,,case rate,76.17,76.17,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,AETNA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,BCBS,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,CIGNA,COM,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,UNITED HEALTHCARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,VA TRICARE,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,WELLMED,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA,MGD,11.84,,,,,,,per diem,11.84,11.84,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% INJ            ,92211511,CDM,250,RC,,,,,,Inpatient,1,EA,11.84,11.84,HUMANA CHOICE PLUS,MGD,11.84,,,,,,,case rate,11.84,11.84,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,AETNA,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,BCBS,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,CIGNA,COM,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,TRICARE,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,UNITED HEALTHCARE,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,UNITED HEALTHCARE,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,VA,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,VA TRICARE,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,WELLMED,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,HUMANA,MGD,74.53,,,,,,,per diem,74.53,74.53,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 10MG/ML SOL      ,92211512,CDM,250,RC,,,,,,Inpatient,1,EA,74.53,74.53,HUMANA CHOICE PLUS,MGD,74.53,,,,,,,case rate,74.53,74.53,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92211513,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,AETNA,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,BCBS,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,CIGNA,COM,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,TRICARE,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UNITED HEALTHCARE,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,UNITED HEALTHCARE,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,VA,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,VA TRICARE,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,WELLMED,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,HUMANA,MGD,10.74,,,,,,,per diem,10.74,10.74,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211514,CDM,250,RC,,,,,,Inpatient,1,EA,10.74,10.74,HUMANA CHOICE PLUS,MGD,10.74,,,,,,,case rate,10.74,10.74,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,AETNA,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,BCBS,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,CIGNA,COM,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,TRICARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,UNITED HEALTHCARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,UNITED HEALTHCARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,VA,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,VA TRICARE,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,WELLMED,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,HUMANA,MGD,25.17,,,,,,,per diem,25.17,25.17,"Per diem rate, code is bundled with other services"
PIPERONYL BUTO PYRETHRUN EXT L,92211515,CDM,250,RC,,,,,,Inpatient,1,EA,25.17,25.17,HUMANA CHOICE PLUS,MGD,25.17,,,,,,,case rate,25.17,25.17,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TER      ,92211516,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,AETNA,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,BCBS,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,CIGNA,COM,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,TRICARE,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,UNITED HEALTHCARE,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,UNITED HEALTHCARE,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,VA,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,VA TRICARE,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,WELLMED,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,HUMANA,MGD,12.52,,,,,,,per diem,12.52,12.52,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 60MG C12        ,92211517,CDM,250,RC,,,,,,Inpatient,1,EA,12.52,12.52,HUMANA CHOICE PLUS,MGD,12.52,,,,,,,case rate,12.52,12.52,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,AETNA,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,BCBS,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,CIGNA,COM,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,TRICARE,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,UNITED HEALTHCARE,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,UNITED HEALTHCARE,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,VA,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,VA TRICARE,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,WELLMED,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,HUMANA,MGD,99.26,,,,,,,per diem,99.26,99.26,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.025% OIN      ,92211518,CDM,250,RC,,,,,,Inpatient,1,EA,99.26,99.26,HUMANA CHOICE PLUS,MGD,99.26,,,,,,,case rate,99.26,99.26,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,AETNA,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,BCBS,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,CIGNA,COM,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,TRICARE,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,UNITED HEALTHCARE,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,UNITED HEALTHCARE,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,VA,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,VA TRICARE,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,WELLMED,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,HUMANA,MGD,615.04,,,,,,,per diem,615.04,615.04,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92211519,CDM,250,RC,,,,,,Inpatient,1,EA,615.04,615.04,HUMANA CHOICE PLUS,MGD,615.04,,,,,,,case rate,615.04,615.04,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92211520,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211521,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,AETNA,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,BCBS,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,CIGNA,COM,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,TRICARE,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,UNITED HEALTHCARE,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,UNITED HEALTHCARE,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,VA,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,VA TRICARE,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,WELLMED,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,HUMANA,MGD,69.02,,,,,,,per diem,69.02,69.02,"Per diem rate, code is bundled with other services"
CA CL/KCL/NA CL SOL           ,92211522,CDM,250,RC,,,,,,Inpatient,1,EA,69.02,69.02,HUMANA CHOICE PLUS,MGD,69.02,,,,,,,case rate,69.02,69.02,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211523,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
COLCHICINE 0.6MG TAB          ,92211524,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,AETNA,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,BCBS,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,CIGNA,COM,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,TRICARE,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,UNITED HEALTHCARE,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,UNITED HEALTHCARE,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,VA,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,VA TRICARE,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,WELLMED,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,HUMANA,MGD,16.25,,,,,,,per diem,16.25,16.25,"Per diem rate, code is bundled with other services"
LOVASTATIN 40MG TAB           ,92211525,CDM,250,RC,,,,,,Inpatient,1,EA,16.25,16.25,HUMANA CHOICE PLUS,MGD,16.25,,,,,,,case rate,16.25,16.25,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,AETNA,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,BCBS,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,CIGNA,COM,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,TRICARE,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,UNITED HEALTHCARE,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,UNITED HEALTHCARE,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,VA,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,VA TRICARE,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,WELLMED,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,HUMANA,MGD,80.45,,,,,,,per diem,80.45,80.45,"Per diem rate, code is bundled with other services"
CEFIXIME 100MG/5ML PDR        ,92211526,CDM,250,RC,,,,,,Inpatient,1,EA,80.45,80.45,HUMANA CHOICE PLUS,MGD,80.45,,,,,,,case rate,80.45,80.45,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92211527,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 250MG TAB            ,92211528,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211529,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,AETNA,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,BCBS,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,CIGNA,COM,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,TRICARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,UNITED HEALTHCARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,UNITED HEALTHCARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,VA,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,VA TRICARE,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,WELLMED,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,HUMANA,MGD,431.11,,,,,,,per diem,431.11,431.11,"Per diem rate, code is bundled with other services"
LINDANE 1% LOT                ,92211530,CDM,250,RC,,,,,,Inpatient,1,EA,431.11,431.11,HUMANA CHOICE PLUS,MGD,431.11,,,,,,,case rate,431.11,431.11,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 2MG TAB              ,92211531,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYPROHEPTADINE 4MG TAB        ,92211532,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG TAB ,92211533,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISMUTH SUBSALICYLATE 262MG SU,92211534,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG ECT        ,92211535,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,AETNA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,CIGNA,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,WELLMED,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA,MGD,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 CAP,92211536,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA CHOICE PLUS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211537,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,AETNA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,CIGNA,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,WELLMED,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA,MGD,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211538,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA CHOICE PLUS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 100MG T12        ,92211539,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,AETNA,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,BCBS,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,CIGNA,COM,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,TRICARE,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,UNITED HEALTHCARE,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,UNITED HEALTHCARE,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,VA,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,VA TRICARE,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,WELLMED,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,HUMANA,MGD,127.2,,,,,,,per diem,127.2,127.2,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% SOL          ,92211540,CDM,250,RC,,,,,,Inpatient,1,EA,127.2,127.2,HUMANA CHOICE PLUS,MGD,127.2,,,,,,,case rate,127.2,127.2,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,AETNA,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,BCBS,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,CIGNA,COM,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,TRICARE,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,UNITED HEALTHCARE,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,UNITED HEALTHCARE,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,VA,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,VA TRICARE,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,WELLMED,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,HUMANA,MGD,56.29,,,,,,,per diem,56.29,56.29,"Per diem rate, code is bundled with other services"
OLANZAPINE 7.5MG TAB          ,92211541,CDM,250,RC,,,,,,Inpatient,1,EA,56.29,56.29,HUMANA CHOICE PLUS,MGD,56.29,,,,,,,case rate,56.29,56.29,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211542,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211543,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,AETNA,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,BCBS,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,CIGNA,COM,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,TRICARE,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,UNITED HEALTHCARE,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,UNITED HEALTHCARE,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,VA,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,VA TRICARE,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,WELLMED,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,HUMANA,MGD,950.42,,,,,,,per diem,950.42,950.42,"Per diem rate, code is bundled with other services"
MOMETASONE FUROATE 50MCG SPR  ,92211544,CDM,250,RC,,,,,,Inpatient,1,EA,950.42,950.42,HUMANA CHOICE PLUS,MGD,950.42,,,,,,,case rate,950.42,950.42,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,AETNA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,CIGNA,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,WELLMED,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA,MGD,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211545,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA CHOICE PLUS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG/10ML LIQ    ,92211546,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,AETNA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,CIGNA,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,WELLMED,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,HUMANA,MGD,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% SOL      ,92211547,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,HUMANA CHOICE PLUS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ TRIAMTERENE 25-37.5MG TAB,92211548,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,AETNA,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,BCBS,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,CIGNA,COM,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,TRICARE,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,UNITED HEALTHCARE,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,UNITED HEALTHCARE,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,VA,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,VA TRICARE,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,WELLMED,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,HUMANA,MGD,523.91,,,,,,,per diem,523.91,523.91,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 5% IVS          ,92211549,CDM,250,RC,,,,,,Inpatient,1,EA,523.91,523.91,HUMANA CHOICE PLUS,MGD,523.91,,,,,,,case rate,523.91,523.91,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRAMADOL HCL 50MG TAB         ,92211550,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,AETNA,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,BCBS,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,CIGNA,COM,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,TRICARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,UNITED HEALTHCARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,UNITED HEALTHCARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,VA,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,VA TRICARE,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,WELLMED,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,HUMANA,MGD,47.09,,,,,,,per diem,47.09,47.09,"Per diem rate, code is bundled with other services"
UREA 10% LOT                  ,92211551,CDM,250,RC,,,,,,Inpatient,1,EA,47.09,47.09,HUMANA CHOICE PLUS,MGD,47.09,,,,,,,case rate,47.09,47.09,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 500MG TAB        ,92211552,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,AETNA,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,BCBS,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,CIGNA,COM,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,TRICARE,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,UNITED HEALTHCARE,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,UNITED HEALTHCARE,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,VA,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,VA TRICARE,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,WELLMED,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,HUMANA,MGD,19.12,,,,,,,per diem,19.12,19.12,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211553,CDM,250,RC,,,,,,Inpatient,1,EA,19.12,19.12,HUMANA CHOICE PLUS,MGD,19.12,,,,,,,case rate,19.12,19.12,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 50MCG TAB    ,92211554,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,AETNA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,CIGNA,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,WELLMED,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA,MGD,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 7MG/24 HR TDM        ,92211555,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA CHOICE PLUS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,AETNA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,CIGNA,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,WELLMED,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA,MGD,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
PENICILLIN VK 500MG TAB       ,92211556,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA CHOICE PLUS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,AETNA,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,BCBS,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,CIGNA,COM,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,TRICARE,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,UNITED HEALTHCARE,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,UNITED HEALTHCARE,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,VA,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,VA TRICARE,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,WELLMED,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,HUMANA,MGD,786.27,,,,,,,per diem,786.27,786.27,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B LIPOSOME 50MG I,92211557,CDM,250,RC,,,,,,Inpatient,1,EA,786.27,786.27,HUMANA CHOICE PLUS,MGD,786.27,,,,,,,case rate,786.27,786.27,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,AETNA,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,BCBS,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,CIGNA,COM,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,TRICARE,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,UNITED HEALTHCARE,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,UNITED HEALTHCARE,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,VA,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,VA TRICARE,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,WELLMED,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,HUMANA,MGD,57.9,,,,,,,per diem,57.9,57.9,"Per diem rate, code is bundled with other services"
AMMONIUM LACTATE 12% CRE      ,92211558,CDM,250,RC,,,,,,Inpatient,1,EA,57.9,57.9,HUMANA CHOICE PLUS,MGD,57.9,,,,,,,case rate,57.9,57.9,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,AETNA,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,BCBS,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,CIGNA,COM,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,TRICARE,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,UNITED HEALTHCARE,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,UNITED HEALTHCARE,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,VA,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,VA TRICARE,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,WELLMED,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,HUMANA,MGD,138.54,,,,,,,per diem,138.54,138.54,"Per diem rate, code is bundled with other services"
BETAMETHASONE ACE/NA 6MG/ML IN,92211559,CDM,250,RC,,,,,,Inpatient,1,EA,138.54,138.54,HUMANA CHOICE PLUS,MGD,138.54,,,,,,,case rate,138.54,138.54,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACYCLOVIR 200MG CAP           ,92211560,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92211561,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,AETNA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,BCBS,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,CIGNA,COM,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,UNITED HEALTHCARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,VA,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,VA TRICARE,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,WELLMED,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,HUMANA,MGD,378,,,,,,,per diem,378,378,"Per diem rate, code is bundled with other services"
BLEOMYCIN SULF 30U INJ        ,92211562,CDM,250,RC,,,,,,Inpatient,1,EA,378,378,HUMANA CHOICE PLUS,MGD,378,,,,,,,case rate,378,378,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211563,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS GLUCONATE 325MG TAB   ,92211564,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,AETNA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,BCBS,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,CIGNA,COM,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,UNITED HEALTHCARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,VA TRICARE,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,WELLMED,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA,MGD,6.3,,,,,,,per diem,6.3,6.3,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92211565,CDM,250,RC,,,,,,Inpatient,1,EA,6.3,6.3,HUMANA CHOICE PLUS,MGD,6.3,,,,,,,case rate,6.3,6.3,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 10MG CAP    ,92211566,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM POLYCARBOPHIL 625MG TA,92211567,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,AETNA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,BCBS,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,CIGNA,COM,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,UNITED HEALTHCARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,VA TRICARE,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,WELLMED,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA,MGD,17.01,,,,,,,per diem,17.01,17.01,"Per diem rate, code is bundled with other services"
BROMOCRIPTINE MESYLATE 2.5MG T,92211568,CDM,250,RC,,,,,,Inpatient,1,EA,17.01,17.01,HUMANA CHOICE PLUS,MGD,17.01,,,,,,,case rate,17.01,17.01,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,AETNA,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,BCBS,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,CIGNA,COM,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,TRICARE,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,UNITED HEALTHCARE,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,UNITED HEALTHCARE,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,VA,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,VA TRICARE,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,WELLMED,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,HUMANA,MGD,5.54,,,,,,,per diem,5.54,5.54,"Per diem rate, code is bundled with other services"
IPRATROPIUM BR 0.02% SOL      ,92211569,CDM,250,RC,,,,,,Inpatient,1,EA,5.54,5.54,HUMANA CHOICE PLUS,MGD,5.54,,,,,,,case rate,5.54,5.54,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,AETNA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,BCBS,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,CIGNA,COM,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,UNITED HEALTHCARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,VA TRICARE,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,WELLMED,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA,MGD,11.37,,,,,,,per diem,11.37,11.37,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211570,CDM,250,RC,,,,,,Inpatient,1,EA,11.37,11.37,HUMANA CHOICE PLUS,MGD,11.37,,,,,,,case rate,11.37,11.37,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,AETNA,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,BCBS,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,CIGNA,COM,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,TRICARE,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,UNITED HEALTHCARE,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,UNITED HEALTHCARE,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,VA,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,VA TRICARE,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,WELLMED,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,HUMANA,MGD,43.16,,,,,,,per diem,43.16,43.16,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92211571,CDM,250,RC,,,,,,Inpatient,1,EA,43.16,43.16,HUMANA CHOICE PLUS,MGD,43.16,,,,,,,case rate,43.16,43.16,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,AETNA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,BCBS,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,CIGNA,COM,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,UNITED HEALTHCARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,VA TRICARE,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,WELLMED,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA,MGD,14.46,,,,,,,per diem,14.46,14.46,"Per diem rate, code is bundled with other services"
DROPERIDOL 2.5MG/ML INJ       ,92211572,CDM,250,RC,,,,,,Inpatient,1,EA,14.46,14.46,HUMANA CHOICE PLUS,MGD,14.46,,,,,,,case rate,14.46,14.46,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 30MG CAP      ,92211573,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92211574,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,AETNA,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,BCBS,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,CIGNA,COM,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,TRICARE,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,UNITED HEALTHCARE,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,UNITED HEALTHCARE,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,VA,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,VA TRICARE,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,WELLMED,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,HUMANA,MGD,95.57,,,,,,,per diem,95.57,95.57,"Per diem rate, code is bundled with other services"
IMIPRAMINE PAMOATE 100MG CAP  ,92211575,CDM,250,RC,,,,,,Inpatient,1,EA,95.57,95.57,HUMANA CHOICE PLUS,MGD,95.57,,,,,,,case rate,95.57,95.57,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,AETNA,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,BCBS,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,CIGNA,COM,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,TRICARE,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,UNITED HEALTHCARE,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,UNITED HEALTHCARE,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,VA,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,VA TRICARE,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,WELLMED,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,HUMANA,MGD,84.89,,,,,,,per diem,84.89,84.89,"Per diem rate, code is bundled with other services"
CAPSAICIN 0.075% CRE          ,92211576,CDM,250,RC,,,,,,Inpatient,1,EA,84.89,84.89,HUMANA CHOICE PLUS,MGD,84.89,,,,,,,case rate,84.89,84.89,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,AETNA,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,BCBS,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,CIGNA,COM,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,TRICARE,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UNITED HEALTHCARE,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,UNITED HEALTHCARE,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,VA TRICARE,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,WELLMED,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,HUMANA,MGD,8.85,,,,,,,per diem,8.85,8.85,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SUL 10MG TAB,92211577,CDM,250,RC,,,,,,Inpatient,1,EA,8.85,8.85,HUMANA CHOICE PLUS,MGD,8.85,,,,,,,case rate,8.85,8.85,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,AETNA,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,BCBS,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,CIGNA,COM,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,TRICARE,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,UNITED HEALTHCARE,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,UNITED HEALTHCARE,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,VA,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,VA TRICARE,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,WELLMED,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,HUMANA,MGD,25.61,,,,,,,per diem,25.61,25.61,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211578,CDM,250,RC,,,,,,Inpatient,1,EA,25.61,25.61,HUMANA CHOICE PLUS,MGD,25.61,,,,,,,case rate,25.61,25.61,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,AETNA,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,BCBS,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,CIGNA,COM,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,TRICARE,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,UNITED HEALTHCARE,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,UNITED HEALTHCARE,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,VA,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,VA TRICARE,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,WELLMED,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,HUMANA,MGD,19.97,,,,,,,per diem,19.97,19.97,"Per diem rate, code is bundled with other services"
DEXAMETHASONE NA PH 4MG/ML INJ,92211579,CDM,250,RC,,,,,,Inpatient,1,EA,19.97,19.97,HUMANA CHOICE PLUS,MGD,19.97,,,,,,,case rate,19.97,19.97,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211580,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211581,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,AETNA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,CIGNA,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,WELLMED,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA,MGD,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211582,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA CHOICE PLUS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211583,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,AETNA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,BCBS,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,CIGNA,COM,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,UNITED HEALTHCARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,VA TRICARE,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,WELLMED,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA,MGD,8.32,,,,,,,per diem,8.32,8.32,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 100MG TAB     ,92211584,CDM,250,RC,,,,,,Inpatient,1,EA,8.32,8.32,HUMANA CHOICE PLUS,MGD,8.32,,,,,,,case rate,8.32,8.32,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE MN 20MG TAB        ,92211585,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 10MG TAB ,92211586,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPOXYPHEN APAP 100-650MG TAB,92211587,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 6MG TAB           ,92211588,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  30MG TAB            ,92211589,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,AETNA,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,BCBS,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,CIGNA,COM,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,TRICARE,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,UNITED HEALTHCARE,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,UNITED HEALTHCARE,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,VA,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,VA TRICARE,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,WELLMED,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,HUMANA,MGD,943.65,,,,,,,per diem,943.65,943.65,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% CRE          ,92211590,CDM,250,RC,,,,,,Inpatient,1,EA,943.65,943.65,HUMANA CHOICE PLUS,MGD,943.65,,,,,,,case rate,943.65,943.65,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,AETNA,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,BCBS,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,CIGNA,COM,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,TRICARE,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UNITED HEALTHCARE,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,UNITED HEALTHCARE,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,VA TRICARE,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,WELLMED,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,HUMANA,MGD,10.11,,,,,,,per diem,10.11,10.11,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 500MG INJ       ,92211591,CDM,250,RC,,,,,,Inpatient,1,EA,10.11,10.11,HUMANA CHOICE PLUS,MGD,10.11,,,,,,,case rate,10.11,10.11,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,AETNA,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,BCBS,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,CIGNA,COM,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,TRICARE,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,UNITED HEALTHCARE,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,UNITED HEALTHCARE,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,VA,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,VA TRICARE,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,WELLMED,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,HUMANA,MGD,1253.45,,,,,,,per diem,1253.45,1253.45,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 20,000U/ML INJ   ",92211592,CDM,250,RC,,,,,,Inpatient,1,EA,1253.45,1253.45,HUMANA CHOICE PLUS,MGD,1253.45,,,,,,,case rate,1253.45,1253.45,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM OXIDE 400MG TAB     ,92211593,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,AETNA,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,BCBS,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,CIGNA,COM,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,TRICARE,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,UNITED HEALTHCARE,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,UNITED HEALTHCARE,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,VA,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,VA TRICARE,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,WELLMED,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,HUMANA,MGD,41.83,,,,,,,per diem,41.83,41.83,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211594,CDM,250,RC,,,,,,Inpatient,1,EA,41.83,41.83,HUMANA CHOICE PLUS,MGD,41.83,,,,,,,case rate,41.83,41.83,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,AETNA,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,BCBS,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,CIGNA,COM,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,TRICARE,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,UNITED HEALTHCARE,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,UNITED HEALTHCARE,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,VA,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,VA TRICARE,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,WELLMED,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,HUMANA,MGD,8.98,,,,,,,per diem,8.98,8.98,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 50MG TAB       ,92211595,CDM,250,RC,,,,,,Inpatient,1,EA,8.98,8.98,HUMANA CHOICE PLUS,MGD,8.98,,,,,,,case rate,8.98,8.98,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,AETNA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,BCBS,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,CIGNA,COM,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,UNITED HEALTHCARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,VA TRICARE,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,WELLMED,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,HUMANA,MGD,11.91,,,,,,,per diem,11.91,11.91,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211596,CDM,250,RC,,,,,,Inpatient,1,EA,11.91,11.91,HUMANA CHOICE PLUS,MGD,11.91,,,,,,,case rate,11.91,11.91,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,AETNA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,CIGNA,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,WELLMED,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA,MGD,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
DOXYCYCLINE HYCLATE 100MG CAP ,92211597,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA CHOICE PLUS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,AETNA,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,BCBS,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,CIGNA,COM,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,TRICARE,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,UNITED HEALTHCARE,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,UNITED HEALTHCARE,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,VA,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,VA TRICARE,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,WELLMED,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,HUMANA,MGD,250.17,,,,,,,per diem,250.17,250.17,"Per diem rate, code is bundled with other services"
DOLASETRON MESYLATE 100MG TAB ,92211598,CDM,250,RC,,,,,,Inpatient,1,EA,250.17,250.17,HUMANA CHOICE PLUS,MGD,250.17,,,,,,,case rate,250.17,250.17,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 5MG TAB              ,92211599,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,AETNA,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,BCBS,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,CIGNA,COM,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,TRICARE,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,UNITED HEALTHCARE,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,UNITED HEALTHCARE,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,VA,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,VA TRICARE,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,WELLMED,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,HUMANA,MGD,44.82,,,,,,,per diem,44.82,44.82,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211600,CDM,250,RC,,,,,,Inpatient,1,EA,44.82,44.82,HUMANA CHOICE PLUS,MGD,44.82,,,,,,,case rate,44.82,44.82,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,AETNA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,CIGNA,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,WELLMED,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA,MGD,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 1% CRE         ,92211601,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA CHOICE PLUS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,AETNA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,BCBS,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,CIGNA,COM,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,UNITED HEALTHCARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,VA TRICARE,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,WELLMED,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA,MGD,6.05,,,,,,,per diem,6.05,6.05,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 25MG CAP   ,92211602,CDM,250,RC,,,,,,Inpatient,1,EA,6.05,6.05,HUMANA CHOICE PLUS,MGD,6.05,,,,,,,case rate,6.05,6.05,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,AETNA,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,BCBS,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,CIGNA,COM,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,TRICARE,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,UNITED HEALTHCARE,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,UNITED HEALTHCARE,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,VA,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,VA TRICARE,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,WELLMED,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,HUMANA,MGD,12.29,,,,,,,per diem,12.29,12.29,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92211603,CDM,250,RC,,,,,,Inpatient,1,EA,12.29,12.29,HUMANA CHOICE PLUS,MGD,12.29,,,,,,,case rate,12.29,12.29,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,AETNA,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,BCBS,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,CIGNA,COM,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,TRICARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UNITED HEALTHCARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,UNITED HEALTHCARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,VA,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,VA TRICARE,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,WELLMED,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,HUMANA,MGD,14.52,,,,,,,per diem,14.52,14.52,"Per diem rate, code is bundled with other services"
VITAMIN E OIL                 ,92211604,CDM,250,RC,,,,,,Inpatient,1,EA,14.52,14.52,HUMANA CHOICE PLUS,MGD,14.52,,,,,,,case rate,14.52,14.52,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,AETNA,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,BCBS,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,CIGNA,COM,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,TRICARE,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,UNITED HEALTHCARE,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,UNITED HEALTHCARE,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,VA,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,VA TRICARE,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,WELLMED,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,HUMANA,MGD,235.02,,,,,,,per diem,235.02,235.02,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92211605,CDM,250,RC,,,,,,Inpatient,1,EA,235.02,235.02,HUMANA CHOICE PLUS,MGD,235.02,,,,,,,case rate,235.02,235.02,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FA CYAN IRON POLYSACCHARIDE CA,92211606,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,AETNA,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,BCBS,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,CIGNA,COM,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,TRICARE,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,UNITED HEALTHCARE,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,UNITED HEALTHCARE,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,VA,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,VA TRICARE,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,WELLMED,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,HUMANA,MGD,14.9,,,,,,,per diem,14.9,14.9,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C12       ,92211607,CDM,250,RC,,,,,,Inpatient,1,EA,14.9,14.9,HUMANA CHOICE PLUS,MGD,14.9,,,,,,,case rate,14.9,14.9,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,AETNA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,CIGNA,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,WELLMED,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA,MGD,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG TAB       ,92211608,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA CHOICE PLUS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,AETNA,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,BCBS,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,CIGNA,COM,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,TRICARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,UNITED HEALTHCARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,UNITED HEALTHCARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,VA,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,VA TRICARE,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,WELLMED,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,HUMANA,MGD,34.78,,,,,,,per diem,34.78,34.78,"Per diem rate, code is bundled with other services"
IODINE 4.7% OIN               ,92211609,CDM,250,RC,,,,,,Inpatient,1,EA,34.78,34.78,HUMANA CHOICE PLUS,MGD,34.78,,,,,,,case rate,34.78,34.78,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,AETNA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,BCBS,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,CIGNA,COM,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,UNITED HEALTHCARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,VA TRICARE,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,WELLMED,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA,MGD,7.47,,,,,,,per diem,7.47,7.47,"Per diem rate, code is bundled with other services"
METOLAZONE 5MG TAB            ,92211610,CDM,250,RC,,,,,,Inpatient,1,EA,7.47,7.47,HUMANA CHOICE PLUS,MGD,7.47,,,,,,,case rate,7.47,7.47,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,AETNA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,CIGNA,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,WELLMED,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA,MGD,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211611,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA CHOICE PLUS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211612,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92211613,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,AETNA,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,BCBS,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,CIGNA,COM,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,TRICARE,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,UNITED HEALTHCARE,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,UNITED HEALTHCARE,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,VA,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,VA TRICARE,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,WELLMED,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,HUMANA,MGD,13.55,,,,,,,per diem,13.55,13.55,"Per diem rate, code is bundled with other services"
VISINE FOR CONTACTS SOL       ,92211614,CDM,250,RC,,,,,,Inpatient,1,EA,13.55,13.55,HUMANA CHOICE PLUS,MGD,13.55,,,,,,,case rate,13.55,13.55,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,AETNA,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,BCBS,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,CIGNA,COM,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,TRICARE,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,UNITED HEALTHCARE,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,UNITED HEALTHCARE,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,VA,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,VA TRICARE,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,WELLMED,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,HUMANA,MGD,89.87,,,,,,,per diem,89.87,89.87,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% SOL           ,92211615,CDM,250,RC,,,,,,Inpatient,1,EA,89.87,89.87,HUMANA CHOICE PLUS,MGD,89.87,,,,,,,case rate,89.87,89.87,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 1MG/5ML LIQ    ,92211616,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,AETNA,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,BCBS,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,CIGNA,COM,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,TRICARE,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,UNITED HEALTHCARE,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,UNITED HEALTHCARE,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,VA,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,VA TRICARE,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,WELLMED,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,HUMANA,MGD,756,,,,,,,per diem,756,756,"Per diem rate, code is bundled with other services"
CEFUROXIME NA 1.5GM INJ       ,92211617,CDM,250,RC,,,,,,Inpatient,1,EA,756,756,HUMANA CHOICE PLUS,MGD,756,,,,,,,case rate,756,756,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92211618,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,AETNA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,CIGNA,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,WELLMED,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA,MGD,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211619,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA CHOICE PLUS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROPAMIDE 250MG TAB      ,92211620,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,AETNA,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,BCBS,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,CIGNA,COM,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,TRICARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,UNITED HEALTHCARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,UNITED HEALTHCARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,VA,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,VA TRICARE,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,WELLMED,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,HUMANA,MGD,7.21,,,,,,,per diem,7.21,7.21,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 75MG TAB         ,92211621,CDM,250,RC,,,,,,Inpatient,1,EA,7.21,7.21,HUMANA CHOICE PLUS,MGD,7.21,,,,,,,case rate,7.21,7.21,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211622,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,AETNA,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,BCBS,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,CIGNA,COM,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,TRICARE,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,UNITED HEALTHCARE,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,UNITED HEALTHCARE,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,VA,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,VA TRICARE,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,WELLMED,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,HUMANA,MGD,716,,,,,,,per diem,716,716,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211623,CDM,250,RC,,,,,,Inpatient,1,EA,716,716,HUMANA CHOICE PLUS,MGD,716,,,,,,,case rate,716,716,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,AETNA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,BCBS,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,CIGNA,COM,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,UNITED HEALTHCARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,VA,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,VA TRICARE,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,WELLMED,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,HUMANA,MGD,22.49,,,,,,,per diem,22.49,22.49,"Per diem rate, code is bundled with other services"
MEPERIDINE 25MG/ML INJ        ,92211624,CDM,250,RC,,,,,,Inpatient,1,EA,22.49,22.49,HUMANA CHOICE PLUS,MGD,22.49,,,,,,,case rate,22.49,22.49,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,AETNA,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,BCBS,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,CIGNA,COM,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,TRICARE,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,UNITED HEALTHCARE,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,UNITED HEALTHCARE,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,VA,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,VA TRICARE,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,WELLMED,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,HUMANA,MGD,47.31,,,,,,,per diem,47.31,47.31,"Per diem rate, code is bundled with other services"
"POLYMYXIN B SULF 500,000U INJ ",92211625,CDM,250,RC,,,,,,Inpatient,1,EA,47.31,47.31,HUMANA CHOICE PLUS,MGD,47.31,,,,,,,case rate,47.31,47.31,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/5ML SOL    ,92211626,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,AETNA,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,CIGNA,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,TRICARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,UNITED HEALTHCARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,UNITED HEALTHCARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,VA,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,VA TRICARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,WELLMED,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,HUMANA,MGD,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211627,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,HUMANA CHOICE PLUS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,AETNA,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,BCBS,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,CIGNA,COM,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,TRICARE,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,UNITED HEALTHCARE,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,UNITED HEALTHCARE,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,VA,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,VA TRICARE,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,WELLMED,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,HUMANA,MGD,113.12,,,,,,,per diem,113.12,113.12,"Per diem rate, code is bundled with other services"
TRETINOIN 0.025% GEL          ,92211628,CDM,250,RC,,,,,,Inpatient,1,EA,113.12,113.12,HUMANA CHOICE PLUS,MGD,113.12,,,,,,,case rate,113.12,113.12,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,AETNA,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,BCBS,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,CIGNA,COM,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,TRICARE,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,UNITED HEALTHCARE,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,UNITED HEALTHCARE,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,VA,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,VA TRICARE,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,WELLMED,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,HUMANA,MGD,25.92,,,,,,,per diem,25.92,25.92,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 16MG TAB         ,92211629,CDM,250,RC,,,,,,Inpatient,1,EA,25.92,25.92,HUMANA CHOICE PLUS,MGD,25.92,,,,,,,case rate,25.92,25.92,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,AETNA,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,BCBS,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,CIGNA,COM,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,TRICARE,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,UNITED HEALTHCARE,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,UNITED HEALTHCARE,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,VA,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,VA TRICARE,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,WELLMED,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,HUMANA,MGD,481.73,,,,,,,per diem,481.73,481.73,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211630,CDM,250,RC,,,,,,Inpatient,1,EA,481.73,481.73,HUMANA CHOICE PLUS,MGD,481.73,,,,,,,case rate,481.73,481.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,AETNA,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,BCBS,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,CIGNA,COM,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,TRICARE,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,UNITED HEALTHCARE,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,UNITED HEALTHCARE,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,VA,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,VA TRICARE,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,WELLMED,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,HUMANA,MGD,764.44,,,,,,,per diem,764.44,764.44,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 0.3% OIN           ,92211631,CDM,250,RC,,,,,,Inpatient,1,EA,764.44,764.44,HUMANA CHOICE PLUS,MGD,764.44,,,,,,,case rate,764.44,764.44,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 1MG TAB            ,92211632,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 175MCG TAB   ,92211633,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,AETNA,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,BCBS,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,CIGNA,COM,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,TRICARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,UNITED HEALTHCARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,UNITED HEALTHCARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,VA,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,VA TRICARE,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,WELLMED,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,HUMANA,MGD,29.77,,,,,,,per diem,29.77,29.77,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92211634,CDM,250,RC,,,,,,Inpatient,1,EA,29.77,29.77,HUMANA CHOICE PLUS,MGD,29.77,,,,,,,case rate,29.77,29.77,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,AETNA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,BCBS,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,CIGNA,COM,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,UNITED HEALTHCARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,VA TRICARE,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,WELLMED,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA,MGD,8.16,,,,,,,per diem,8.16,8.16,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 120MG CER     ,92211635,CDM,250,RC,,,,,,Inpatient,1,EA,8.16,8.16,HUMANA CHOICE PLUS,MGD,8.16,,,,,,,case rate,8.16,8.16,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG TAB     ,92211636,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,AETNA,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,BCBS,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,CIGNA,COM,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,TRICARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UNITED HEALTHCARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,UNITED HEALTHCARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,VA TRICARE,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,WELLMED,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,HUMANA,MGD,7.59,,,,,,,per diem,7.59,7.59,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 250MG TAB     ,92211637,CDM,250,RC,,,,,,Inpatient,1,EA,7.59,7.59,HUMANA CHOICE PLUS,MGD,7.59,,,,,,,case rate,7.59,7.59,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92211638,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MELATONIN 5MG TAB             ,92211639,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,AETNA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,BCBS,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,CIGNA,COM,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,UNITED HEALTHCARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,VA,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,VA TRICARE,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,WELLMED,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,HUMANA,MGD,24.63,,,,,,,per diem,24.63,24.63,"Per diem rate, code is bundled with other services"
CEFTAZIDIME 1GM INJ           ,92211640,CDM,250,RC,,,,,,Inpatient,1,EA,24.63,24.63,HUMANA CHOICE PLUS,MGD,24.63,,,,,,,case rate,24.63,24.63,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,AETNA,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,BCBS,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,CIGNA,COM,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,TRICARE,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,UNITED HEALTHCARE,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,UNITED HEALTHCARE,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,VA,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,VA TRICARE,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,WELLMED,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,HUMANA,MGD,87.92,,,,,,,per diem,87.92,87.92,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 2.5MG TAB        ,92211641,CDM,250,RC,,,,,,Inpatient,1,EA,87.92,87.92,HUMANA CHOICE PLUS,MGD,87.92,,,,,,,case rate,87.92,87.92,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211642,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,AETNA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,CIGNA,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,VA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,VA TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,WELLMED,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,HUMANA,MGD,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINIUM CAP,92211643,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,HUMANA CHOICE PLUS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE CLIDINM BR CA,92211644,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,AETNA,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,BCBS,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,CIGNA,COM,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,TRICARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,UNITED HEALTHCARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,UNITED HEALTHCARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,VA,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,VA TRICARE,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,WELLMED,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,HUMANA,MGD,435.42,,,,,,,per diem,435.42,435.42,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 0.75% GEL       ,92211645,CDM,250,RC,,,,,,Inpatient,1,EA,435.42,435.42,HUMANA CHOICE PLUS,MGD,435.42,,,,,,,case rate,435.42,435.42,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,AETNA,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,BCBS,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,CIGNA,COM,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,TRICARE,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,UNITED HEALTHCARE,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,UNITED HEALTHCARE,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,VA,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,VA TRICARE,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,WELLMED,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,HUMANA,MGD,4857.3,,,,,,,per diem,4857.3,4857.3,"Per diem rate, code is bundled with other services"
CYTOGAM 2.5GM INJ             ,92211646,CDM,250,RC,,,,,,Inpatient,1,EA,4857.3,4857.3,HUMANA CHOICE PLUS,MGD,4857.3,,,,,,,case rate,4857.3,4857.3,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 100MG TAB       ,92211647,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,AETNA,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,BCBS,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,CIGNA,COM,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,TRICARE,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,UNITED HEALTHCARE,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,UNITED HEALTHCARE,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,VA,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,VA TRICARE,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,WELLMED,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,HUMANA,MGD,37.26,,,,,,,per diem,37.26,37.26,"Per diem rate, code is bundled with other services"
TRIENTINE HCL 250MG CAP       ,92211648,CDM,250,RC,,,,,,Inpatient,1,EA,37.26,37.26,HUMANA CHOICE PLUS,MGD,37.26,,,,,,,case rate,37.26,37.26,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,AETNA,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,BCBS,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,CIGNA,COM,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,TRICARE,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,UNITED HEALTHCARE,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,UNITED HEALTHCARE,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,VA,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,VA TRICARE,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,WELLMED,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,HUMANA,MGD,321.14,,,,,,,per diem,321.14,321.14,"Per diem rate, code is bundled with other services"
AMINO ACIDS 8% IVS            ,92211649,CDM,258,RC,,,,,,Inpatient,1,EA,321.14,321.14,HUMANA CHOICE PLUS,MGD,321.14,,,,,,,case rate,321.14,321.14,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 10MG TAB          ,92211650,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211651,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,AETNA,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,BCBS,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,CIGNA,COM,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,TRICARE,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UNITED HEALTHCARE,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,UNITED HEALTHCARE,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,VA,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,VA TRICARE,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,WELLMED,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,HUMANA,MGD,19.5,,,,,,,per diem,19.5,19.5,"Per diem rate, code is bundled with other services"
NADOLOL 20MG TAB              ,92211652,CDM,250,RC,,,,,,Inpatient,1,EA,19.5,19.5,HUMANA CHOICE PLUS,MGD,19.5,,,,,,,case rate,19.5,19.5,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,AETNA,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,BCBS,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,CIGNA,COM,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,TRICARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,UNITED HEALTHCARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,UNITED HEALTHCARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,VA,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,VA TRICARE,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,WELLMED,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,HUMANA,MGD,9.32,,,,,,,per diem,9.32,9.32,"Per diem rate, code is bundled with other services"
ALBENDAZOLE 200MG TAB         ,92211653,CDM,250,RC,,,,,,Inpatient,1,EA,9.32,9.32,HUMANA CHOICE PLUS,MGD,9.32,,,,,,,case rate,9.32,9.32,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,AETNA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,CIGNA,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,WELLMED,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA,MGD,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
BUTALB CAFF APAP 50-40-325 TAB,92211654,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA CHOICE PLUS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,AETNA,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,BCBS,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,CIGNA,COM,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,TRICARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,UNITED HEALTHCARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,UNITED HEALTHCARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,VA,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,VA TRICARE,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,WELLMED,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,HUMANA,MGD,9.61,,,,,,,per diem,9.61,9.61,"Per diem rate, code is bundled with other services"
INDINAVIR SULF 400MG CAP      ,92211655,CDM,250,RC,,,,,,Inpatient,1,EA,9.61,9.61,HUMANA CHOICE PLUS,MGD,9.61,,,,,,,case rate,9.61,9.61,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211656,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92211657,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPHENIDATE HCL 10MG TAB  ,92211658,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,AETNA,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,BCBS,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,CIGNA,COM,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,TRICARE,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,UNITED HEALTHCARE,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,UNITED HEALTHCARE,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,VA,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,VA TRICARE,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,WELLMED,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,HUMANA,MGD,149.31,,,,,,,per diem,149.31,149.31,"Per diem rate, code is bundled with other services"
CEFOTETAN DISODIUM 1GM INJ    ,92211659,CDM,250,RC,,,,,,Inpatient,1,EA,149.31,149.31,HUMANA CHOICE PLUS,MGD,149.31,,,,,,,case rate,149.31,149.31,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92211660,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,AETNA,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,BCBS,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,CIGNA,COM,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,TRICARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,UNITED HEALTHCARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,UNITED HEALTHCARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,VA,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,VA TRICARE,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,WELLMED,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,HUMANA,MGD,19.15,,,,,,,per diem,19.15,19.15,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 5MG TAB      ,92211661,CDM,250,RC,,,,,,Inpatient,1,EA,19.15,19.15,HUMANA CHOICE PLUS,MGD,19.15,,,,,,,case rate,19.15,19.15,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,AETNA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,BCBS,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,CIGNA,COM,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,UNITED HEALTHCARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,VA,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,VA TRICARE,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,WELLMED,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,HUMANA,MGD,122.09,,,,,,,per diem,122.09,122.09,"Per diem rate, code is bundled with other services"
AMINO ACIDS 10% IVS           ,92211662,CDM,258,RC,,,,,,Inpatient,1,EA,122.09,122.09,HUMANA CHOICE PLUS,MGD,122.09,,,,,,,case rate,122.09,122.09,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,AETNA,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,BCBS,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,CIGNA,COM,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,TRICARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UNITED HEALTHCARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,UNITED HEALTHCARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,VA,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,VA TRICARE,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,WELLMED,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,HUMANA,MGD,6.46,,,,,,,per diem,6.46,6.46,"Per diem rate, code is bundled with other services"
FLECAINIDE ACETATE 50MG TAB   ,92211663,CDM,250,RC,,,,,,Inpatient,1,EA,6.46,6.46,HUMANA CHOICE PLUS,MGD,6.46,,,,,,,case rate,6.46,6.46,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,AETNA,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,BCBS,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,CIGNA,COM,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,TRICARE,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,UNITED HEALTHCARE,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,UNITED HEALTHCARE,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,VA,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,VA TRICARE,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,WELLMED,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,HUMANA,MGD,18.71,,,,,,,per diem,18.71,18.71,"Per diem rate, code is bundled with other services"
CLARITHROMYCIN 500MG TAB      ,92211664,CDM,250,RC,,,,,,Inpatient,1,EA,18.71,18.71,HUMANA CHOICE PLUS,MGD,18.71,,,,,,,case rate,18.71,18.71,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 50MG CAP          ,92211665,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211666,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211667,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,AETNA,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,BCBS,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,CIGNA,COM,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,TRICARE,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,UNITED HEALTHCARE,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,UNITED HEALTHCARE,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,VA,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,VA TRICARE,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,WELLMED,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,HUMANA,MGD,240.35,,,,,,,per diem,240.35,240.35,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% CRE        ,92211668,CDM,250,RC,,,,,,Inpatient,1,EA,240.35,240.35,HUMANA CHOICE PLUS,MGD,240.35,,,,,,,case rate,240.35,240.35,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,AETNA,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,BCBS,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,CIGNA,COM,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,TRICARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,UNITED HEALTHCARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,UNITED HEALTHCARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,VA,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,VA TRICARE,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,WELLMED,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,HUMANA,MGD,34.59,,,,,,,per diem,34.59,34.59,"Per diem rate, code is bundled with other services"
"ACYCLOVIR 1,000MG INJ         ",92211669,CDM,250,RC,,,,,,Inpatient,1,EA,34.59,34.59,HUMANA CHOICE PLUS,MGD,34.59,,,,,,,case rate,34.59,34.59,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDRALAZINE HCL               ,92211670,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,AETNA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,CIGNA,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,WELLMED,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA,MGD,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 2MG TAB        ,92211671,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA CHOICE PLUS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,AETNA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,BCBS,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,CIGNA,COM,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,UNITED HEALTHCARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,VA TRICARE,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,WELLMED,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA,MGD,5.73,,,,,,,per diem,5.73,5.73,"Per diem rate, code is bundled with other services"
LOSARTAN POTASSIUM 25MG TAB   ,92211672,CDM,250,RC,,,,,,Inpatient,1,EA,5.73,5.73,HUMANA CHOICE PLUS,MGD,5.73,,,,,,,case rate,5.73,5.73,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG ECT             ,92211673,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROCHLORPERAZINE MAL 5MG TAB  ,92211674,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,AETNA,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,BCBS,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,CIGNA,COM,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,TRICARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,UNITED HEALTHCARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,UNITED HEALTHCARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,VA,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,VA TRICARE,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,WELLMED,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,HUMANA,MGD,6.08,,,,,,,per diem,6.08,6.08,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG CER       ,92211675,CDM,250,RC,,,,,,Inpatient,1,EA,6.08,6.08,HUMANA CHOICE PLUS,MGD,6.08,,,,,,,case rate,6.08,6.08,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,AETNA,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,BCBS,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,CIGNA,COM,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,TRICARE,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,UNITED HEALTHCARE,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,UNITED HEALTHCARE,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,VA,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,VA TRICARE,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,WELLMED,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,HUMANA,MGD,34.62,,,,,,,per diem,34.62,34.62,"Per diem rate, code is bundled with other services"
ITRACONAZOLE 100MG CAP        ,92211676,CDM,250,RC,,,,,,Inpatient,1,EA,34.62,34.62,HUMANA CHOICE PLUS,MGD,34.62,,,,,,,case rate,34.62,34.62,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 15MG CAP       ,92211677,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,AETNA,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,BCBS,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,CIGNA,COM,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,TRICARE,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,UNITED HEALTHCARE,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,UNITED HEALTHCARE,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,VA,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,VA TRICARE,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,WELLMED,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,HUMANA,MGD,218.07,,,,,,,per diem,218.07,218.07,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 400-57/5 SUS,92211678,CDM,250,RC,,,,,,Inpatient,1,EA,218.07,218.07,HUMANA CHOICE PLUS,MGD,218.07,,,,,,,case rate,218.07,218.07,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,AETNA,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,BCBS,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,CIGNA,COM,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,TRICARE,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,UNITED HEALTHCARE,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,UNITED HEALTHCARE,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,VA,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,VA TRICARE,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,WELLMED,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,HUMANA,MGD,721.98,,,,,,,per diem,721.98,721.98,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% OIN    ,92211679,CDM,250,RC,,,,,,Inpatient,1,EA,721.98,721.98,HUMANA CHOICE PLUS,MGD,721.98,,,,,,,case rate,721.98,721.98,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,AETNA,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,BCBS,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,CIGNA,COM,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,TRICARE,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,UNITED HEALTHCARE,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,UNITED HEALTHCARE,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,VA,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,VA TRICARE,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,WELLMED,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,HUMANA,MGD,33.11,,,,,,,per diem,33.11,33.11,"Per diem rate, code is bundled with other services"
BARRIER SKIN PROTECTANT OIN   ,92211680,CDM,250,RC,,,,,,Inpatient,1,EA,33.11,33.11,HUMANA CHOICE PLUS,MGD,33.11,,,,,,,case rate,33.11,33.11,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 100MG TAB         ,92211681,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,AETNA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,BCBS,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,CIGNA,COM,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,UNITED HEALTHCARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,VA,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,VA TRICARE,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,WELLMED,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,HUMANA,MGD,21.42,,,,,,,per diem,21.42,21.42,"Per diem rate, code is bundled with other services"
BUPIVACAINE/EPI 0.5%/0.0005 IN,92211682,CDM,250,RC,,,,,,Inpatient,1,EA,21.42,21.42,HUMANA CHOICE PLUS,MGD,21.42,,,,,,,case rate,21.42,21.42,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,AETNA,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,BCBS,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,CIGNA,COM,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,TRICARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,UNITED HEALTHCARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,UNITED HEALTHCARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,VA,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,VA TRICARE,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,WELLMED,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,HUMANA,MGD,8.63,,,,,,,per diem,8.63,8.63,"Per diem rate, code is bundled with other services"
BUTALBITAL COMP/COD #3 CAP    ,92211683,CDM,250,RC,,,,,,Inpatient,1,EA,8.63,8.63,HUMANA CHOICE PLUS,MGD,8.63,,,,,,,case rate,8.63,8.63,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,AETNA,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,BCBS,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,CIGNA,COM,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,TRICARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,UNITED HEALTHCARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,UNITED HEALTHCARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,VA,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,VA TRICARE,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,WELLMED,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,HUMANA,MGD,502.49,,,,,,,per diem,502.49,502.49,"Per diem rate, code is bundled with other services"
NYSTATIN/TRIAMCINOLONE CRE    ,92211684,CDM,250,RC,,,,,,Inpatient,1,EA,502.49,502.49,HUMANA CHOICE PLUS,MGD,502.49,,,,,,,case rate,502.49,502.49,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211685,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 50MG TAB      ,92211686,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,AETNA,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,BCBS,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,CIGNA,COM,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,TRICARE,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,UNITED HEALTHCARE,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,UNITED HEALTHCARE,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,VA,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,VA TRICARE,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,WELLMED,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,HUMANA,MGD,968.88,,,,,,,per diem,968.88,968.88,"Per diem rate, code is bundled with other services"
BECLOMETHASONE DIPRO 42MCG SPR,92211687,CDM,250,RC,,,,,,Inpatient,1,EA,968.88,968.88,HUMANA CHOICE PLUS,MGD,968.88,,,,,,,case rate,968.88,968.88,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,AETNA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,CIGNA,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,WELLMED,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA,MGD,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92211688,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA CHOICE PLUS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,AETNA,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,BCBS,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,CIGNA,COM,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,TRICARE,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,UNITED HEALTHCARE,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,UNITED HEALTHCARE,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,VA,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,VA TRICARE,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,WELLMED,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,HUMANA,MGD,555.12,,,,,,,per diem,555.12,555.12,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.25% GFS     ,92211689,CDM,250,RC,,,,,,Inpatient,1,EA,555.12,555.12,HUMANA CHOICE PLUS,MGD,555.12,,,,,,,case rate,555.12,555.12,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,AETNA,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,BCBS,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,CIGNA,COM,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,TRICARE,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,UNITED HEALTHCARE,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,UNITED HEALTHCARE,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,VA,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,VA TRICARE,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,WELLMED,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,HUMANA,MGD,78.59,,,,,,,per diem,78.59,78.59,"Per diem rate, code is bundled with other services"
OXACILLIN NA 2GM/50ML INJ     ,92211690,CDM,250,RC,,,,,,Inpatient,1,EA,78.59,78.59,HUMANA CHOICE PLUS,MGD,78.59,,,,,,,case rate,78.59,78.59,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,AETNA,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,BCBS,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,CIGNA,COM,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,TRICARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,UNITED HEALTHCARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,UNITED HEALTHCARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,VA,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,VA TRICARE,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,WELLMED,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,HUMANA,MGD,9.14,,,,,,,per diem,9.14,9.14,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG TAB,92211691,CDM,250,RC,,,,,,Inpatient,1,EA,9.14,9.14,HUMANA CHOICE PLUS,MGD,9.14,,,,,,,case rate,9.14,9.14,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1/4 STRENGTH TAB     ,92211692,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,AETNA,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,BCBS,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,CIGNA,COM,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,TRICARE,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,UNITED HEALTHCARE,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,UNITED HEALTHCARE,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,VA,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,VA TRICARE,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,WELLMED,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,HUMANA,MGD,98.28,,,,,,,per diem,98.28,98.28,"Per diem rate, code is bundled with other services"
ROPIVACAINE HCL 5MG/ML INJ    ,92211693,CDM,250,RC,,,,,,Inpatient,1,EA,98.28,98.28,HUMANA CHOICE PLUS,MGD,98.28,,,,,,,case rate,98.28,98.28,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,AETNA,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,BCBS,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,CIGNA,COM,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,TRICARE,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,UNITED HEALTHCARE,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,UNITED HEALTHCARE,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,VA,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,VA TRICARE,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,WELLMED,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,HUMANA,MGD,15.88,,,,,,,per diem,15.88,15.88,"Per diem rate, code is bundled with other services"
NUTRILYTE II 20ML INJ         ,92211694,CDM,250,RC,,,,,,Inpatient,1,EA,15.88,15.88,HUMANA CHOICE PLUS,MGD,15.88,,,,,,,case rate,15.88,15.88,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,AETNA,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,BCBS,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,CIGNA,COM,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,TRICARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,UNITED HEALTHCARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,UNITED HEALTHCARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,VA,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,VA TRICARE,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,WELLMED,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,HUMANA,MGD,33.64,,,,,,,per diem,33.64,33.64,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 2% EYE SOL    ,92211695,CDM,250,RC,,,,,,Inpatient,1,EA,33.64,33.64,HUMANA CHOICE PLUS,MGD,33.64,,,,,,,case rate,33.64,33.64,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 800MG TAB           ,92211696,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,AETNA,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,BCBS,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,CIGNA,COM,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,TRICARE,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,UNITED HEALTHCARE,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,UNITED HEALTHCARE,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,VA,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,VA TRICARE,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,WELLMED,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,HUMANA,MGD,31.69,,,,,,,per diem,31.69,31.69,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE ACET 40MG I,92211697,CDM,250,RC,,,,,,Inpatient,1,EA,31.69,31.69,HUMANA CHOICE PLUS,MGD,31.69,,,,,,,case rate,31.69,31.69,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE            ,92211698,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211699,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 10MG CAP   ,92211700,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,AETNA,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,BCBS,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,CIGNA,COM,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,TRICARE,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,UNITED HEALTHCARE,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,UNITED HEALTHCARE,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,VA,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,VA TRICARE,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,WELLMED,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,HUMANA,MGD,166.32,,,,,,,per diem,166.32,166.32,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG/ML SOL    ,92211701,CDM,250,RC,,,,,,Inpatient,1,EA,166.32,166.32,HUMANA CHOICE PLUS,MGD,166.32,,,,,,,case rate,166.32,166.32,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,AETNA,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,BCBS,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,CIGNA,COM,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,TRICARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,UNITED HEALTHCARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,UNITED HEALTHCARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,VA,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,VA TRICARE,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,WELLMED,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,HUMANA,MGD,27.88,,,,,,,per diem,27.88,27.88,"Per diem rate, code is bundled with other services"
ETOMIDATE 2MG/ML INJ          ,92211702,CDM,250,RC,,,,,,Inpatient,1,EA,27.88,27.88,HUMANA CHOICE PLUS,MGD,27.88,,,,,,,case rate,27.88,27.88,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,AETNA,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,BCBS,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,CIGNA,COM,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,TRICARE,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,UNITED HEALTHCARE,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,UNITED HEALTHCARE,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,VA,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,VA TRICARE,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,WELLMED,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,HUMANA,MGD,534.74,,,,,,,per diem,534.74,534.74,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP/REG 70U-30U I,92211703,CDM,250,RC,,,,,,Inpatient,1,EA,534.74,534.74,HUMANA CHOICE PLUS,MGD,534.74,,,,,,,case rate,534.74,534.74,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPHENIRAMINE MALEATE 4MG T,92211704,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,AETNA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,CIGNA,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,WELLMED,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA,MGD,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 80MG CER      ,92211705,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA CHOICE PLUS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,AETNA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,BCBS,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,CIGNA,COM,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,UNITED HEALTHCARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,VA,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,VA TRICARE,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,WELLMED,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,HUMANA,MGD,8.51,,,,,,,per diem,8.51,8.51,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211706,CDM,250,RC,,,,,,Inpatient,1,EA,8.51,8.51,HUMANA CHOICE PLUS,MGD,8.51,,,,,,,case rate,8.51,8.51,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,AETNA,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,BCBS,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,CIGNA,COM,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,TRICARE,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,UNITED HEALTHCARE,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,UNITED HEALTHCARE,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,VA,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,VA TRICARE,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,WELLMED,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,HUMANA,MGD,153.56,,,,,,,per diem,153.56,153.56,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92211707,CDM,250,RC,,,,,,Inpatient,1,EA,153.56,153.56,HUMANA CHOICE PLUS,MGD,153.56,,,,,,,case rate,153.56,153.56,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 500MG TAB       ,92211708,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,AETNA,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,BCBS,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,CIGNA,COM,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,TRICARE,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,UNITED HEALTHCARE,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,UNITED HEALTHCARE,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,VA,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,VA TRICARE,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,WELLMED,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,HUMANA,MGD,19.22,,,,,,,per diem,19.22,19.22,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG/5ML SUS     ,92211709,CDM,250,RC,,,,,,Inpatient,1,EA,19.22,19.22,HUMANA CHOICE PLUS,MGD,19.22,,,,,,,case rate,19.22,19.22,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,AETNA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,BCBS,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,CIGNA,COM,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,UNITED HEALTHCARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,VA TRICARE,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,WELLMED,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,HUMANA,MGD,12.6,,,,,,,per diem,12.6,12.6,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG/5ML SOL        ,92211710,CDM,250,RC,,,,,,Inpatient,1,EA,12.6,12.6,HUMANA CHOICE PLUS,MGD,12.6,,,,,,,case rate,12.6,12.6,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,AETNA,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,BCBS,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,CIGNA,COM,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,TRICARE,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,UNITED HEALTHCARE,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,UNITED HEALTHCARE,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,VA,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,VA TRICARE,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,WELLMED,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,HUMANA,MGD,76.26,,,,,,,per diem,76.26,76.26,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211711,CDM,250,RC,,,,,,Inpatient,1,EA,76.26,76.26,HUMANA CHOICE PLUS,MGD,76.26,,,,,,,case rate,76.26,76.26,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,AETNA,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,BCBS,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,CIGNA,COM,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,TRICARE,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,UNITED HEALTHCARE,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,UNITED HEALTHCARE,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,VA,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,VA TRICARE,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,WELLMED,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,HUMANA,MGD,88.01,,,,,,,per diem,88.01,88.01,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 10% GEL      ,92211712,CDM,250,RC,,,,,,Inpatient,1,EA,88.01,88.01,HUMANA CHOICE PLUS,MGD,88.01,,,,,,,case rate,88.01,88.01,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,AETNA,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,BCBS,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,CIGNA,COM,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,TRICARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,UNITED HEALTHCARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,UNITED HEALTHCARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,VA,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,VA TRICARE,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,WELLMED,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,HUMANA,MGD,5.39,,,,,,,per diem,5.39,5.39,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211713,CDM,250,RC,,,,,,Inpatient,1,EA,5.39,5.39,HUMANA CHOICE PLUS,MGD,5.39,,,,,,,case rate,5.39,5.39,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIP PERPHEN 25-4 TAB      ,92211714,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,AETNA,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,BCBS,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,CIGNA,COM,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,TRICARE,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,UNITED HEALTHCARE,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,UNITED HEALTHCARE,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,VA,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,VA TRICARE,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,WELLMED,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,HUMANA,MGD,256.41,,,,,,,per diem,256.41,256.41,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM INJ             ,92211715,CDM,250,RC,,,,,,Inpatient,1,EA,256.41,256.41,HUMANA CHOICE PLUS,MGD,256.41,,,,,,,case rate,256.41,256.41,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 325MG TAB             ,92211716,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,AETNA,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,BCBS,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,CIGNA,COM,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,TRICARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UNITED HEALTHCARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,UNITED HEALTHCARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,VA,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,VA TRICARE,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,WELLMED,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,HUMANA,MGD,13.14,,,,,,,per diem,13.14,13.14,"Per diem rate, code is bundled with other services"
NEOMYCIN SULF/POLYMYX B/PRAM C,92211717,CDM,250,RC,,,,,,Inpatient,1,EA,13.14,13.14,HUMANA CHOICE PLUS,MGD,13.14,,,,,,,case rate,13.14,13.14,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,AETNA,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,BCBS,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,CIGNA,COM,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,TRICARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,UNITED HEALTHCARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,UNITED HEALTHCARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,VA,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,VA TRICARE,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,WELLMED,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,HUMANA,MGD,19.78,,,,,,,per diem,19.78,19.78,"Per diem rate, code is bundled with other services"
TIAGAINE HCL 12MG TAB         ,92211718,CDM,250,RC,,,,,,Inpatient,1,EA,19.78,19.78,HUMANA CHOICE PLUS,MGD,19.78,,,,,,,case rate,19.78,19.78,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,AETNA,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,CIGNA,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,TRICARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UNITED HEALTHCARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UNITED HEALTHCARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA TRICARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,WELLMED,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,HUMANA,MGD,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
NALOXONE PENTAXOCINE 0.5-50 TA,92211719,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,HUMANA CHOICE PLUS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92211720,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NA PHOS DIBASIC/MONOBASIC NMA ,92211721,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 25MG TAB        ,92211722,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,AETNA,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,BCBS,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,CIGNA,COM,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,TRICARE,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,UNITED HEALTHCARE,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,UNITED HEALTHCARE,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,VA,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,VA TRICARE,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,WELLMED,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,HUMANA,MGD,268.98,,,,,,,per diem,268.98,268.98,"Per diem rate, code is bundled with other services"
ALBUTEROL SULF 90MCG ARO      ,92211723,CDM,250,RC,,,,,,Inpatient,1,EA,268.98,268.98,HUMANA CHOICE PLUS,MGD,268.98,,,,,,,case rate,268.98,268.98,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THYROLAR-1 STRENGTH TAB       ,92211724,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHOLINE MAG TRISAL 500MG/5ML L,92211725,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACARBOSE 25MG TAB             ,92211726,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 2MG TAB           ,92211727,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,AETNA,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,BCBS,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,CIGNA,COM,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,TRICARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,UNITED HEALTHCARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,UNITED HEALTHCARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,VA,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,VA TRICARE,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,WELLMED,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,HUMANA,MGD,34.56,,,,,,,per diem,34.56,34.56,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 1MG/ML INJ     ,92211728,CDM,250,RC,,,,,,Inpatient,1,EA,34.56,34.56,HUMANA CHOICE PLUS,MGD,34.56,,,,,,,case rate,34.56,34.56,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 650MG TAB        ,92211729,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,AETNA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,CIGNA,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,WELLMED,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA,MGD,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 25MG TAB      ,92211730,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA CHOICE PLUS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,AETNA,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,BCBS,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,CIGNA,COM,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,TRICARE,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,UNITED HEALTHCARE,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,UNITED HEALTHCARE,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,VA,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,VA TRICARE,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,WELLMED,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,HUMANA,MGD,9.7,,,,,,,per diem,9.7,9.7,"Per diem rate, code is bundled with other services"
TRIFLUOPERAZINE HCL 10MG TAB  ,92211731,CDM,250,RC,,,,,,Inpatient,1,EA,9.7,9.7,HUMANA CHOICE PLUS,MGD,9.7,,,,,,,case rate,9.7,9.7,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,AETNA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,BCBS,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,CIGNA,COM,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,UNITED HEALTHCARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,VA TRICARE,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,WELLMED,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA,MGD,22.05,,,,,,,per diem,22.05,22.05,"Per diem rate, code is bundled with other services"
METHYLENE BLUE 1% INJ         ,92211732,CDM,250,RC,,,,,,Inpatient,1,EA,22.05,22.05,HUMANA CHOICE PLUS,MGD,22.05,,,,,,,case rate,22.05,22.05,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPYRIDAMOLE 50MG TAB         ,92211733,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,AETNA,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,BCBS,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,CIGNA,COM,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,TRICARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,UNITED HEALTHCARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,UNITED HEALTHCARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,VA,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,VA TRICARE,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,WELLMED,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,HUMANA,MGD,86.59,,,,,,,per diem,86.59,86.59,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211734,CDM,250,RC,,,,,,Inpatient,1,EA,86.59,86.59,HUMANA CHOICE PLUS,MGD,86.59,,,,,,,case rate,86.59,86.59,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,AETNA,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,BCBS,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,CIGNA,COM,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,TRICARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,UNITED HEALTHCARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,UNITED HEALTHCARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,VA,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,VA TRICARE,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,WELLMED,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,HUMANA,MGD,17.39,,,,,,,per diem,17.39,17.39,"Per diem rate, code is bundled with other services"
OINTMENT BASE OIN             ,92211735,CDM,250,RC,,,,,,Inpatient,1,EA,17.39,17.39,HUMANA CHOICE PLUS,MGD,17.39,,,,,,,case rate,17.39,17.39,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG TER              ,92211736,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,AETNA,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,BCBS,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,CIGNA,COM,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,TRICARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,UNITED HEALTHCARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,UNITED HEALTHCARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,VA,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,VA TRICARE,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,WELLMED,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,HUMANA,MGD,34.97,,,,,,,per diem,34.97,34.97,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 40MG/ML INJ,92211737,CDM,250,RC,,,,,,Inpatient,1,EA,34.97,34.97,HUMANA CHOICE PLUS,MGD,34.97,,,,,,,case rate,34.97,34.97,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MORPHINE  10MG/5ML SOL        ,92211738,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211739,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211740,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,AETNA,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,BCBS,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,CIGNA,COM,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,TRICARE,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UNITED HEALTHCARE,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,UNITED HEALTHCARE,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,VA TRICARE,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,WELLMED,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,HUMANA,MGD,6.43,,,,,,,per diem,6.43,6.43,"Per diem rate, code is bundled with other services"
HALOPERIDOL LAC 2MG/ML SOL    ,92211741,CDM,250,RC,,,,,,Inpatient,1,EA,6.43,6.43,HUMANA CHOICE PLUS,MGD,6.43,,,,,,,case rate,6.43,6.43,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,AETNA,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,BCBS,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,CIGNA,COM,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,TRICARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,UNITED HEALTHCARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,UNITED HEALTHCARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,VA,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,VA TRICARE,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,WELLMED,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,HUMANA,MGD,26.68,,,,,,,per diem,26.68,26.68,"Per diem rate, code is bundled with other services"
CALCIUM CL 10% INJ            ,92211742,CDM,250,RC,,,,,,Inpatient,1,EA,26.68,26.68,HUMANA CHOICE PLUS,MGD,26.68,,,,,,,case rate,26.68,26.68,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,AETNA,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,BCBS,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,CIGNA,COM,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,TRICARE,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,UNITED HEALTHCARE,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,UNITED HEALTHCARE,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,VA,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,VA TRICARE,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,WELLMED,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,HUMANA,MGD,225.29,,,,,,,per diem,225.29,225.29,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211743,CDM,250,RC,,,,,,Inpatient,1,EA,225.29,225.29,HUMANA CHOICE PLUS,MGD,225.29,,,,,,,case rate,225.29,225.29,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROMORPHONE 2MG TAB         ,92211744,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,AETNA,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,BCBS,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,CIGNA,COM,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,TRICARE,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,UNITED HEALTHCARE,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,UNITED HEALTHCARE,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,VA,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,VA TRICARE,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,WELLMED,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,HUMANA,MGD,38.65,,,,,,,per diem,38.65,38.65,"Per diem rate, code is bundled with other services"
ANTIPYRINE/BENZOCAINE EAR SOL ,92211745,CDM,250,RC,,,,,,Inpatient,1,EA,38.65,38.65,HUMANA CHOICE PLUS,MGD,38.65,,,,,,,case rate,38.65,38.65,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,AETNA,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,BCBS,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,CIGNA,COM,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,TRICARE,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,UNITED HEALTHCARE,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,UNITED HEALTHCARE,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,VA,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,VA TRICARE,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,WELLMED,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,HUMANA,MGD,221.54,,,,,,,per diem,221.54,221.54,"Per diem rate, code is bundled with other services"
PILOCARPINE HCL 1% EYE SOL    ,92211746,CDM,250,RC,,,,,,Inpatient,1,EA,221.54,221.54,HUMANA CHOICE PLUS,MGD,221.54,,,,,,,case rate,221.54,221.54,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 80MG TAB           ,92211747,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,AETNA,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,BCBS,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,CIGNA,COM,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,TRICARE,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,UNITED HEALTHCARE,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,UNITED HEALTHCARE,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,VA,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,VA TRICARE,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,WELLMED,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,HUMANA,MGD,285.71,,,,,,,per diem,285.71,285.71,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92211748,CDM,250,RC,,,,,,Inpatient,1,EA,285.71,285.71,HUMANA CHOICE PLUS,MGD,285.71,,,,,,,case rate,285.71,285.71,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,AETNA,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,BCBS,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,CIGNA,COM,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,TRICARE,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,UNITED HEALTHCARE,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,UNITED HEALTHCARE,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,VA,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,VA TRICARE,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,WELLMED,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,HUMANA,MGD,771.56,,,,,,,per diem,771.56,771.56,"Per diem rate, code is bundled with other services"
MUPIROCIN 2% CRE              ,92211749,CDM,250,RC,,,,,,Inpatient,1,EA,771.56,771.56,HUMANA CHOICE PLUS,MGD,771.56,,,,,,,case rate,771.56,771.56,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,AETNA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,BCBS,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,CIGNA,COM,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,UNITED HEALTHCARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,VA TRICARE,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,WELLMED,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA,MGD,6.11,,,,,,,per diem,6.11,6.11,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 120MG CER       ,92211750,CDM,250,RC,,,,,,Inpatient,1,EA,6.11,6.11,HUMANA CHOICE PLUS,MGD,6.11,,,,,,,case rate,6.11,6.11,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 25MG CAP         ,92211751,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NORTRIPTYLINE HCL 25MG CAP    ,92211752,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,AETNA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,CIGNA,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,WELLMED,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA,MGD,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211753,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA CHOICE PLUS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,AETNA,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,BCBS,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,CIGNA,COM,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,TRICARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UNITED HEALTHCARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,UNITED HEALTHCARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,VA TRICARE,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,WELLMED,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,HUMANA,MGD,9.51,,,,,,,per diem,9.51,9.51,"Per diem rate, code is bundled with other services"
BENZOYL PEROXIDE 5% LOT       ,92211754,CDM,250,RC,,,,,,Inpatient,1,EA,9.51,9.51,HUMANA CHOICE PLUS,MGD,9.51,,,,,,,case rate,9.51,9.51,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,AETNA,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,BCBS,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,CIGNA,COM,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,TRICARE,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,UNITED HEALTHCARE,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,UNITED HEALTHCARE,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,VA,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,VA TRICARE,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,WELLMED,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,HUMANA,MGD,260.22,,,,,,,per diem,260.22,260.22,"Per diem rate, code is bundled with other services"
DORZOLAMIDE HCL 2% SOL        ,92211755,CDM,250,RC,,,,,,Inpatient,1,EA,260.22,260.22,HUMANA CHOICE PLUS,MGD,260.22,,,,,,,case rate,260.22,260.22,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,AETNA,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,BCBS,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,CIGNA,COM,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,TRICARE,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,UNITED HEALTHCARE,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,UNITED HEALTHCARE,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,VA,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,VA TRICARE,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,WELLMED,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,HUMANA,MGD,239.72,,,,,,,per diem,239.72,239.72,"Per diem rate, code is bundled with other services"
HALOBETASOL PROP 0.05% CRE    ,92211756,CDM,250,RC,,,,,,Inpatient,1,EA,239.72,239.72,HUMANA CHOICE PLUS,MGD,239.72,,,,,,,case rate,239.72,239.72,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,AETNA,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,BCBS,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,CIGNA,COM,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,TRICARE,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,UNITED HEALTHCARE,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,UNITED HEALTHCARE,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,VA,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,VA TRICARE,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,WELLMED,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,HUMANA,MGD,31.37,,,,,,,per diem,31.37,31.37,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 60MG/0.9% NACL INJ ,92211757,CDM,250,RC,,,,,,Inpatient,1,EA,31.37,31.37,HUMANA CHOICE PLUS,MGD,31.37,,,,,,,case rate,31.37,31.37,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,AETNA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,BCBS,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,CIGNA,COM,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,UNITED HEALTHCARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,VA,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,VA TRICARE,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,WELLMED,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,HUMANA,MGD,27.85,,,,,,,per diem,27.85,27.85,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 250MG TAB        ,92211758,CDM,250,RC,,,,,,Inpatient,1,EA,27.85,27.85,HUMANA CHOICE PLUS,MGD,27.85,,,,,,,case rate,27.85,27.85,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CETIRIZINE HCL 1MG/ML SYR     ,92211759,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,AETNA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,CIGNA,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,WELLMED,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA,MGD,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
AMPHETAMINE SALTS 10MG TAB    ,92211760,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA CHOICE PLUS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TETRACYCLINE HCL 250MG CAP    ,92211761,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,AETNA,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,CIGNA,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,TRICARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,UNITED HEALTHCARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,UNITED HEALTHCARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,VA,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,VA TRICARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,WELLMED,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,HUMANA,MGD,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 40MG/ML INJ   ,92211762,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,HUMANA CHOICE PLUS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG CAP       ,92211763,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,AETNA,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,CIGNA,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,TRICARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UNITED HEALTHCARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UNITED HEALTHCARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA TRICARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,WELLMED,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,HUMANA,MGD,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
FLUTAMIDE 125MG CAP           ,92211764,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,HUMANA CHOICE PLUS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,AETNA,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,BCBS,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,CIGNA,COM,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,TRICARE,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,UNITED HEALTHCARE,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,UNITED HEALTHCARE,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,VA,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,VA TRICARE,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,WELLMED,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,HUMANA,MGD,24.73,,,,,,,per diem,24.73,24.73,"Per diem rate, code is bundled with other services"
TOPIRAMATE 200MG TAB          ,92211765,CDM,250,RC,,,,,,Inpatient,1,EA,24.73,24.73,HUMANA CHOICE PLUS,MGD,24.73,,,,,,,case rate,24.73,24.73,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 0.5MG TAB           ,92211766,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,AETNA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,CIGNA,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,WELLMED,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA,MGD,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
FLUOXETINE HCL 20MG TAB       ,92211767,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA CHOICE PLUS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 25MG TAB      ,92211768,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE DM 6.25-15MG/5 SY,92211769,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,AETNA,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,BCBS,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,CIGNA,COM,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,TRICARE,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,UNITED HEALTHCARE,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,UNITED HEALTHCARE,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,VA,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,VA TRICARE,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,WELLMED,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,HUMANA,MGD,1500.75,,,,,,,per diem,1500.75,1500.75,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 250-62.5 SUS,92211770,CDM,250,RC,,,,,,Inpatient,1,EA,1500.75,1500.75,HUMANA CHOICE PLUS,MGD,1500.75,,,,,,,case rate,1500.75,1500.75,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,AETNA,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,BCBS,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,CIGNA,COM,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,TRICARE,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,UNITED HEALTHCARE,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,UNITED HEALTHCARE,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,VA,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,VA TRICARE,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,WELLMED,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,HUMANA,MGD,491.4,,,,,,,per diem,491.4,491.4,"Per diem rate, code is bundled with other services"
HYALURONATE NA 10MG/ML INJ    ,92211771,CDM,250,RC,,,,,,Inpatient,1,EA,491.4,491.4,HUMANA CHOICE PLUS,MGD,491.4,,,,,,,case rate,491.4,491.4,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOCUSATE NA 100MG SGL         ,92211772,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,AETNA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,BCBS,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,CIGNA,COM,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,UNITED HEALTHCARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,VA TRICARE,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,WELLMED,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA,MGD,13.39,,,,,,,per diem,13.39,13.39,"Per diem rate, code is bundled with other services"
DEXTRAN HYPROMELLOSE SOL      ,92211773,CDM,250,RC,,,,,,Inpatient,1,EA,13.39,13.39,HUMANA CHOICE PLUS,MGD,13.39,,,,,,,case rate,13.39,13.39,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NAPROXEN 500MG TAB            ,92211774,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,AETNA,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,BCBS,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,CIGNA,COM,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,TRICARE,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UNITED HEALTHCARE,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,UNITED HEALTHCARE,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,VA,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,VA TRICARE,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,WELLMED,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,HUMANA,MGD,12.57,,,,,,,per diem,12.57,12.57,"Per diem rate, code is bundled with other services"
SODIUM CL 4MEQ/ML INJ         ,92211775,CDM,250,RC,,,,,,Inpatient,1,EA,12.57,12.57,HUMANA CHOICE PLUS,MGD,12.57,,,,,,,case rate,12.57,12.57,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,AETNA,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,BCBS,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,CIGNA,COM,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,TRICARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,UNITED HEALTHCARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,UNITED HEALTHCARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,VA,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,VA TRICARE,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,WELLMED,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,HUMANA,MGD,12.76,,,,,,,per diem,12.76,12.76,"Per diem rate, code is bundled with other services"
DEXTROAMPHETAMINE SULF 5MG CER,92211776,CDM,250,RC,,,,,,Inpatient,1,EA,12.76,12.76,HUMANA CHOICE PLUS,MGD,12.76,,,,,,,case rate,12.76,12.76,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 100MG/5ML SUS       ,92211777,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,AETNA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,BCBS,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,CIGNA,COM,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,UNITED HEALTHCARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,VA TRICARE,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,WELLMED,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA,MGD,26.46,,,,,,,per diem,26.46,26.46,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SPR            ,92211778,CDM,250,RC,,,,,,Inpatient,1,EA,26.46,26.46,HUMANA CHOICE PLUS,MGD,26.46,,,,,,,case rate,26.46,26.46,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDOMETHACIN 50MG CAP         ,92211779,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92211780,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
WARFARIN NA 1MG TAB           ,92211781,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,AETNA,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,BCBS,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,CIGNA,COM,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,TRICARE,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,UNITED HEALTHCARE,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,UNITED HEALTHCARE,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,VA,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,VA TRICARE,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,WELLMED,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,HUMANA,MGD,62.37,,,,,,,per diem,62.37,62.37,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL 1GM/D5W 250ML I,92211782,CDM,250,RC,,,,,,Inpatient,1,EA,62.37,62.37,HUMANA CHOICE PLUS,MGD,62.37,,,,,,,case rate,62.37,62.37,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,AETNA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,BCBS,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,CIGNA,COM,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,UNITED HEALTHCARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,VA,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,VA TRICARE,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,WELLMED,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,HUMANA,MGD,174.57,,,,,,,per diem,174.57,174.57,"Per diem rate, code is bundled with other services"
ZOLMITRIPTAN 5MG TAB          ,92211783,CDM,250,RC,,,,,,Inpatient,1,EA,174.57,174.57,HUMANA CHOICE PLUS,MGD,174.57,,,,,,,case rate,174.57,174.57,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,AETNA,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,BCBS,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,CIGNA,COM,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,TRICARE,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,UNITED HEALTHCARE,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,UNITED HEALTHCARE,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,VA,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,VA TRICARE,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,WELLMED,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,HUMANA,MGD,136.84,,,,,,,per diem,136.84,136.84,"Per diem rate, code is bundled with other services"
HEXACHLOROPHENE HBR 5% SOL    ,92211784,CDM,250,RC,,,,,,Inpatient,1,EA,136.84,136.84,HUMANA CHOICE PLUS,MGD,136.84,,,,,,,case rate,136.84,136.84,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 5MG TAB         ,92211785,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,AETNA,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,BCBS,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,CIGNA,COM,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,TRICARE,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,UNITED HEALTHCARE,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,UNITED HEALTHCARE,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,VA,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,VA TRICARE,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,WELLMED,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,HUMANA,MGD,113.94,,,,,,,per diem,113.94,113.94,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 200-28.5/5 S,92211786,CDM,250,RC,,,,,,Inpatient,1,EA,113.94,113.94,HUMANA CHOICE PLUS,MGD,113.94,,,,,,,case rate,113.94,113.94,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,AETNA,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,BCBS,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,CIGNA,COM,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,TRICARE,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,UNITED HEALTHCARE,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,UNITED HEALTHCARE,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,VA,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,VA TRICARE,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,WELLMED,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,HUMANA,MGD,737.73,,,,,,,per diem,737.73,737.73,"Per diem rate, code is bundled with other services"
ACYCLOVIR 5% OIN              ,92211787,CDM,250,RC,,,,,,Inpatient,1,EA,737.73,737.73,HUMANA CHOICE PLUS,MGD,737.73,,,,,,,case rate,737.73,737.73,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG TAB        ,92211788,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,AETNA,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,BCBS,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,CIGNA,COM,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,TRICARE,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,UNITED HEALTHCARE,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,UNITED HEALTHCARE,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,VA,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,VA TRICARE,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,WELLMED,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,HUMANA,MGD,23.78,,,,,,,per diem,23.78,23.78,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 4% INJ          ,92211789,CDM,250,RC,,,,,,Inpatient,1,EA,23.78,23.78,HUMANA CHOICE PLUS,MGD,23.78,,,,,,,case rate,23.78,23.78,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211790,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,AETNA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,BCBS,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,CIGNA,COM,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,UNITED HEALTHCARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,VA,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,VA TRICARE,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,WELLMED,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,HUMANA,MGD,21.11,,,,,,,per diem,21.11,21.11,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 2.5% SOL    ,92211791,CDM,250,RC,,,,,,Inpatient,1,EA,21.11,21.11,HUMANA CHOICE PLUS,MGD,21.11,,,,,,,case rate,21.11,21.11,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,AETNA,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,BCBS,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,CIGNA,COM,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,TRICARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,UNITED HEALTHCARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,UNITED HEALTHCARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,VA,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,VA TRICARE,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,WELLMED,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,HUMANA,MGD,5.92,,,,,,,per diem,5.92,5.92,"Per diem rate, code is bundled with other services"
HALOPERIDOL 10MG TAB          ,92211792,CDM,250,RC,,,,,,Inpatient,1,EA,5.92,5.92,HUMANA CHOICE PLUS,MGD,5.92,,,,,,,case rate,5.92,5.92,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,AETNA,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,BCBS,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,CIGNA,COM,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,TRICARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,UNITED HEALTHCARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,UNITED HEALTHCARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,VA,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,VA TRICARE,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,WELLMED,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,HUMANA,MGD,7.72,,,,,,,per diem,7.72,7.72,"Per diem rate, code is bundled with other services"
CAPTOPRIL 50MG TAB            ,92211793,CDM,250,RC,,,,,,Inpatient,1,EA,7.72,7.72,HUMANA CHOICE PLUS,MGD,7.72,,,,,,,case rate,7.72,7.72,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICOTINE 14MG/24 HR TDM       ,92211794,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,AETNA,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,BCBS,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,CIGNA,COM,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,TRICARE,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,UNITED HEALTHCARE,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,UNITED HEALTHCARE,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,VA,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,VA TRICARE,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,WELLMED,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,HUMANA,MGD,27.94,,,,,,,per diem,27.94,27.94,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 8% INJ         ,92211795,CDM,250,RC,,,,,,Inpatient,1,EA,27.94,27.94,HUMANA CHOICE PLUS,MGD,27.94,,,,,,,case rate,27.94,27.94,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,AETNA,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,CIGNA,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,TRICARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UNITED HEALTHCARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UNITED HEALTHCARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA TRICARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,WELLMED,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,HUMANA,MGD,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
HYDROCODONE IBU 7.5-200MG TAB ,92211796,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,HUMANA CHOICE PLUS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ASPIRIN 81MG TAB              ,92211797,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,AETNA,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,BCBS,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,CIGNA,COM,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,TRICARE,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,UNITED HEALTHCARE,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,UNITED HEALTHCARE,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,VA,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,VA TRICARE,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,WELLMED,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,HUMANA,MGD,507.09,,,,,,,per diem,507.09,507.09,"Per diem rate, code is bundled with other services"
TOBRAMYCIN DEX 0.3-0.1% SUS   ,92211798,CDM,250,RC,,,,,,Inpatient,1,EA,507.09,507.09,HUMANA CHOICE PLUS,MGD,507.09,,,,,,,case rate,507.09,507.09,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211799,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN SOL              ,92211800,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIAZEPAM 10MG TAB             ,92211801,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,AETNA,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,BCBS,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,CIGNA,COM,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,TRICARE,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,UNITED HEALTHCARE,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,UNITED HEALTHCARE,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,VA,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,VA TRICARE,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,WELLMED,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,HUMANA,MGD,205.22,,,,,,,per diem,205.22,205.22,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 100MG TAB    ,92211802,CDM,250,RC,,,,,,Inpatient,1,EA,205.22,205.22,HUMANA CHOICE PLUS,MGD,205.22,,,,,,,case rate,205.22,205.22,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,AETNA,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,BCBS,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,CIGNA,COM,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,TRICARE,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UNITED HEALTHCARE,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,UNITED HEALTHCARE,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,VA TRICARE,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,WELLMED,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,HUMANA,MGD,5.76,,,,,,,per diem,5.76,5.76,"Per diem rate, code is bundled with other services"
MEPROBAMATE 400MG TAB         ,92211803,CDM,250,RC,,,,,,Inpatient,1,EA,5.76,5.76,HUMANA CHOICE PLUS,MGD,5.76,,,,,,,case rate,5.76,5.76,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYCLOBENZAPRINE HCL 10MG TAB  ,92211804,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,AETNA,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,CIGNA,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,TRICARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UNITED HEALTHCARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UNITED HEALTHCARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA TRICARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,WELLMED,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,HUMANA,MGD,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 250MG TAB       ,92211805,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,HUMANA CHOICE PLUS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,AETNA,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,BCBS,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,CIGNA,COM,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,TRICARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,UNITED HEALTHCARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,UNITED HEALTHCARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,VA,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,VA TRICARE,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,WELLMED,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,HUMANA,MGD,12.38,,,,,,,per diem,12.38,12.38,"Per diem rate, code is bundled with other services"
CITRIC ACID NA CITRATE SOL    ,92211806,CDM,250,RC,,,,,,Inpatient,1,EA,12.38,12.38,HUMANA CHOICE PLUS,MGD,12.38,,,,,,,case rate,12.38,12.38,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,AETNA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,CIGNA,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,WELLMED,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA,MGD,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
IRBESARTAN 150MG TAB          ,92211807,CDM,250,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA CHOICE PLUS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORAL HYDRATE 500MG/5ML SYR ,92211808,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,AETNA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,BCBS,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,CIGNA,COM,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,UNITED HEALTHCARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,VA TRICARE,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,WELLMED,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA,MGD,14.77,,,,,,,per diem,14.77,14.77,"Per diem rate, code is bundled with other services"
BACITRACIN 500U/GM OIN        ,92211809,CDM,250,RC,,,,,,Inpatient,1,EA,14.77,14.77,HUMANA CHOICE PLUS,MGD,14.77,,,,,,,case rate,14.77,14.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,AETNA,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,BCBS,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,CIGNA,COM,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,TRICARE,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,UNITED HEALTHCARE,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,UNITED HEALTHCARE,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,VA,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,VA TRICARE,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,WELLMED,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,HUMANA,MGD,28.76,,,,,,,per diem,28.76,28.76,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211810,CDM,258,RC,,,,,,Inpatient,1,EA,28.76,28.76,HUMANA CHOICE PLUS,MGD,28.76,,,,,,,case rate,28.76,28.76,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,AETNA,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,BCBS,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,CIGNA,COM,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,TRICARE,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,UNITED HEALTHCARE,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,UNITED HEALTHCARE,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,VA,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,VA TRICARE,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,WELLMED,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,HUMANA,MGD,1148.74,,,,,,,per diem,1148.74,1148.74,"Per diem rate, code is bundled with other services"
"EPOETIN ALFA 10,000U/ML INJ   ",92211811,CDM,250,RC,,,,,,Inpatient,1,EA,1148.74,1148.74,HUMANA CHOICE PLUS,MGD,1148.74,,,,,,,case rate,1148.74,1148.74,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 40MG TAB       ,92211812,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,AETNA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,BCBS,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,CIGNA,COM,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,UNITED HEALTHCARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,VA,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,VA TRICARE,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,WELLMED,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,HUMANA,MGD,110.31,,,,,,,per diem,110.31,110.31,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 200MG/5ML SUS    ,92211813,CDM,250,RC,,,,,,Inpatient,1,EA,110.31,110.31,HUMANA CHOICE PLUS,MGD,110.31,,,,,,,case rate,110.31,110.31,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,AETNA,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,BCBS,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,CIGNA,COM,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,TRICARE,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,UNITED HEALTHCARE,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,UNITED HEALTHCARE,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,VA,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,VA TRICARE,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,WELLMED,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,HUMANA,MGD,1952.18,,,,,,,per diem,1952.18,1952.18,"Per diem rate, code is bundled with other services"
FILGRASTIM 480MCG/0.8ML INJ   ,92211814,CDM,250,RC,,,,,,Inpatient,1,EA,1952.18,1952.18,HUMANA CHOICE PLUS,MGD,1952.18,,,,,,,case rate,1952.18,1952.18,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,AETNA,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,BCBS,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,CIGNA,COM,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,TRICARE,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,UNITED HEALTHCARE,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,UNITED HEALTHCARE,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,VA,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,VA TRICARE,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,WELLMED,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,HUMANA,MGD,11.69,,,,,,,per diem,11.69,11.69,"Per diem rate, code is bundled with other services"
PROVIDONE IODINE 10% OIN      ,92211815,CDM,250,RC,,,,,,Inpatient,1,EA,11.69,11.69,HUMANA CHOICE PLUS,MGD,11.69,,,,,,,case rate,11.69,11.69,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,AETNA,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,BCBS,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,CIGNA,COM,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,TRICARE,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,UNITED HEALTHCARE,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,UNITED HEALTHCARE,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,VA,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,VA TRICARE,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,WELLMED,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,HUMANA,MGD,12.35,,,,,,,per diem,12.35,12.35,"Per diem rate, code is bundled with other services"
SOTALOL HCL 160MG TAB         ,92211816,CDM,250,RC,,,,,,Inpatient,1,EA,12.35,12.35,HUMANA CHOICE PLUS,MGD,12.35,,,,,,,case rate,12.35,12.35,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG/5ML SOL   ,92211817,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,AETNA,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,BCBS,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,CIGNA,COM,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,TRICARE,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,UNITED HEALTHCARE,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,UNITED HEALTHCARE,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,VA,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,VA TRICARE,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,WELLMED,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,HUMANA,MGD,29.52,,,,,,,per diem,29.52,29.52,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG/500ML INJ  ,92211818,CDM,250,RC,,,,,,Inpatient,1,EA,29.52,29.52,HUMANA CHOICE PLUS,MGD,29.52,,,,,,,case rate,29.52,29.52,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 2MG TAB             ,92211819,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,AETNA,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,BCBS,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,CIGNA,COM,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,TRICARE,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,UNITED HEALTHCARE,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,UNITED HEALTHCARE,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,VA,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,VA TRICARE,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,WELLMED,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,HUMANA,MGD,34.74,,,,,,,per diem,34.74,34.74,"Per diem rate, code is bundled with other services"
TETRACAINE HCL 0.5% SOL       ,92211820,CDM,250,RC,,,,,,Inpatient,1,EA,34.74,34.74,HUMANA CHOICE PLUS,MGD,34.74,,,,,,,case rate,34.74,34.74,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 60MG TAB  ,92211821,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL FUMARATE/HCTZ TAB  ,92211822,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,AETNA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,BCBS,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,CIGNA,COM,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,UNITED HEALTHCARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,VA TRICARE,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,WELLMED,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA,MGD,11.34,,,,,,,per diem,11.34,11.34,"Per diem rate, code is bundled with other services"
ESTRIFIED ESTROGENS METHY TAB ,92211823,CDM,250,RC,,,,,,Inpatient,1,EA,11.34,11.34,HUMANA CHOICE PLUS,MGD,11.34,,,,,,,case rate,11.34,11.34,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,AETNA,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,BCBS,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,CIGNA,COM,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,TRICARE,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,UNITED HEALTHCARE,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,UNITED HEALTHCARE,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,VA,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,VA TRICARE,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,WELLMED,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,HUMANA,MGD,817.65,,,,,,,per diem,817.65,817.65,"Per diem rate, code is bundled with other services"
IPRATR-ALBUTEROL 200ACT ARO   ,92211824,CDM,250,RC,,,,,,Inpatient,1,EA,817.65,817.65,HUMANA CHOICE PLUS,MGD,817.65,,,,,,,case rate,817.65,817.65,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,AETNA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,BCBS,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,CIGNA,COM,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,UNITED HEALTHCARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,VA TRICARE,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,WELLMED,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA,MGD,8.1,,,,,,,per diem,8.1,8.1,"Per diem rate, code is bundled with other services"
IRBESARTAN 75MG TAB           ,92211825,CDM,250,RC,,,,,,Inpatient,1,EA,8.1,8.1,HUMANA CHOICE PLUS,MGD,8.1,,,,,,,case rate,8.1,8.1,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXAZEPAM 15MG CAP             ,92211826,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,AETNA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,CIGNA,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,WELLMED,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA,MGD,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92211827,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA CHOICE PLUS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
METOCLOPRAMIDE 5MG/ML INJ     ,92211828,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,AETNA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,BCBS,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,CIGNA,COM,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,UNITED HEALTHCARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,VA,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,VA TRICARE,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,WELLMED,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,HUMANA,MGD,13.1,,,,,,,per diem,13.1,13.1,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 5MG TAB         ,92211829,CDM,250,RC,,,,,,Inpatient,1,EA,13.1,13.1,HUMANA CHOICE PLUS,MGD,13.1,,,,,,,case rate,13.1,13.1,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,AETNA,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,BCBS,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,CIGNA,COM,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,TRICARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UNITED HEALTHCARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,UNITED HEALTHCARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,VA TRICARE,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,WELLMED,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,HUMANA,MGD,11.4,,,,,,,per diem,11.4,11.4,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG C12        ,92211830,CDM,250,RC,,,,,,Inpatient,1,EA,11.4,11.4,HUMANA CHOICE PLUS,MGD,11.4,,,,,,,case rate,11.4,11.4,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211831,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,AETNA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,BCBS,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,CIGNA,COM,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,UNITED HEALTHCARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,VA,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,VA TRICARE,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,WELLMED,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,HUMANA,MGD,58.91,,,,,,,per diem,58.91,58.91,"Per diem rate, code is bundled with other services"
PENICILLIN GK 5MMU INJ        ,92211832,CDM,250,RC,,,,,,Inpatient,1,EA,58.91,58.91,HUMANA CHOICE PLUS,MGD,58.91,,,,,,,case rate,58.91,58.91,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,AETNA,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,BCBS,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,CIGNA,COM,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,TRICARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UNITED HEALTHCARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,UNITED HEALTHCARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,VA TRICARE,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,WELLMED,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,HUMANA,MGD,10.05,,,,,,,per diem,10.05,10.05,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 2GM INJ         ,92211833,CDM,250,RC,,,,,,Inpatient,1,EA,10.05,10.05,HUMANA CHOICE PLUS,MGD,10.05,,,,,,,case rate,10.05,10.05,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211834,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYBUTYNIN CL 5MG/5ML SYR     ,92211835,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,AETNA,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,BCBS,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,CIGNA,COM,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,TRICARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,UNITED HEALTHCARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,UNITED HEALTHCARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,VA,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,VA TRICARE,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,WELLMED,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,HUMANA,MGD,27.5,,,,,,,per diem,27.5,27.5,"Per diem rate, code is bundled with other services"
FLURBIPROFEN NA 0.03% EYE SOL ,92211836,CDM,250,RC,,,,,,Inpatient,1,EA,27.5,27.5,HUMANA CHOICE PLUS,MGD,27.5,,,,,,,case rate,27.5,27.5,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 20MG TAB           ,92211837,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92211838,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,AETNA,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,BCBS,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,CIGNA,COM,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,TRICARE,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,UNITED HEALTHCARE,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,UNITED HEALTHCARE,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,VA,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,VA TRICARE,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,WELLMED,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,HUMANA,MGD,9.83,,,,,,,per diem,9.83,9.83,"Per diem rate, code is bundled with other services"
KETOROLAC 15MG/ML INJ         ,92211839,CDM,250,RC,,,,,,Inpatient,1,EA,9.83,9.83,HUMANA CHOICE PLUS,MGD,9.83,,,,,,,case rate,9.83,9.83,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,AETNA,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,BCBS,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,CIGNA,COM,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,TRICARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,UNITED HEALTHCARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,UNITED HEALTHCARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,VA,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,VA TRICARE,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,WELLMED,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,HUMANA,MGD,35.41,,,,,,,per diem,35.41,35.41,"Per diem rate, code is bundled with other services"
CLOMIPRAMINE HCL 75MG CAP     ,92211840,CDM,250,RC,,,,,,Inpatient,1,EA,35.41,35.41,HUMANA CHOICE PLUS,MGD,35.41,,,,,,,case rate,35.41,35.41,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,AETNA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,BCBS,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,CIGNA,COM,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,UNITED HEALTHCARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,VA TRICARE,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,WELLMED,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA,MGD,5.99,,,,,,,per diem,5.99,5.99,"Per diem rate, code is bundled with other services"
MAGNESIUM SULF 50% INJ        ,92211841,CDM,250,RC,,,,,,Inpatient,1,EA,5.99,5.99,HUMANA CHOICE PLUS,MGD,5.99,,,,,,,case rate,5.99,5.99,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,AETNA,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,BCBS,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,CIGNA,COM,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,TRICARE,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,UNITED HEALTHCARE,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,UNITED HEALTHCARE,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,VA,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,VA TRICARE,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,WELLMED,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,HUMANA,MGD,126.13,,,,,,,per diem,126.13,126.13,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 1% CRE           ,92211842,CDM,250,RC,,,,,,Inpatient,1,EA,126.13,126.13,HUMANA CHOICE PLUS,MGD,126.13,,,,,,,case rate,126.13,126.13,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,AETNA,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,BCBS,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,CIGNA,COM,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,TRICARE,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,UNITED HEALTHCARE,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,UNITED HEALTHCARE,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,VA,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,VA TRICARE,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,WELLMED,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,HUMANA,MGD,73.68,,,,,,,per diem,73.68,73.68,"Per diem rate, code is bundled with other services"
DTAP VACCINE SUS              ,92211843,CDM,250,RC,,,,,,Inpatient,1,EA,73.68,73.68,HUMANA CHOICE PLUS,MGD,73.68,,,,,,,case rate,73.68,73.68,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,AETNA,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,BCBS,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,CIGNA,COM,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,TRICARE,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,UNITED HEALTHCARE,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,UNITED HEALTHCARE,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,VA,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,VA TRICARE,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,WELLMED,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,HUMANA,MGD,55.19,,,,,,,per diem,55.19,55.19,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 200MG SUP  ,92211844,CDM,250,RC,,,,,,Inpatient,1,EA,55.19,55.19,HUMANA CHOICE PLUS,MGD,55.19,,,,,,,case rate,55.19,55.19,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,AETNA,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,BCBS,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,CIGNA,COM,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,TRICARE,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,UNITED HEALTHCARE,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,UNITED HEALTHCARE,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,VA,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,VA TRICARE,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,WELLMED,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,HUMANA,MGD,46.97,,,,,,,per diem,46.97,46.97,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 5MG/GM OIN       ,92211845,CDM,250,RC,,,,,,Inpatient,1,EA,46.97,46.97,HUMANA CHOICE PLUS,MGD,46.97,,,,,,,case rate,46.97,46.97,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LISINOPRIL 20MG TAB           ,92211846,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,AETNA,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,CIGNA,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,TRICARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,UNITED HEALTHCARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,UNITED HEALTHCARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,VA,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,VA TRICARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,WELLMED,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,HUMANA,MGD,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
MENTHOL METHYL SALICYL 8-30% C,92211847,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,HUMANA CHOICE PLUS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,AETNA,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,CIGNA,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,TRICARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,UNITED HEALTHCARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,UNITED HEALTHCARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,VA,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,VA TRICARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,WELLMED,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,HUMANA,MGD,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% OIN  ,92211848,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,HUMANA CHOICE PLUS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,AETNA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,CIGNA,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,WELLMED,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA,MGD,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92211849,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA CHOICE PLUS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMITRIPTYLINE HCL 50MG TAB    ,92211850,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,AETNA,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,BCBS,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,CIGNA,COM,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,TRICARE,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,UNITED HEALTHCARE,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,UNITED HEALTHCARE,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,VA,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,VA TRICARE,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,WELLMED,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,HUMANA,MGD,11.47,,,,,,,per diem,11.47,11.47,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211851,CDM,250,RC,,,,,,Inpatient,1,EA,11.47,11.47,HUMANA CHOICE PLUS,MGD,11.47,,,,,,,case rate,11.47,11.47,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISACODYL 10MG SUP            ,92211852,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92211853,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 150MG/ML INJ ,92211854,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDODRINE HCL 2.5MG TAB       ,92211855,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,AETNA,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,BCBS,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,CIGNA,COM,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,TRICARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,UNITED HEALTHCARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,UNITED HEALTHCARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,VA,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,VA TRICARE,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,WELLMED,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,HUMANA,MGD,9.54,,,,,,,per diem,9.54,9.54,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 100MG CAP  ,92211856,CDM,250,RC,,,,,,Inpatient,1,EA,9.54,9.54,HUMANA CHOICE PLUS,MGD,9.54,,,,,,,case rate,9.54,9.54,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,AETNA,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,BCBS,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,CIGNA,COM,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,TRICARE,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,UNITED HEALTHCARE,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,UNITED HEALTHCARE,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,VA,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,VA TRICARE,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,WELLMED,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,HUMANA,MGD,11.59,,,,,,,per diem,11.59,11.59,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211857,CDM,258,RC,,,,,,Inpatient,1,EA,11.59,11.59,HUMANA CHOICE PLUS,MGD,11.59,,,,,,,case rate,11.59,11.59,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92211858,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SUCRALFATE 1GM TAB            ,92211859,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
INDAPAMIDE 2.5MG TAB          ,92211860,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,AETNA,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,CIGNA,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,TRICARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,UNITED HEALTHCARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,UNITED HEALTHCARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,VA,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,VA TRICARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,WELLMED,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,HUMANA,MGD,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 10MG TAB       ,92211861,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,HUMANA CHOICE PLUS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 120MG C24       ,92211862,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,AETNA,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,BCBS,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,CIGNA,COM,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,TRICARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,UNITED HEALTHCARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,UNITED HEALTHCARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,VA,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,VA TRICARE,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,WELLMED,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,HUMANA,MGD,19.66,,,,,,,per diem,19.66,19.66,"Per diem rate, code is bundled with other services"
CONJUCATED ESTROGENS 0.625MG T,92211863,CDM,250,RC,,,,,,Inpatient,1,EA,19.66,19.66,HUMANA CHOICE PLUS,MGD,19.66,,,,,,,case rate,19.66,19.66,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,AETNA,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,BCBS,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,CIGNA,COM,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,TRICARE,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,UNITED HEALTHCARE,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,UNITED HEALTHCARE,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,VA,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,VA TRICARE,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,WELLMED,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,HUMANA,MGD,57.49,,,,,,,per diem,57.49,57.49,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 10MG/ML SOL       ,92211864,CDM,250,RC,,,,,,Inpatient,1,EA,57.49,57.49,HUMANA CHOICE PLUS,MGD,57.49,,,,,,,case rate,57.49,57.49,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,AETNA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,CIGNA,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,WELLMED,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA,MGD,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 300MG TAB      ,92211865,CDM,250,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA CHOICE PLUS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211866,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,AETNA,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,CIGNA,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,TRICARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,UNITED HEALTHCARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,UNITED HEALTHCARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,VA,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,VA TRICARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,WELLMED,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,HUMANA,MGD,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% CRE      ,92211867,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,HUMANA CHOICE PLUS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,AETNA,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,BCBS,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,CIGNA,COM,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,TRICARE,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,UNITED HEALTHCARE,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,UNITED HEALTHCARE,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,VA,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,VA TRICARE,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,WELLMED,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,HUMANA,MGD,807.82,,,,,,,per diem,807.82,807.82,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% CRE     ,92211868,CDM,250,RC,,,,,,Inpatient,1,EA,807.82,807.82,HUMANA CHOICE PLUS,MGD,807.82,,,,,,,case rate,807.82,807.82,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,AETNA,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,BCBS,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,CIGNA,COM,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,TRICARE,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,UNITED HEALTHCARE,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,UNITED HEALTHCARE,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,VA,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,VA TRICARE,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,WELLMED,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,HUMANA,MGD,683.3,,,,,,,per diem,683.3,683.3,"Per diem rate, code is bundled with other services"
SUMATRIPTAN SUCC 6MG/0.5ML KIT,92211869,CDM,250,RC,,,,,,Inpatient,1,EA,683.3,683.3,HUMANA CHOICE PLUS,MGD,683.3,,,,,,,case rate,683.3,683.3,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHYLDOPA 500MG TAB          ,92211870,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,AETNA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,BCBS,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,CIGNA,COM,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,UNITED HEALTHCARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,VA TRICARE,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,WELLMED,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA,MGD,6.84,,,,,,,per diem,6.84,6.84,"Per diem rate, code is bundled with other services"
LACTULOSE 10GM/15ML SOL       ,92211871,CDM,250,RC,,,,,,Inpatient,1,EA,6.84,6.84,HUMANA CHOICE PLUS,MGD,6.84,,,,,,,case rate,6.84,6.84,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,AETNA,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,BCBS,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,CIGNA,COM,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,TRICARE,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,UNITED HEALTHCARE,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,UNITED HEALTHCARE,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,VA,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,VA TRICARE,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,WELLMED,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,HUMANA,MGD,204.94,,,,,,,per diem,204.94,204.94,"Per diem rate, code is bundled with other services"
COLLAGENASE 250U/GM OIN       ,92211872,CDM,250,RC,,,,,,Inpatient,1,EA,204.94,204.94,HUMANA CHOICE PLUS,MGD,204.94,,,,,,,case rate,204.94,204.94,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,AETNA,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,BCBS,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,CIGNA,COM,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,TRICARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,UNITED HEALTHCARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,UNITED HEALTHCARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,VA,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,VA TRICARE,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,WELLMED,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,HUMANA,MGD,23.81,,,,,,,per diem,23.81,23.81,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211873,CDM,250,RC,,,,,,Inpatient,1,EA,23.81,23.81,HUMANA CHOICE PLUS,MGD,23.81,,,,,,,case rate,23.81,23.81,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 30MG TAB        ,92211874,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 50MG TAB            ,92211875,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,AETNA,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,BCBS,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,CIGNA,COM,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,TRICARE,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UNITED HEALTHCARE,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,UNITED HEALTHCARE,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,VA,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,VA TRICARE,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,WELLMED,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,HUMANA,MGD,7.56,,,,,,,per diem,7.56,7.56,"Per diem rate, code is bundled with other services"
VENLAFAXINE HCL 25MG TAB      ,92211876,CDM,250,RC,,,,,,Inpatient,1,EA,7.56,7.56,HUMANA CHOICE PLUS,MGD,7.56,,,,,,,case rate,7.56,7.56,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92211877,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM CARB 250 W/D 125U TAB ,92211878,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,AETNA,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,BCBS,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,CIGNA,COM,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,TRICARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UNITED HEALTHCARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,UNITED HEALTHCARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,VA TRICARE,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,WELLMED,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,HUMANA,MGD,6.17,,,,,,,per diem,6.17,6.17,"Per diem rate, code is bundled with other services"
MEPERIDINE 75MG/1.5ML INJ     ,92211879,CDM,250,RC,,,,,,Inpatient,1,EA,6.17,6.17,HUMANA CHOICE PLUS,MGD,6.17,,,,,,,case rate,6.17,6.17,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLURAZEPAM HCL 30MG CAP       ,92211880,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,AETNA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,BCBS,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,CIGNA,COM,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,UNITED HEALTHCARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,VA TRICARE,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,WELLMED,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA,MGD,5.36,,,,,,,per diem,5.36,5.36,"Per diem rate, code is bundled with other services"
NITROGLYCERIN 0.4MG/HR TDM    ,92211881,CDM,250,RC,,,,,,Inpatient,1,EA,5.36,5.36,HUMANA CHOICE PLUS,MGD,5.36,,,,,,,case rate,5.36,5.36,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,AETNA,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,BCBS,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,CIGNA,COM,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,TRICARE,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,UNITED HEALTHCARE,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,UNITED HEALTHCARE,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,VA,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,VA TRICARE,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,WELLMED,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,HUMANA,MGD,22.46,,,,,,,per diem,22.46,22.46,"Per diem rate, code is bundled with other services"
ENALAPRILAT 1.25MG/ML INJ     ,92211882,CDM,250,RC,,,,,,Inpatient,1,EA,22.46,22.46,HUMANA CHOICE PLUS,MGD,22.46,,,,,,,case rate,22.46,22.46,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,AETNA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,BCBS,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,CIGNA,COM,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,UNITED HEALTHCARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,VA TRICARE,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,WELLMED,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA,MGD,12.54,,,,,,,per diem,12.54,12.54,"Per diem rate, code is bundled with other services"
CALAMINE LOT                  ,92211883,CDM,250,RC,,,,,,Inpatient,1,EA,12.54,12.54,HUMANA CHOICE PLUS,MGD,12.54,,,,,,,case rate,12.54,12.54,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 500MG TAB       ,92211884,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 100MG TAB     ,92211885,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,AETNA,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,BCBS,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,CIGNA,COM,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,TRICARE,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,UNITED HEALTHCARE,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,UNITED HEALTHCARE,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,VA,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,VA TRICARE,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,WELLMED,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,HUMANA,MGD,2298.18,,,,,,,per diem,2298.18,2298.18,"Per diem rate, code is bundled with other services"
LEUPROLIDE ACET 3.75MG KIT PI1,92211886,CDM,250,RC,,,,,,Inpatient,1,EA,2298.18,2298.18,HUMANA CHOICE PLUS,MGD,2298.18,,,,,,,case rate,2298.18,2298.18,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 5MG TAB            ,92211887,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92211888,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.5MG TAB          ,92211889,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92211890,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,AETNA,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,BCBS,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,CIGNA,COM,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,TRICARE,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,UNITED HEALTHCARE,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,UNITED HEALTHCARE,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,VA,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,VA TRICARE,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,WELLMED,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,HUMANA,MGD,1356.39,,,,,,,per diem,1356.39,1356.39,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% IVS         ,92211891,CDM,258,RC,,,,,,Inpatient,1,EA,1356.39,1356.39,HUMANA CHOICE PLUS,MGD,1356.39,,,,,,,case rate,1356.39,1356.39,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PINDOLOL 5MG TAB              ,92211892,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,AETNA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,BCBS,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,CIGNA,COM,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,UNITED HEALTHCARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,VA TRICARE,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,WELLMED,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA,MGD,37.8,,,,,,,per diem,37.8,37.8,"Per diem rate, code is bundled with other services"
ETHANOL 98% INJ               ,92211893,CDM,250,RC,,,,,,Inpatient,1,EA,37.8,37.8,HUMANA CHOICE PLUS,MGD,37.8,,,,,,,case rate,37.8,37.8,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,AETNA,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,BCBS,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,CIGNA,COM,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,TRICARE,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,UNITED HEALTHCARE,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,UNITED HEALTHCARE,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,VA,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,VA TRICARE,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,WELLMED,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,HUMANA,MGD,133.56,,,,,,,per diem,133.56,133.56,"Per diem rate, code is bundled with other services"
IRON DEXTRAN 50MG/ML INJ      ,92211894,CDM,250,RC,,,,,,Inpatient,1,EA,133.56,133.56,HUMANA CHOICE PLUS,MGD,133.56,,,,,,,case rate,133.56,133.56,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92211895,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,AETNA,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,BCBS,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,CIGNA,COM,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,TRICARE,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,UNITED HEALTHCARE,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,UNITED HEALTHCARE,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,VA,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,VA TRICARE,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,WELLMED,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,HUMANA,MGD,229.64,,,,,,,per diem,229.64,229.64,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% OIN        ,92211896,CDM,250,RC,,,,,,Inpatient,1,EA,229.64,229.64,HUMANA CHOICE PLUS,MGD,229.64,,,,,,,case rate,229.64,229.64,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92211897,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,AETNA,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,BCBS,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,CIGNA,COM,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,TRICARE,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,UNITED HEALTHCARE,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,UNITED HEALTHCARE,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,VA,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,VA TRICARE,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,WELLMED,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,HUMANA,MGD,11.25,,,,,,,per diem,11.25,11.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL Z ACE CRE ,92211898,CDM,250,RC,,,,,,Inpatient,1,EA,11.25,11.25,HUMANA CHOICE PLUS,MGD,11.25,,,,,,,case rate,11.25,11.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONIDINE HCL 0.1MG TAB       ,92211899,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BISOPROLOL/HCTZ 2.5/6.25 TAB  ,92211900,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,AETNA,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,BCBS,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,CIGNA,COM,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,TRICARE,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,UNITED HEALTHCARE,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,UNITED HEALTHCARE,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,VA,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,VA TRICARE,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,WELLMED,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,HUMANA,MGD,77.9,,,,,,,per diem,77.9,77.9,"Per diem rate, code is bundled with other services"
LEUCOVORIN CALCIUM 25MG TAB   ,92211901,CDM,250,RC,,,,,,Inpatient,1,EA,77.9,77.9,HUMANA CHOICE PLUS,MGD,77.9,,,,,,,case rate,77.9,77.9,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,AETNA,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,BCBS,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,CIGNA,COM,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,TRICARE,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,UNITED HEALTHCARE,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,UNITED HEALTHCARE,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,VA,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,VA TRICARE,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,WELLMED,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,HUMANA,MGD,68.04,,,,,,,per diem,68.04,68.04,"Per diem rate, code is bundled with other services"
SODIUM THIOSULFATE 25% INJ    ,92211902,CDM,250,RC,,,,,,Inpatient,1,EA,68.04,68.04,HUMANA CHOICE PLUS,MGD,68.04,,,,,,,case rate,68.04,68.04,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,AETNA,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,BCBS,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,CIGNA,COM,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,TRICARE,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,UNITED HEALTHCARE,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,UNITED HEALTHCARE,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,VA,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,VA TRICARE,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,WELLMED,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,HUMANA,MGD,18.08,,,,,,,per diem,18.08,18.08,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211903,CDM,258,RC,,,,,,Inpatient,1,EA,18.08,18.08,HUMANA CHOICE PLUS,MGD,18.08,,,,,,,case rate,18.08,18.08,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 20MG TAB      ,92211904,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,AETNA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,CIGNA,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,WELLMED,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA,MGD,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
ISRADIPINE 5MG TER            ,92211905,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA CHOICE PLUS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,AETNA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,BCBS,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,CIGNA,COM,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,UNITED HEALTHCARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,VA,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,VA TRICARE,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,WELLMED,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,HUMANA,MGD,13.2,,,,,,,per diem,13.2,13.2,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 250MG INJ       ,92211906,CDM,250,RC,,,,,,Inpatient,1,EA,13.2,13.2,HUMANA CHOICE PLUS,MGD,13.2,,,,,,,case rate,13.2,13.2,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,AETNA,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,BCBS,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,CIGNA,COM,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,TRICARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UNITED HEALTHCARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,UNITED HEALTHCARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,VA TRICARE,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,WELLMED,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,HUMANA,MGD,6.93,,,,,,,per diem,6.93,6.93,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211907,CDM,250,RC,,,,,,Inpatient,1,EA,6.93,6.93,HUMANA CHOICE PLUS,MGD,6.93,,,,,,,case rate,6.93,6.93,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,AETNA,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,BCBS,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,CIGNA,COM,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,TRICARE,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,UNITED HEALTHCARE,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,UNITED HEALTHCARE,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,VA,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,VA TRICARE,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,WELLMED,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,HUMANA,MGD,18.55,,,,,,,per diem,18.55,18.55,"Per diem rate, code is bundled with other services"
WATER STERILE INJ             ,92211908,CDM,250,RC,,,,,,Inpatient,1,EA,18.55,18.55,HUMANA CHOICE PLUS,MGD,18.55,,,,,,,case rate,18.55,18.55,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92211909,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,AETNA,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,BCBS,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,CIGNA,COM,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,TRICARE,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,UNITED HEALTHCARE,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,UNITED HEALTHCARE,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,VA,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,VA TRICARE,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,WELLMED,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,HUMANA,MGD,107.19,,,,,,,per diem,107.19,107.19,"Per diem rate, code is bundled with other services"
DPT TOX-PED SUS               ,92211910,CDM,250,RC,,,,,,Inpatient,1,EA,107.19,107.19,HUMANA CHOICE PLUS,MGD,107.19,,,,,,,case rate,107.19,107.19,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,AETNA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,CIGNA,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,WELLMED,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA,MGD,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92211911,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA CHOICE PLUS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FAMOTIDINE 10MG TAB           ,92211912,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,AETNA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,CIGNA,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,WELLMED,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA,MGD,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
CEFPODOXIME PROXETIL 100MG TAB,92211913,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA CHOICE PLUS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,AETNA,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,BCBS,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,CIGNA,COM,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,TRICARE,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,UNITED HEALTHCARE,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,UNITED HEALTHCARE,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,VA,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,VA TRICARE,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,WELLMED,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,HUMANA,MGD,822.78,,,,,,,per diem,822.78,822.78,"Per diem rate, code is bundled with other services"
KETOROLAC 0.5% SOL            ,92211914,CDM,250,RC,,,,,,Inpatient,1,EA,822.78,822.78,HUMANA CHOICE PLUS,MGD,822.78,,,,,,,case rate,822.78,822.78,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,AETNA,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,BCBS,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,CIGNA,COM,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,TRICARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,UNITED HEALTHCARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,UNITED HEALTHCARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,VA,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,VA TRICARE,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,WELLMED,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,HUMANA,MGD,9.1,,,,,,,per diem,9.1,9.1,"Per diem rate, code is bundled with other services"
GLYCERIN LIQ                  ,92211915,CDM,250,RC,,,,,,Inpatient,1,EA,9.1,9.1,HUMANA CHOICE PLUS,MGD,9.1,,,,,,,case rate,9.1,9.1,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,AETNA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,BCBS,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,CIGNA,COM,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,UNITED HEALTHCARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,VA,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,VA TRICARE,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,WELLMED,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,HUMANA,MGD,25.86,,,,,,,per diem,25.86,25.86,"Per diem rate, code is bundled with other services"
AMPICILLIN NA 1GM A-V INJ     ,92211916,CDM,250,RC,,,,,,Inpatient,1,EA,25.86,25.86,HUMANA CHOICE PLUS,MGD,25.86,,,,,,,case rate,25.86,25.86,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,AETNA,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,BCBS,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,CIGNA,COM,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,TRICARE,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,UNITED HEALTHCARE,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,UNITED HEALTHCARE,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,VA,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,VA TRICARE,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,WELLMED,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,HUMANA,MGD,43.34,,,,,,,per diem,43.34,43.34,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211917,CDM,250,RC,,,,,,Inpatient,1,EA,43.34,43.34,HUMANA CHOICE PLUS,MGD,43.34,,,,,,,case rate,43.34,43.34,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,AETNA,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,BCBS,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,CIGNA,COM,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,TRICARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,UNITED HEALTHCARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,UNITED HEALTHCARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,VA,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,VA TRICARE,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,WELLMED,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,HUMANA,MGD,14.87,,,,,,,per diem,14.87,14.87,"Per diem rate, code is bundled with other services"
GANCICLOVIR 250MG CAP         ,92211918,CDM,250,RC,,,,,,Inpatient,1,EA,14.87,14.87,HUMANA CHOICE PLUS,MGD,14.87,,,,,,,case rate,14.87,14.87,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,AETNA,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,BCBS,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,CIGNA,COM,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,TRICARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,UNITED HEALTHCARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,UNITED HEALTHCARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,VA,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,VA TRICARE,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,WELLMED,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,HUMANA,MGD,143.33,,,,,,,per diem,143.33,143.33,"Per diem rate, code is bundled with other services"
AMPHOTERICIN B 50MG INJ       ,92211919,CDM,250,RC,,,,,,Inpatient,1,EA,143.33,143.33,HUMANA CHOICE PLUS,MGD,143.33,,,,,,,case rate,143.33,143.33,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,AETNA,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,BCBS,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,CIGNA,COM,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,TRICARE,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,UNITED HEALTHCARE,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,UNITED HEALTHCARE,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,VA,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,VA TRICARE,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,WELLMED,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,HUMANA,MGD,269.96,,,,,,,per diem,269.96,269.96,"Per diem rate, code is bundled with other services"
NEOSTIGMINE MS 0.5MG/ML INJ   ,92211920,CDM,250,RC,,,,,,Inpatient,1,EA,269.96,269.96,HUMANA CHOICE PLUS,MGD,269.96,,,,,,,case rate,269.96,269.96,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,AETNA,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,BCBS,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,CIGNA,COM,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,TRICARE,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,UNITED HEALTHCARE,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,UNITED HEALTHCARE,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,VA,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,VA TRICARE,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,WELLMED,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,HUMANA,MGD,155.23,,,,,,,per diem,155.23,155.23,"Per diem rate, code is bundled with other services"
DESOXIMETASONE 0.05% CRE      ,92211921,CDM,250,RC,,,,,,Inpatient,1,EA,155.23,155.23,HUMANA CHOICE PLUS,MGD,155.23,,,,,,,case rate,155.23,155.23,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL          ,92211922,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN E 400U SGL            ,92211923,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 25MG ECT        ,92211924,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOXAPINE SUCCINATE 5MG CAP    ,92211925,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,AETNA,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,BCBS,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,CIGNA,COM,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,TRICARE,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,UNITED HEALTHCARE,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,UNITED HEALTHCARE,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,VA,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,VA TRICARE,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,WELLMED,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,HUMANA,MGD,17.73,,,,,,,per diem,17.73,17.73,"Per diem rate, code is bundled with other services"
DOXAZOSIN MESYLATE 8MG TAB    ,92211926,CDM,250,RC,,,,,,Inpatient,1,EA,17.73,17.73,HUMANA CHOICE PLUS,MGD,17.73,,,,,,,case rate,17.73,17.73,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,AETNA,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,BCBS,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,CIGNA,COM,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,TRICARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,UNITED HEALTHCARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,UNITED HEALTHCARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,VA,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,VA TRICARE,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,WELLMED,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,HUMANA,MGD,22.81,,,,,,,per diem,22.81,22.81,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG/ML SOL     ,92211927,CDM,250,RC,,,,,,Inpatient,1,EA,22.81,22.81,HUMANA CHOICE PLUS,MGD,22.81,,,,,,,case rate,22.81,22.81,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE PAM 25MG CAP      ,92211928,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,AETNA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,BCBS,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,CIGNA,COM,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,UNITED HEALTHCARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,VA TRICARE,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,WELLMED,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA,MGD,9.04,,,,,,,per diem,9.04,9.04,"Per diem rate, code is bundled with other services"
NITROFURANTOIN MCR 50MG CAP   ,92211929,CDM,250,RC,,,,,,Inpatient,1,EA,9.04,9.04,HUMANA CHOICE PLUS,MGD,9.04,,,,,,,case rate,9.04,9.04,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LOPERAMIDE HCL 2MG CAP        ,92211930,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLIC ACID 0.8MG TAB          ,92211931,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 2MG TAB            ,92211932,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,AETNA,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,BCBS,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,CIGNA,COM,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,TRICARE,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,UNITED HEALTHCARE,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,UNITED HEALTHCARE,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,VA,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,VA TRICARE,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,WELLMED,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,HUMANA,MGD,193.66,,,,,,,per diem,193.66,193.66,"Per diem rate, code is bundled with other services"
BETAMETHASONE DP 0.05% GEL    ,92211933,CDM,250,RC,,,,,,Inpatient,1,EA,193.66,193.66,HUMANA CHOICE PLUS,MGD,193.66,,,,,,,case rate,193.66,193.66,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,AETNA,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,BCBS,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,CIGNA,COM,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,TRICARE,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,UNITED HEALTHCARE,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,UNITED HEALTHCARE,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,VA,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,VA TRICARE,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,WELLMED,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,HUMANA,MGD,17.86,,,,,,,per diem,17.86,17.86,"Per diem rate, code is bundled with other services"
LANSOPRAZOLE 15MG ECC         ,92211934,CDM,250,RC,,,,,,Inpatient,1,EA,17.86,17.86,HUMANA CHOICE PLUS,MGD,17.86,,,,,,,case rate,17.86,17.86,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,AETNA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,CIGNA,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,WELLMED,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA,MGD,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PROPOFOL 10MG/ML INJ          ,92211935,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA CHOICE PLUS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,AETNA,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,BCBS,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,CIGNA,COM,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,TRICARE,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,UNITED HEALTHCARE,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,UNITED HEALTHCARE,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,VA,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,VA TRICARE,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,WELLMED,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,HUMANA,MGD,49.33,,,,,,,per diem,49.33,49.33,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE SOL          ,92211936,CDM,250,RC,,,,,,Inpatient,1,EA,49.33,49.33,HUMANA CHOICE PLUS,MGD,49.33,,,,,,,case rate,49.33,49.33,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,AETNA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,BCBS,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,CIGNA,COM,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,UNITED HEALTHCARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,VA TRICARE,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,WELLMED,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA,MGD,18.52,,,,,,,per diem,18.52,18.52,"Per diem rate, code is bundled with other services"
TETRAHYDROZOLINE HCL 0.05% SOL,92211937,CDM,250,RC,,,,,,Inpatient,1,EA,18.52,18.52,HUMANA CHOICE PLUS,MGD,18.52,,,,,,,case rate,18.52,18.52,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92211938,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,AETNA,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,BCBS,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,CIGNA,COM,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,TRICARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,UNITED HEALTHCARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,UNITED HEALTHCARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,VA,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,VA TRICARE,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,WELLMED,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,HUMANA,MGD,311.06,,,,,,,per diem,311.06,311.06,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 0.1% OIN      ,92211939,CDM,250,RC,,,,,,Inpatient,1,EA,311.06,311.06,HUMANA CHOICE PLUS,MGD,311.06,,,,,,,case rate,311.06,311.06,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHADONE HCL 10MG/ML SOL     ,92211940,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B1                    ,92211941,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 25MG CAP          ,92211942,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,AETNA,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,BCBS,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,CIGNA,COM,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,TRICARE,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,UNITED HEALTHCARE,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,UNITED HEALTHCARE,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,VA,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,VA TRICARE,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,WELLMED,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,HUMANA,MGD,129.37,,,,,,,per diem,129.37,129.37,"Per diem rate, code is bundled with other services"
WARFARIN NA 5MG INJ           ,92211943,CDM,250,RC,,,,,,Inpatient,1,EA,129.37,129.37,HUMANA CHOICE PLUS,MGD,129.37,,,,,,,case rate,129.37,129.37,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CYANOCABALAMIN 100MCG TAB     ,92211944,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92211945,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,AETNA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,BCBS,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,CIGNA,COM,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,UNITED HEALTHCARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,VA TRICARE,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,WELLMED,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA,MGD,8.57,,,,,,,per diem,8.57,8.57,"Per diem rate, code is bundled with other services"
PIROXICAM 20MG CAP            ,92211946,CDM,250,RC,,,,,,Inpatient,1,EA,8.57,8.57,HUMANA CHOICE PLUS,MGD,8.57,,,,,,,case rate,8.57,8.57,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,AETNA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,BCBS,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,CIGNA,COM,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,UNITED HEALTHCARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,VA,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,VA TRICARE,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,WELLMED,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,HUMANA,MGD,70.69,,,,,,,per diem,70.69,70.69,"Per diem rate, code is bundled with other services"
DIFLORASONE DIACETATE 0.05% CR,92211947,CDM,250,RC,,,,,,Inpatient,1,EA,70.69,70.69,HUMANA CHOICE PLUS,MGD,70.69,,,,,,,case rate,70.69,70.69,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92211948,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,AETNA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,BCBS,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,CIGNA,COM,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,UNITED HEALTHCARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,VA,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,VA TRICARE,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,WELLMED,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,HUMANA,MGD,52.92,,,,,,,per diem,52.92,52.92,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 0.3% SOL        ,92211949,CDM,250,RC,,,,,,Inpatient,1,EA,52.92,52.92,HUMANA CHOICE PLUS,MGD,52.92,,,,,,,case rate,52.92,52.92,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,AETNA,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,BCBS,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,CIGNA,COM,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,TRICARE,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,UNITED HEALTHCARE,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,UNITED HEALTHCARE,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,VA,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,VA TRICARE,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,WELLMED,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,HUMANA,MGD,124.74,,,,,,,per diem,124.74,124.74,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% SOL     ,92211950,CDM,250,RC,,,,,,Inpatient,1,EA,124.74,124.74,HUMANA CHOICE PLUS,MGD,124.74,,,,,,,case rate,124.74,124.74,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,AETNA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,CIGNA,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,WELLMED,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA,MGD,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
LIDOCAINE HCL 2% VISCOUS SOL  ,92211951,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA CHOICE PLUS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,AETNA,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,BCBS,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,CIGNA,COM,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,TRICARE,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,UNITED HEALTHCARE,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,UNITED HEALTHCARE,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,VA,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,VA TRICARE,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,WELLMED,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,HUMANA,MGD,114.72,,,,,,,per diem,114.72,114.72,"Per diem rate, code is bundled with other services"
SCOPOLAMINE HBR 0.25% SOL     ,92211952,CDM,250,RC,,,,,,Inpatient,1,EA,114.72,114.72,HUMANA CHOICE PLUS,MGD,114.72,,,,,,,case rate,114.72,114.72,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-660MG TAB ,92211953,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,AETNA,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,BCBS,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,CIGNA,COM,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,TRICARE,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,UNITED HEALTHCARE,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,UNITED HEALTHCARE,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,VA,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,VA TRICARE,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,WELLMED,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,HUMANA,MGD,84.58,,,,,,,per diem,84.58,84.58,"Per diem rate, code is bundled with other services"
METIPRANOLOL 0.3% EYE SOL     ,92211954,CDM,250,RC,,,,,,Inpatient,1,EA,84.58,84.58,HUMANA CHOICE PLUS,MGD,84.58,,,,,,,case rate,84.58,84.58,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92211955,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,AETNA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,BCBS,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,CIGNA,COM,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,UNITED HEALTHCARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,VA TRICARE,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,WELLMED,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA,MGD,226.8,,,,,,,per diem,226.8,226.8,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% CRE       ,92211956,CDM,250,RC,,,,,,Inpatient,1,EA,226.8,226.8,HUMANA CHOICE PLUS,MGD,226.8,,,,,,,case rate,226.8,226.8,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,AETNA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,BCBS,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,CIGNA,COM,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,UNITED HEALTHCARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,VA TRICARE,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,WELLMED,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA,MGD,7.09,,,,,,,per diem,7.09,7.09,"Per diem rate, code is bundled with other services"
CASTOR OIL                    ,92211957,CDM,250,RC,,,,,,Inpatient,1,EA,7.09,7.09,HUMANA CHOICE PLUS,MGD,7.09,,,,,,,case rate,7.09,7.09,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,AETNA,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,BCBS,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,CIGNA,COM,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,TRICARE,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,UNITED HEALTHCARE,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,UNITED HEALTHCARE,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,VA,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,VA TRICARE,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,WELLMED,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,HUMANA,MGD,121.94,,,,,,,per diem,121.94,121.94,"Per diem rate, code is bundled with other services"
CROMOLYN NA 4% SOL            ,92211958,CDM,250,RC,,,,,,Inpatient,1,EA,121.94,121.94,HUMANA CHOICE PLUS,MGD,121.94,,,,,,,case rate,121.94,121.94,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,AETNA,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,CIGNA,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,TRICARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,UNITED HEALTHCARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,UNITED HEALTHCARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,VA,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,VA TRICARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,WELLMED,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,HUMANA,MGD,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 10MG TAB  ,92211959,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,HUMANA CHOICE PLUS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,AETNA,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,BCBS,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,CIGNA,COM,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,TRICARE,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,UNITED HEALTHCARE,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,UNITED HEALTHCARE,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,VA,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,VA TRICARE,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,WELLMED,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,HUMANA,MGD,73.8,,,,,,,per diem,73.8,73.8,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 500MG TAB        ,92211960,CDM,250,RC,,,,,,Inpatient,1,EA,73.8,73.8,HUMANA CHOICE PLUS,MGD,73.8,,,,,,,case rate,73.8,73.8,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,AETNA,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,BCBS,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,CIGNA,COM,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,TRICARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,UNITED HEALTHCARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,UNITED HEALTHCARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,VA,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,VA TRICARE,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,WELLMED,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,HUMANA,MGD,31.19,,,,,,,per diem,31.19,31.19,"Per diem rate, code is bundled with other services"
"HEPARIN 25,000U/D5W 250ML INJ ",92211961,CDM,250,RC,,,,,,Inpatient,1,EA,31.19,31.19,HUMANA CHOICE PLUS,MGD,31.19,,,,,,,case rate,31.19,31.19,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,AETNA,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,BCBS,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,CIGNA,COM,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,TRICARE,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,UNITED HEALTHCARE,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,UNITED HEALTHCARE,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,VA,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,VA TRICARE,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,WELLMED,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,HUMANA,MGD,30.71,,,,,,,per diem,30.71,30.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 50MG TAB   ,92211962,CDM,250,RC,,,,,,Inpatient,1,EA,30.71,30.71,HUMANA CHOICE PLUS,MGD,30.71,,,,,,,case rate,30.71,30.71,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM BICARB 650MG TAB       ,92211963,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICLOFENAC NA 75MG ECT        ,92211964,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PIROXICAM 10MG CAP            ,92211965,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN W/F 0.25MG/ML LIQ,92211966,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,AETNA,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,BCBS,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,CIGNA,COM,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,TRICARE,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,UNITED HEALTHCARE,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,UNITED HEALTHCARE,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,VA,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,VA TRICARE,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,WELLMED,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,HUMANA,MGD,14.43,,,,,,,per diem,14.43,14.43,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 10MG/ML INJ        ,92211967,CDM,250,RC,,,,,,Inpatient,1,EA,14.43,14.43,HUMANA CHOICE PLUS,MGD,14.43,,,,,,,case rate,14.43,14.43,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 20MG TAB        ,92211968,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN COD  120-12/5 SO,92211969,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,AETNA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,BCBS,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,CIGNA,COM,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,UNITED HEALTHCARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,VA,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,VA TRICARE,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,WELLMED,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,HUMANA,MGD,61.05,,,,,,,per diem,61.05,61.05,"Per diem rate, code is bundled with other services"
DONEPEZIL HCL 5MG TAB         ,92211970,CDM,250,RC,,,,,,Inpatient,1,EA,61.05,61.05,HUMANA CHOICE PLUS,MGD,61.05,,,,,,,case rate,61.05,61.05,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,AETNA,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,BCBS,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,CIGNA,COM,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,TRICARE,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UNITED HEALTHCARE,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,UNITED HEALTHCARE,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,VA,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,VA TRICARE,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,WELLMED,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,HUMANA,MGD,13.29,,,,,,,per diem,13.29,13.29,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92211971,CDM,250,RC,,,,,,Inpatient,1,EA,13.29,13.29,HUMANA CHOICE PLUS,MGD,13.29,,,,,,,case rate,13.29,13.29,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,AETNA,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,BCBS,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,CIGNA,COM,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,TRICARE,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,UNITED HEALTHCARE,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,UNITED HEALTHCARE,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,VA,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,VA TRICARE,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,WELLMED,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,HUMANA,MGD,112.68,,,,,,,per diem,112.68,112.68,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 50MG SUP     ,92211972,CDM,250,RC,,,,,,Inpatient,1,EA,112.68,112.68,HUMANA CHOICE PLUS,MGD,112.68,,,,,,,case rate,112.68,112.68,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUMETANIDE 1MG TAB            ,92211973,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,AETNA,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,BCBS,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,CIGNA,COM,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,TRICARE,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,UNITED HEALTHCARE,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,UNITED HEALTHCARE,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,VA,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,VA TRICARE,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,WELLMED,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,HUMANA,MGD,366.91,,,,,,,per diem,366.91,366.91,"Per diem rate, code is bundled with other services"
PREMETHRIN 5% CRE             ,92211974,CDM,250,RC,,,,,,Inpatient,1,EA,366.91,366.91,HUMANA CHOICE PLUS,MGD,366.91,,,,,,,case rate,366.91,366.91,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,AETNA,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,BCBS,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,CIGNA,COM,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,TRICARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UNITED HEALTHCARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,UNITED HEALTHCARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,VA TRICARE,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,WELLMED,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,HUMANA,MGD,9.48,,,,,,,per diem,9.48,9.48,"Per diem rate, code is bundled with other services"
MORPHINE 1MG/ML INJ           ,92211975,CDM,250,RC,,,,,,Inpatient,1,EA,9.48,9.48,HUMANA CHOICE PLUS,MGD,9.48,,,,,,,case rate,9.48,9.48,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,AETNA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,BCBS,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,CIGNA,COM,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,UNITED HEALTHCARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,VA TRICARE,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,WELLMED,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA,MGD,15.12,,,,,,,per diem,15.12,15.12,"Per diem rate, code is bundled with other services"
PHYTONADIONE 1MG/0.5ML INJ    ,92211976,CDM,250,RC,,,,,,Inpatient,1,EA,15.12,15.12,HUMANA CHOICE PLUS,MGD,15.12,,,,,,,case rate,15.12,15.12,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,AETNA,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,BCBS,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,CIGNA,COM,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,TRICARE,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,UNITED HEALTHCARE,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,UNITED HEALTHCARE,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,VA,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,VA TRICARE,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,WELLMED,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,HUMANA,MGD,77.77,,,,,,,per diem,77.77,77.77,"Per diem rate, code is bundled with other services"
BRIMONIDINE TARTRATE 0.2% SOL ,92211977,CDM,250,RC,,,,,,Inpatient,1,EA,77.77,77.77,HUMANA CHOICE PLUS,MGD,77.77,,,,,,,case rate,77.77,77.77,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,AETNA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,BCBS,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,CIGNA,COM,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,UNITED HEALTHCARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,VA TRICARE,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,WELLMED,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA,MGD,22.68,,,,,,,per diem,22.68,22.68,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92211978,CDM,258,RC,,,,,,Inpatient,1,EA,22.68,22.68,HUMANA CHOICE PLUS,MGD,22.68,,,,,,,case rate,22.68,22.68,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,AETNA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,CIGNA,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,WELLMED,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA,MGD,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
BUPROPION HCL 150MG TER       ,92211979,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA CHOICE PLUS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92211980,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 20MG TAB           ,92211981,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMLODIPINE BESYLATE 5MG TAB   ,92211982,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE ECC   ,92211983,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,AETNA,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,BCBS,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,CIGNA,COM,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,TRICARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,UNITED HEALTHCARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,UNITED HEALTHCARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,VA,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,VA TRICARE,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,WELLMED,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,HUMANA,MGD,106.38,,,,,,,per diem,106.38,106.38,"Per diem rate, code is bundled with other services"
FLUOCINOLONE ACET 0.025% CRE  ,92211984,CDM,250,RC,,,,,,Inpatient,1,EA,106.38,106.38,HUMANA CHOICE PLUS,MGD,106.38,,,,,,,case rate,106.38,106.38,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92211985,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,AETNA,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,BCBS,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,CIGNA,COM,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,TRICARE,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,UNITED HEALTHCARE,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,UNITED HEALTHCARE,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,VA,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,VA TRICARE,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,WELLMED,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,HUMANA,MGD,63.35,,,,,,,per diem,63.35,63.35,"Per diem rate, code is bundled with other services"
METHYLPREDNISOLONE 80MG/ML INJ,92211986,CDM,250,RC,,,,,,Inpatient,1,EA,63.35,63.35,HUMANA CHOICE PLUS,MGD,63.35,,,,,,,case rate,63.35,63.35,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TER ,92211987,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,AETNA,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,BCBS,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,CIGNA,COM,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,TRICARE,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UNITED HEALTHCARE,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,UNITED HEALTHCARE,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,VA,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,VA TRICARE,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,WELLMED,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,HUMANA,MGD,13.92,,,,,,,per diem,13.92,13.92,"Per diem rate, code is bundled with other services"
SILVER SULFADIAZINE 1% CRE    ,92211988,CDM,250,RC,,,,,,Inpatient,1,EA,13.92,13.92,HUMANA CHOICE PLUS,MGD,13.92,,,,,,,case rate,13.92,13.92,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MINTOX MAXIMUM STRENGTH SUS   ,92211989,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,AETNA,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,BCBS,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,CIGNA,COM,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,TRICARE,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,UNITED HEALTHCARE,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,UNITED HEALTHCARE,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,VA,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,VA TRICARE,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,WELLMED,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,HUMANA,MGD,51.69,,,,,,,per diem,51.69,51.69,"Per diem rate, code is bundled with other services"
CYCLOSPORINE 100MG SGL        ,92211990,CDM,250,RC,,,,,,Inpatient,1,EA,51.69,51.69,HUMANA CHOICE PLUS,MGD,51.69,,,,,,,case rate,51.69,51.69,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,AETNA,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,BCBS,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,CIGNA,COM,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,TRICARE,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,UNITED HEALTHCARE,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,UNITED HEALTHCARE,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,VA,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,VA TRICARE,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,WELLMED,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,HUMANA,MGD,344.23,,,,,,,per diem,344.23,344.23,"Per diem rate, code is bundled with other services"
GENTAMICIN SULF 3MG/ML SOL    ,92211991,CDM,250,RC,,,,,,Inpatient,1,EA,344.23,344.23,HUMANA CHOICE PLUS,MGD,344.23,,,,,,,case rate,344.23,344.23,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,AETNA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,CIGNA,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,WELLMED,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA,MGD,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92211992,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA CHOICE PLUS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METRONIDAZOLE 250MG TAB       ,92211993,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 1GM TAB             ,92211994,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE MICRO 3MG TAB       ,92211995,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,AETNA,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,BCBS,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,CIGNA,COM,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,TRICARE,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,UNITED HEALTHCARE,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,UNITED HEALTHCARE,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,VA,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,VA TRICARE,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,WELLMED,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,HUMANA,MGD,1377.05,,,,,,,per diem,1377.05,1377.05,"Per diem rate, code is bundled with other services"
ALBUMIN HUMAN 25% INJ         ,92211996,CDM,250,RC,,,,,,Inpatient,1,EA,1377.05,1377.05,HUMANA CHOICE PLUS,MGD,1377.05,,,,,,,case rate,1377.05,1377.05,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92211997,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM HYDROXIDE 400MG SUS ,92211998,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,AETNA,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,BCBS,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,CIGNA,COM,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,TRICARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,UNITED HEALTHCARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,UNITED HEALTHCARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,VA,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,VA TRICARE,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,WELLMED,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,HUMANA,MGD,13.73,,,,,,,per diem,13.73,13.73,"Per diem rate, code is bundled with other services"
EPINEPHRINE HCL 1MG/ML INJ    ,92211999,CDM,250,RC,,,,,,Inpatient,1,EA,13.73,13.73,HUMANA CHOICE PLUS,MGD,13.73,,,,,,,case rate,13.73,13.73,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-500MG TAB ,92212000,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 500MG CER              ,92212001,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PSEUDOEPHEDRINE HCL 30MG TAB  ,92212002,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,AETNA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,BCBS,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,CIGNA,COM,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,UNITED HEALTHCARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,VA TRICARE,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,WELLMED,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA,MGD,9.07,,,,,,,per diem,9.07,9.07,"Per diem rate, code is bundled with other services"
LORAZEPAM 4MG/ML INJ          ,92212003,CDM,250,RC,,,,,,Inpatient,1,EA,9.07,9.07,HUMANA CHOICE PLUS,MGD,9.07,,,,,,,case rate,9.07,9.07,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
RANITIDINE HCL 150MG TAB      ,92212004,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,AETNA,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,BCBS,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,CIGNA,COM,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,TRICARE,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,UNITED HEALTHCARE,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,UNITED HEALTHCARE,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,VA,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,VA TRICARE,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,WELLMED,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,HUMANA,MGD,23.03,,,,,,,per diem,23.03,23.03,"Per diem rate, code is bundled with other services"
LACTIC ACID UREA 5%-10% CRE   ,92212005,CDM,250,RC,,,,,,Inpatient,1,EA,23.03,23.03,HUMANA CHOICE PLUS,MGD,23.03,,,,,,,case rate,23.03,23.03,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212006,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FOLTRIN CAP                   ,92212007,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,AETNA,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,CIGNA,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,TRICARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UNITED HEALTHCARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UNITED HEALTHCARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,VA,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,VA TRICARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,WELLMED,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,HUMANA,MGD,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CEFTRIAXONE NA 1GM INJ        ,92212008,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,HUMANA CHOICE PLUS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,AETNA,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,BCBS,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,CIGNA,COM,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,TRICARE,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,UNITED HEALTHCARE,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,UNITED HEALTHCARE,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,VA,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,VA TRICARE,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,WELLMED,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,HUMANA,MGD,437.22,,,,,,,per diem,437.22,437.22,"Per diem rate, code is bundled with other services"
BLEPHAMIDE 0.2-10% SUS        ,92212009,CDM,250,RC,,,,,,Inpatient,1,EA,437.22,437.22,HUMANA CHOICE PLUS,MGD,437.22,,,,,,,case rate,437.22,437.22,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,AETNA,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,BCBS,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,CIGNA,COM,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,TRICARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,UNITED HEALTHCARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,UNITED HEALTHCARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,VA,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,VA TRICARE,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,WELLMED,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,HUMANA,MGD,30.84,,,,,,,per diem,30.84,30.84,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 0.25%-3% OIN,92212010,CDM,250,RC,,,,,,Inpatient,1,EA,30.84,30.84,HUMANA CHOICE PLUS,MGD,30.84,,,,,,,case rate,30.84,30.84,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 112MCG TAB   ,92212011,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,AETNA,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,BCBS,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,CIGNA,COM,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,TRICARE,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,UNITED HEALTHCARE,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,UNITED HEALTHCARE,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,VA,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,VA TRICARE,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,WELLMED,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,HUMANA,MGD,61.33,,,,,,,per diem,61.33,61.33,"Per diem rate, code is bundled with other services"
VECURONIUM BROMIDE 20MG INJ   ,92212012,CDM,250,RC,,,,,,Inpatient,1,EA,61.33,61.33,HUMANA CHOICE PLUS,MGD,61.33,,,,,,,case rate,61.33,61.33,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MEGESTROL ACET 20MG TAB       ,92212013,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBIDOPA/LEVO 25/100 TAB     ,92212014,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
POTASSIUM CL 8MEQ CER         ,92212015,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,AETNA,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,BCBS,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,CIGNA,COM,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,TRICARE,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,UNITED HEALTHCARE,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,UNITED HEALTHCARE,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,VA,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,VA TRICARE,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,WELLMED,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,HUMANA,MGD,23.18,,,,,,,per diem,23.18,23.18,"Per diem rate, code is bundled with other services"
PRAMIPEXOLE DIHCL 1.5MG TAB   ,92212016,CDM,250,RC,,,,,,Inpatient,1,EA,23.18,23.18,HUMANA CHOICE PLUS,MGD,23.18,,,,,,,case rate,23.18,23.18,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,AETNA,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,BCBS,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,CIGNA,COM,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,TRICARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,UNITED HEALTHCARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,UNITED HEALTHCARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,VA,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,VA TRICARE,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,WELLMED,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,HUMANA,MGD,8.03,,,,,,,per diem,8.03,8.03,"Per diem rate, code is bundled with other services"
ZINC OXIDE 20% OIN            ,92212017,CDM,250,RC,,,,,,Inpatient,1,EA,8.03,8.03,HUMANA CHOICE PLUS,MGD,8.03,,,,,,,case rate,8.03,8.03,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,AETNA,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,BCBS,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,CIGNA,COM,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,TRICARE,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,UNITED HEALTHCARE,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,UNITED HEALTHCARE,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,VA,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,VA TRICARE,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,WELLMED,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,HUMANA,MGD,231.93,,,,,,,per diem,231.93,231.93,"Per diem rate, code is bundled with other services"
MORPHINE  20MG/ML SOL         ,92212018,CDM,250,RC,,,,,,Inpatient,1,EA,231.93,231.93,HUMANA CHOICE PLUS,MGD,231.93,,,,,,,case rate,231.93,231.93,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,AETNA,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,BCBS,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,CIGNA,COM,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,TRICARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,UNITED HEALTHCARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,UNITED HEALTHCARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,VA,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,VA TRICARE,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,WELLMED,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,HUMANA,MGD,53.36,,,,,,,per diem,53.36,53.36,"Per diem rate, code is bundled with other services"
HETASTARCH 6%/NS INJ          ,92212019,CDM,250,RC,,,,,,Inpatient,1,EA,53.36,53.36,HUMANA CHOICE PLUS,MGD,53.36,,,,,,,case rate,53.36,53.36,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,AETNA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,BCBS,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,CIGNA,COM,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,UNITED HEALTHCARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,VA TRICARE,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,WELLMED,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA,MGD,5.67,,,,,,,per diem,5.67,5.67,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 100MG CAP         ,92212020,CDM,250,RC,,,,,,Inpatient,1,EA,5.67,5.67,HUMANA CHOICE PLUS,MGD,5.67,,,,,,,case rate,5.67,5.67,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212021,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/5ML SYR  ,92212022,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINIDINE SULF 300MG TAB      ,92212023,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 90MG TAB        ,92212024,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX W/C TAB     ,92212025,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATROPINE  SULF 0.4MG TAB      ,92212026,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,AETNA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,BCBS,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,CIGNA,COM,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,UNITED HEALTHCARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,VA,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,VA TRICARE,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,WELLMED,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,HUMANA,MGD,11.94,,,,,,,per diem,11.94,11.94,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG CAP          ,92212027,CDM,250,RC,,,,,,Inpatient,1,EA,11.94,11.94,HUMANA CHOICE PLUS,MGD,11.94,,,,,,,case rate,11.94,11.94,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PRIMIDONE 250MG TAB           ,92212028,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212029,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MECLIZINE HCL 12.5MG TAB      ,92212030,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"NIACIN 1,000MG TER            ",92212031,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 400MG T24        ,92212032,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,AETNA,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,BCBS,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,CIGNA,COM,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,TRICARE,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,UNITED HEALTHCARE,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,UNITED HEALTHCARE,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,VA,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,VA TRICARE,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,WELLMED,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,HUMANA,MGD,77.58,,,,,,,per diem,77.58,77.58,"Per diem rate, code is bundled with other services"
DOBUTAMINE HCL D5W 250-250ML I,92212033,CDM,250,RC,,,,,,Inpatient,1,EA,77.58,77.58,HUMANA CHOICE PLUS,MGD,77.58,,,,,,,case rate,77.58,77.58,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,AETNA,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,BCBS,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,CIGNA,COM,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,TRICARE,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,UNITED HEALTHCARE,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,UNITED HEALTHCARE,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,VA,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,VA TRICARE,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,WELLMED,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,HUMANA,MGD,101.9,,,,,,,per diem,101.9,101.9,"Per diem rate, code is bundled with other services"
TIMOLOL MALEATE 0.5% SOL      ,92212034,CDM,250,RC,,,,,,Inpatient,1,EA,101.9,101.9,HUMANA CHOICE PLUS,MGD,101.9,,,,,,,case rate,101.9,101.9,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212035,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 1MG TAB            ,92212036,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,AETNA,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,BCBS,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,CIGNA,COM,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,TRICARE,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,UNITED HEALTHCARE,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,UNITED HEALTHCARE,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,VA,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,VA TRICARE,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,WELLMED,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,HUMANA,MGD,77.46,,,,,,,per diem,77.46,77.46,"Per diem rate, code is bundled with other services"
CICLOPIROX 0.77% CRE          ,92212037,CDM,250,RC,,,,,,Inpatient,1,EA,77.46,77.46,HUMANA CHOICE PLUS,MGD,77.46,,,,,,,case rate,77.46,77.46,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
QUINAPRIL HCL 20MG TAB        ,92212038,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALLOPURINOL 300MG TAB         ,92212039,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,AETNA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,BCBS,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,CIGNA,COM,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,UNITED HEALTHCARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,VA TRICARE,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,WELLMED,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA,MGD,8.13,,,,,,,per diem,8.13,8.13,"Per diem rate, code is bundled with other services"
RIFAMPIN 300MG CAP            ,92212040,CDM,250,RC,,,,,,Inpatient,1,EA,8.13,8.13,HUMANA CHOICE PLUS,MGD,8.13,,,,,,,case rate,8.13,8.13,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,AETNA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,BCBS,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,CIGNA,COM,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,UNITED HEALTHCARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,VA,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,VA TRICARE,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,WELLMED,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,HUMANA,MGD,41.64,,,,,,,per diem,41.64,41.64,"Per diem rate, code is bundled with other services"
OLANZAPINE 5MG TAB            ,92212041,CDM,250,RC,,,,,,Inpatient,1,EA,41.64,41.64,HUMANA CHOICE PLUS,MGD,41.64,,,,,,,case rate,41.64,41.64,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,AETNA,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,CIGNA,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,TRICARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,UNITED HEALTHCARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,UNITED HEALTHCARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,VA,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,VA TRICARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,WELLMED,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,HUMANA,MGD,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG/5ML SUS   ,92212042,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,HUMANA CHOICE PLUS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYUREA 500MG CAP         ,92212043,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PENTOXIFYLLINE 400MG TER      ,92212044,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,AETNA,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,BCBS,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,CIGNA,COM,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,TRICARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,UNITED HEALTHCARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,UNITED HEALTHCARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,VA,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,VA TRICARE,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,WELLMED,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,HUMANA,MGD,12.22,,,,,,,per diem,12.22,12.22,"Per diem rate, code is bundled with other services"
HYDROXYCHLOROQUINE 200MG TAB  ,92212045,CDM,250,RC,,,,,,Inpatient,1,EA,12.22,12.22,HUMANA CHOICE PLUS,MGD,12.22,,,,,,,case rate,12.22,12.22,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,AETNA,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,BCBS,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,CIGNA,COM,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,TRICARE,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,UNITED HEALTHCARE,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,UNITED HEALTHCARE,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,VA,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,VA TRICARE,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,WELLMED,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,HUMANA,MGD,13.45,,,,,,,per diem,13.45,13.45,"Per diem rate, code is bundled with other services"
VALSARTAN 160MG TAB           ,92212046,CDM,250,RC,,,,,,Inpatient,1,EA,13.45,13.45,HUMANA CHOICE PLUS,MGD,13.45,,,,,,,case rate,13.45,13.45,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,AETNA,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,BCBS,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,CIGNA,COM,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,TRICARE,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,UNITED HEALTHCARE,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,UNITED HEALTHCARE,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,VA,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,VA TRICARE,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,WELLMED,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,HUMANA,MGD,351.67,,,,,,,per diem,351.67,351.67,"Per diem rate, code is bundled with other services"
BENZOYL ERYTHROMYCIN 5%-3% GEL,92212047,CDM,250,RC,,,,,,Inpatient,1,EA,351.67,351.67,HUMANA CHOICE PLUS,MGD,351.67,,,,,,,case rate,351.67,351.67,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HCTZ 25MG TAB                 ,92212048,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROXYZINE HCL 10MG/5ML SYR  ,92212049,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROPHYLLIN COPPER 100MG TAB,92212050,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,AETNA,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,BCBS,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,CIGNA,COM,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,TRICARE,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,UNITED HEALTHCARE,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,UNITED HEALTHCARE,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,VA,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,VA TRICARE,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,WELLMED,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,HUMANA,MGD,35.6,,,,,,,per diem,35.6,35.6,"Per diem rate, code is bundled with other services"
VALPROATE NA 500MG INJ        ,92212051,CDM,250,RC,,,,,,Inpatient,1,EA,35.6,35.6,HUMANA CHOICE PLUS,MGD,35.6,,,,,,,case rate,35.6,35.6,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212052,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG TAB       ,92212053,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,AETNA,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,BCBS,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,CIGNA,COM,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,TRICARE,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,UNITED HEALTHCARE,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,UNITED HEALTHCARE,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,VA,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,VA TRICARE,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,WELLMED,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,HUMANA,MGD,700.56,,,,,,,per diem,700.56,700.56,"Per diem rate, code is bundled with other services"
FLUOROMETHOLONE 0.1% SUS      ,92212054,CDM,250,RC,,,,,,Inpatient,1,EA,700.56,700.56,HUMANA CHOICE PLUS,MGD,700.56,,,,,,,case rate,700.56,700.56,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORDIAZEPOXIDE HCL 25MG CAP ,92212055,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN 250MG CER              ,92212056,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,AETNA,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,BCBS,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,CIGNA,COM,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,TRICARE,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,UNITED HEALTHCARE,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,UNITED HEALTHCARE,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,VA,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,VA TRICARE,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,WELLMED,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,HUMANA,MGD,24.7,,,,,,,per diem,24.7,24.7,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212057,CDM,250,RC,,,,,,Inpatient,1,EA,24.7,24.7,HUMANA CHOICE PLUS,MGD,24.7,,,,,,,case rate,24.7,24.7,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212058,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,AETNA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,BCBS,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,CIGNA,COM,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,UNITED HEALTHCARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,VA TRICARE,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,WELLMED,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA,MGD,9.45,,,,,,,per diem,9.45,9.45,"Per diem rate, code is bundled with other services"
INDOMETHACIN 75MG CER         ,92212059,CDM,250,RC,,,,,,Inpatient,1,EA,9.45,9.45,HUMANA CHOICE PLUS,MGD,9.45,,,,,,,case rate,9.45,9.45,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,AETNA,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,BCBS,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,CIGNA,COM,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,TRICARE,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,UNITED HEALTHCARE,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,UNITED HEALTHCARE,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,VA,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,VA TRICARE,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,WELLMED,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,HUMANA,MGD,722.01,,,,,,,per diem,722.01,722.01,"Per diem rate, code is bundled with other services"
KETOCONAZOLE 2% CRE           ,92212060,CDM,250,RC,,,,,,Inpatient,1,EA,722.01,722.01,HUMANA CHOICE PLUS,MGD,722.01,,,,,,,case rate,722.01,722.01,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,AETNA,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,BCBS,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,CIGNA,COM,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,TRICARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,UNITED HEALTHCARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,UNITED HEALTHCARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,VA,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,VA TRICARE,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,WELLMED,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,HUMANA,MGD,7.31,,,,,,,per diem,7.31,7.31,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212061,CDM,250,RC,,,,,,Inpatient,1,EA,7.31,7.31,HUMANA CHOICE PLUS,MGD,7.31,,,,,,,case rate,7.31,7.31,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 5MG TAB             ,92212062,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VITAMIN B COMPLEX TAB         ,92212063,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,AETNA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,BCBS,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,CIGNA,COM,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,UNITED HEALTHCARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,VA TRICARE,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,WELLMED,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA,MGD,7.88,,,,,,,per diem,7.88,7.88,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 0.5% CRE       ,92212064,CDM,250,RC,,,,,,Inpatient,1,EA,7.88,7.88,HUMANA CHOICE PLUS,MGD,7.88,,,,,,,case rate,7.88,7.88,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 30MG TAB        ,92212065,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,AETNA,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,BCBS,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,CIGNA,COM,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,TRICARE,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,UNITED HEALTHCARE,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,UNITED HEALTHCARE,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,VA,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,VA TRICARE,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,WELLMED,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,HUMANA,MGD,32.89,,,,,,,per diem,32.89,32.89,"Per diem rate, code is bundled with other services"
ANAGRELIDE HCL 0.5MG CAP      ,92212066,CDM,250,RC,,,,,,Inpatient,1,EA,32.89,32.89,HUMANA CHOICE PLUS,MGD,32.89,,,,,,,case rate,32.89,32.89,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,AETNA,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,BCBS,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,CIGNA,COM,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,TRICARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,UNITED HEALTHCARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,UNITED HEALTHCARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,VA,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,VA TRICARE,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,WELLMED,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,HUMANA,MGD,7.84,,,,,,,per diem,7.84,7.84,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 180MG TER       ,92212067,CDM,250,RC,,,,,,Inpatient,1,EA,7.84,7.84,HUMANA CHOICE PLUS,MGD,7.84,,,,,,,case rate,7.84,7.84,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,AETNA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,BCBS,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,CIGNA,COM,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,UNITED HEALTHCARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,VA TRICARE,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,WELLMED,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,HUMANA,MGD,10.08,,,,,,,per diem,10.08,10.08,"Per diem rate, code is bundled with other services"
HCTZ LOSARTAN K 12.5-50MG TAB ,92212068,CDM,250,RC,,,,,,Inpatient,1,EA,10.08,10.08,HUMANA CHOICE PLUS,MGD,10.08,,,,,,,case rate,10.08,10.08,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,AETNA,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,BCBS,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,CIGNA,COM,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,TRICARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UNITED HEALTHCARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,UNITED HEALTHCARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,VA TRICARE,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,WELLMED,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,HUMANA,MGD,13.95,,,,,,,per diem,13.95,13.95,"Per diem rate, code is bundled with other services"
BUPRENORPHINE HCL 0.3MG/ML INJ,92212069,CDM,250,RC,,,,,,Inpatient,1,EA,13.95,13.95,HUMANA CHOICE PLUS,MGD,13.95,,,,,,,case rate,13.95,13.95,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FERROUS SULF 325MG TAB        ,92212070,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN ST 500MG TAB     ,92212071,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,AETNA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,BCBS,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,CIGNA,COM,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,UNITED HEALTHCARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,VA,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,VA TRICARE,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,WELLMED,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,HUMANA,MGD,11.56,,,,,,,per diem,11.56,11.56,"Per diem rate, code is bundled with other services"
AMOXICILLIN CLV K 500-125MG TA,92212072,CDM,250,RC,,,,,,Inpatient,1,EA,11.56,11.56,HUMANA CHOICE PLUS,MGD,11.56,,,,,,,case rate,11.56,11.56,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN DM 600MG-30MG TAB ,92212073,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,AETNA,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,BCBS,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,CIGNA,COM,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,TRICARE,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,UNITED HEALTHCARE,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,UNITED HEALTHCARE,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,VA,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,VA TRICARE,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,WELLMED,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,HUMANA,MGD,429.94,,,,,,,per diem,429.94,429.94,"Per diem rate, code is bundled with other services"
PAMIDRONATE DISOD 90MG INJ    ,92212074,CDM,250,RC,,,,,,Inpatient,1,EA,429.94,429.94,HUMANA CHOICE PLUS,MGD,429.94,,,,,,,case rate,429.94,429.94,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,AETNA,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,BCBS,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,CIGNA,COM,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,TRICARE,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UNITED HEALTHCARE,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,UNITED HEALTHCARE,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,VA,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,VA TRICARE,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,WELLMED,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,HUMANA,MGD,13.8,,,,,,,per diem,13.8,13.8,"Per diem rate, code is bundled with other services"
CEFPROZIL 250MG TAB           ,92212075,CDM,250,RC,,,,,,Inpatient,1,EA,13.8,13.8,HUMANA CHOICE PLUS,MGD,13.8,,,,,,,case rate,13.8,13.8,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,AETNA,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,BCBS,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,CIGNA,COM,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,TRICARE,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,UNITED HEALTHCARE,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,UNITED HEALTHCARE,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,VA,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,VA TRICARE,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,WELLMED,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,HUMANA,MGD,437.13,,,,,,,per diem,437.13,437.13,"Per diem rate, code is bundled with other services"
NAFCILLIN 10GM INJ            ,92212076,CDM,250,RC,,,,,,Inpatient,1,EA,437.13,437.13,HUMANA CHOICE PLUS,MGD,437.13,,,,,,,case rate,437.13,437.13,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 7.5-500MG TAB,92212077,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,AETNA,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,BCBS,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,CIGNA,COM,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,TRICARE,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,UNITED HEALTHCARE,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,UNITED HEALTHCARE,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,VA,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,VA TRICARE,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,WELLMED,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,HUMANA,MGD,711.18,,,,,,,per diem,711.18,711.18,"Per diem rate, code is bundled with other services"
ACETIC ACID HC 2%-1% SOL      ,92212078,CDM,250,RC,,,,,,Inpatient,1,EA,711.18,711.18,HUMANA CHOICE PLUS,MGD,711.18,,,,,,,case rate,711.18,711.18,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,AETNA,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,BCBS,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,CIGNA,COM,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,TRICARE,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,UNITED HEALTHCARE,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,UNITED HEALTHCARE,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,VA,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,VA TRICARE,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,WELLMED,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,HUMANA,MGD,276.63,,,,,,,per diem,276.63,276.63,"Per diem rate, code is bundled with other services"
DICYCLOMINE HCL 10MG/ML INJ   ,92212079,CDM,250,RC,,,,,,Inpatient,1,EA,276.63,276.63,HUMANA CHOICE PLUS,MGD,276.63,,,,,,,case rate,276.63,276.63,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METHOCARBAMOL 750MG TAB       ,92212080,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,AETNA,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,BCBS,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,CIGNA,COM,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,TRICARE,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,UNITED HEALTHCARE,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,UNITED HEALTHCARE,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,VA,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,VA TRICARE,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,WELLMED,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,HUMANA,MGD,887.48,,,,,,,per diem,887.48,887.48,"Per diem rate, code is bundled with other services"
AMYLASE/LIPASE/PROTEASE POW   ,92212081,CDM,250,RC,,,,,,Inpatient,1,EA,887.48,887.48,HUMANA CHOICE PLUS,MGD,887.48,,,,,,,case rate,887.48,887.48,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BENZTROPINE MESYLATE 0.5MG TAB,92212082,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,AETNA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,BCBS,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,CIGNA,COM,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,UNITED HEALTHCARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,VA TRICARE,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,WELLMED,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA,MGD,8.73,,,,,,,per diem,8.73,8.73,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/ML SUS      ",92212083,CDM,250,RC,,,,,,Inpatient,1,EA,8.73,8.73,HUMANA CHOICE PLUS,MGD,8.73,,,,,,,case rate,8.73,8.73,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
TOBRAMYCIN 40MG/ML INJ        ,92212084,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,AETNA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,BCBS,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,CIGNA,COM,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,UNITED HEALTHCARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,VA TRICARE,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,WELLMED,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA,MGD,21.23,,,,,,,per diem,21.23,21.23,"Per diem rate, code is bundled with other services"
COLCRYS                       ,92212085,CDM,250,RC,,,,,,Inpatient,1,EA,21.23,21.23,HUMANA CHOICE PLUS,MGD,21.23,,,,,,,case rate,21.23,21.23,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,AETNA,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,BCBS,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,CIGNA,COM,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,TRICARE,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,UNITED HEALTHCARE,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,UNITED HEALTHCARE,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,VA,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,VA TRICARE,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,WELLMED,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,HUMANA,MGD,502.55,,,,,,,per diem,502.55,502.55,"Per diem rate, code is bundled with other services"
CLINDAMYCIN PHOS 1% LOT       ,92212086,CDM,250,RC,,,,,,Inpatient,1,EA,502.55,502.55,HUMANA CHOICE PLUS,MGD,502.55,,,,,,,case rate,502.55,502.55,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLAVOXATE HCL 100MG TAB       ,92212087,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
CHOLESTYRAMINE 4GM/5.5GM PDR  ,92212088,CDM,250,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,AETNA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,BCBS,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,CIGNA,COM,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,UNITED HEALTHCARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,VA TRICARE,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,WELLMED,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA,MGD,9.29,,,,,,,per diem,9.29,9.29,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212089,CDM,258,RC,,,,,,Inpatient,1,EA,9.29,9.29,HUMANA CHOICE PLUS,MGD,9.29,,,,,,,case rate,9.29,9.29,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,AETNA,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,BCBS,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,CIGNA,COM,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,TRICARE,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,UNITED HEALTHCARE,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,UNITED HEALTHCARE,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,VA,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,VA TRICARE,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,WELLMED,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,HUMANA,MGD,265.14,,,,,,,per diem,265.14,265.14,"Per diem rate, code is bundled with other services"
CEFADROXIL 500MG/5ML SUS      ,92212090,CDM,250,RC,,,,,,Inpatient,1,EA,265.14,265.14,HUMANA CHOICE PLUS,MGD,265.14,,,,,,,case rate,265.14,265.14,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,AETNA,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,BCBS,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,CIGNA,COM,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,TRICARE,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,UNITED HEALTHCARE,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,UNITED HEALTHCARE,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,VA,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,VA TRICARE,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,WELLMED,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,HUMANA,MGD,33.96,,,,,,,per diem,33.96,33.96,"Per diem rate, code is bundled with other services"
MIDAZOLAM HCL 5MG/ML INJ      ,92212091,CDM,250,RC,,,,,,Inpatient,1,EA,33.96,33.96,HUMANA CHOICE PLUS,MGD,33.96,,,,,,,case rate,33.96,33.96,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,AETNA,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,BCBS,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,CIGNA,COM,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,TRICARE,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,UNITED HEALTHCARE,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,UNITED HEALTHCARE,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,VA,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,VA TRICARE,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,WELLMED,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,HUMANA,MGD,258.33,,,,,,,per diem,258.33,258.33,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212092,CDM,250,RC,,,,,,Inpatient,1,EA,258.33,258.33,HUMANA CHOICE PLUS,MGD,258.33,,,,,,,case rate,258.33,258.33,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,AETNA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,BCBS,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,CIGNA,COM,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,UNITED HEALTHCARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,VA TRICARE,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,WELLMED,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA,MGD,11.66,,,,,,,per diem,11.66,11.66,"Per diem rate, code is bundled with other services"
OMEPRAZOLE 10MG ECC           ,92212093,CDM,250,RC,,,,,,Inpatient,1,EA,11.66,11.66,HUMANA CHOICE PLUS,MGD,11.66,,,,,,,case rate,11.66,11.66,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,AETNA,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,BCBS,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,CIGNA,COM,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,TRICARE,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,UNITED HEALTHCARE,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,UNITED HEALTHCARE,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,VA,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,VA TRICARE,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,WELLMED,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,HUMANA,MGD,306.15,,,,,,,per diem,306.15,306.15,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% SOL        ,92212094,CDM,250,RC,,,,,,Inpatient,1,EA,306.15,306.15,HUMANA CHOICE PLUS,MGD,306.15,,,,,,,case rate,306.15,306.15,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FUROSEMIDE 20MG TAB           ,92212095,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,AETNA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,BCBS,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,CIGNA,COM,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,UNITED HEALTHCARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,VA TRICARE,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,WELLMED,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA,MGD,6.9,,,,,,,per diem,6.9,6.9,"Per diem rate, code is bundled with other services"
THEOPHYLLINE 600MG T24        ,92212096,CDM,250,RC,,,,,,Inpatient,1,EA,6.9,6.9,HUMANA CHOICE PLUS,MGD,6.9,,,,,,,case rate,6.9,6.9,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,AETNA,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,BCBS,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,CIGNA,COM,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,TRICARE,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UNITED HEALTHCARE,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,UNITED HEALTHCARE,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,VA TRICARE,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,WELLMED,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,HUMANA,MGD,11.97,,,,,,,per diem,11.97,11.97,"Per diem rate, code is bundled with other services"
"LIDOCAINE 2%/EPI 1:100,000 INJ",92212097,CDM,250,RC,,,,,,Inpatient,1,EA,11.97,11.97,HUMANA CHOICE PLUS,MGD,11.97,,,,,,,case rate,11.97,11.97,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORAZEPAM 1MG TAB             ,92212098,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,AETNA,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,BCBS,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,CIGNA,COM,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,TRICARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UNITED HEALTHCARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,UNITED HEALTHCARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,VA TRICARE,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,WELLMED,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,HUMANA,MGD,13.83,,,,,,,per diem,13.83,13.83,"Per diem rate, code is bundled with other services"
ALPRAZOLAM 0.25MG TAB         ,92212099,CDM,250,RC,,,,,,Inpatient,1,EA,13.83,13.83,HUMANA CHOICE PLUS,MGD,13.83,,,,,,,case rate,13.83,13.83,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,AETNA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,BCBS,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,CIGNA,COM,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,UNITED HEALTHCARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,VA TRICARE,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,WELLMED,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA,MGD,7.28,,,,,,,per diem,7.28,7.28,"Per diem rate, code is bundled with other services"
BUMETANIDE 0.25MG/ML INJ      ,92212100,CDM,250,RC,,,,,,Inpatient,1,EA,7.28,7.28,HUMANA CHOICE PLUS,MGD,7.28,,,,,,,case rate,7.28,7.28,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,AETNA,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,BCBS,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,CIGNA,COM,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,TRICARE,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UNITED HEALTHCARE,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,UNITED HEALTHCARE,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,VA,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,VA TRICARE,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,WELLMED,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,HUMANA,MGD,20.22,,,,,,,per diem,20.22,20.22,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212101,CDM,250,RC,,,,,,Inpatient,1,EA,20.22,20.22,HUMANA CHOICE PLUS,MGD,20.22,,,,,,,case rate,20.22,20.22,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENOBARBITAL 100MG TAB       ,92212102,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,AETNA,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,BCBS,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,CIGNA,COM,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,TRICARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,UNITED HEALTHCARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,UNITED HEALTHCARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,VA,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,VA TRICARE,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,WELLMED,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,HUMANA,MGD,7.15,,,,,,,per diem,7.15,7.15,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212103,CDM,250,RC,,,,,,Inpatient,1,EA,7.15,7.15,HUMANA CHOICE PLUS,MGD,7.15,,,,,,,case rate,7.15,7.15,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,AETNA,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,BCBS,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,CIGNA,COM,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,TRICARE,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,UNITED HEALTHCARE,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,UNITED HEALTHCARE,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,VA,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,VA TRICARE,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,WELLMED,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,HUMANA,MGD,110.03,,,,,,,per diem,110.03,110.03,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 2.5MG/ML INJ    ,92212104,CDM,250,RC,,,,,,Inpatient,1,EA,110.03,110.03,HUMANA CHOICE PLUS,MGD,110.03,,,,,,,case rate,110.03,110.03,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,AETNA,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,BCBS,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,CIGNA,COM,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,TRICARE,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,UNITED HEALTHCARE,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,UNITED HEALTHCARE,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,VA,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,VA TRICARE,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,WELLMED,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,HUMANA,MGD,25.8,,,,,,,per diem,25.8,25.8,"Per diem rate, code is bundled with other services"
PHENYLEPHRINE HCL 10MG/ML INJ ,92212105,CDM,250,RC,,,,,,Inpatient,1,EA,25.8,25.8,HUMANA CHOICE PLUS,MGD,25.8,,,,,,,case rate,25.8,25.8,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IBUPROFEN 600MG TAB           ,92212106,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212107,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212108,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,AETNA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,BCBS,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,CIGNA,COM,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,UNITED HEALTHCARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,VA TRICARE,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,WELLMED,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA,MGD,5.7,,,,,,,per diem,5.7,5.7,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212109,CDM,250,RC,,,,,,Inpatient,1,EA,5.7,5.7,HUMANA CHOICE PLUS,MGD,5.7,,,,,,,case rate,5.7,5.7,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,AETNA,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,BCBS,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,CIGNA,COM,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,TRICARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,UNITED HEALTHCARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,UNITED HEALTHCARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,VA,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,VA TRICARE,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,WELLMED,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,HUMANA,MGD,82.69,,,,,,,per diem,82.69,82.69,"Per diem rate, code is bundled with other services"
"NYSTATIN 100,000U/GM CRE      ",92212110,CDM,250,RC,,,,,,Inpatient,1,EA,82.69,82.69,HUMANA CHOICE PLUS,MGD,82.69,,,,,,,case rate,82.69,82.69,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,AETNA,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,BCBS,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,CIGNA,COM,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,TRICARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UNITED HEALTHCARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,UNITED HEALTHCARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,VA TRICARE,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,WELLMED,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,HUMANA,MGD,14.58,,,,,,,per diem,14.58,14.58,"Per diem rate, code is bundled with other services"
CARVEDILOL 6.25MG TAB         ,92212111,CDM,250,RC,,,,,,Inpatient,1,EA,14.58,14.58,HUMANA CHOICE PLUS,MGD,14.58,,,,,,,case rate,14.58,14.58,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
IMIPRAMINE HCL 25MG TAB       ,92212112,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
"BIOTIN 1,000MCG  TAB          ",92212113,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,AETNA,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,BCBS,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,CIGNA,COM,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,TRICARE,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,UNITED HEALTHCARE,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,UNITED HEALTHCARE,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,VA,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,VA TRICARE,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,WELLMED,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,HUMANA,MGD,342.56,,,,,,,per diem,342.56,342.56,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212114,CDM,250,RC,,,,,,Inpatient,1,EA,342.56,342.56,HUMANA CHOICE PLUS,MGD,342.56,,,,,,,case rate,342.56,342.56,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,AETNA,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,BCBS,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,CIGNA,COM,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,TRICARE,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,UNITED HEALTHCARE,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,UNITED HEALTHCARE,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,VA,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,VA TRICARE,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,WELLMED,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,HUMANA,MGD,108.05,,,,,,,per diem,108.05,108.05,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212115,CDM,250,RC,,,,,,Inpatient,1,EA,108.05,108.05,HUMANA CHOICE PLUS,MGD,108.05,,,,,,,case rate,108.05,108.05,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,AETNA,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,BCBS,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,CIGNA,COM,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,TRICARE,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,UNITED HEALTHCARE,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,UNITED HEALTHCARE,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,VA,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,VA TRICARE,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,WELLMED,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,HUMANA,MGD,111.51,,,,,,,per diem,111.51,111.51,"Per diem rate, code is bundled with other services"
HYDROCORTISONE 2.5% LOT       ,92212116,CDM,250,RC,,,,,,Inpatient,1,EA,111.51,111.51,HUMANA CHOICE PLUS,MGD,111.51,,,,,,,case rate,111.51,111.51,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,AETNA,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,BCBS,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,CIGNA,COM,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,TRICARE,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,UNITED HEALTHCARE,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,UNITED HEALTHCARE,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,VA,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,VA TRICARE,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,WELLMED,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,HUMANA,MGD,10.4,,,,,,,per diem,10.4,10.4,"Per diem rate, code is bundled with other services"
PRAVASTATIN NA 20MG TAB       ,92212117,CDM,250,RC,,,,,,Inpatient,1,EA,10.4,10.4,HUMANA CHOICE PLUS,MGD,10.4,,,,,,,case rate,10.4,10.4,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,AETNA,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,BCBS,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,CIGNA,COM,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,TRICARE,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,UNITED HEALTHCARE,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,UNITED HEALTHCARE,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,VA,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,VA TRICARE,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,WELLMED,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,HUMANA,MGD,31.59,,,,,,,per diem,31.59,31.59,"Per diem rate, code is bundled with other services"
BENZOCAINE 20% GEL            ,92212118,CDM,250,RC,,,,,,Inpatient,1,EA,31.59,31.59,HUMANA CHOICE PLUS,MGD,31.59,,,,,,,case rate,31.59,31.59,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TRIPLE ANTIBIOTIC OIN         ,92212119,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,AETNA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,BCBS,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,CIGNA,COM,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,UNITED HEALTHCARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,VA TRICARE,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,WELLMED,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA,MGD,5.51,,,,,,,per diem,5.51,5.51,"Per diem rate, code is bundled with other services"
PERPHENAZINE 2MG TAB          ,92212120,CDM,250,RC,,,,,,Inpatient,1,EA,5.51,5.51,HUMANA CHOICE PLUS,MGD,5.51,,,,,,,case rate,5.51,5.51,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,AETNA,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,BCBS,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,CIGNA,COM,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,TRICARE,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,UNITED HEALTHCARE,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,UNITED HEALTHCARE,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,VA,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,VA TRICARE,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,WELLMED,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,HUMANA,MGD,57.24,,,,,,,per diem,57.24,57.24,"Per diem rate, code is bundled with other services"
LEVOFLOXACIN 250MG TAB        ,92212121,CDM,250,RC,,,,,,Inpatient,1,EA,57.24,57.24,HUMANA CHOICE PLUS,MGD,57.24,,,,,,,case rate,57.24,57.24,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
VALPROIC ACID 250MG CAP       ,92212122,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,AETNA,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,BCBS,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,CIGNA,COM,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,TRICARE,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,UNITED HEALTHCARE,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,UNITED HEALTHCARE,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,VA,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,VA TRICARE,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,WELLMED,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,HUMANA,MGD,924.75,,,,,,,per diem,924.75,924.75,"Per diem rate, code is bundled with other services"
TRIFLURIDINE 1% EYE SOL       ,92212123,CDM,250,RC,,,,,,Inpatient,1,EA,924.75,924.75,HUMANA CHOICE PLUS,MGD,924.75,,,,,,,case rate,924.75,924.75,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,AETNA,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,BCBS,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,CIGNA,COM,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,TRICARE,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UNITED HEALTHCARE,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,UNITED HEALTHCARE,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,VA TRICARE,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,WELLMED,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,HUMANA,MGD,12.66,,,,,,,per diem,12.66,12.66,"Per diem rate, code is bundled with other services"
ATROPINE SULF 0.4MG/ML INJ    ,92212124,CDM,250,RC,,,,,,Inpatient,1,EA,12.66,12.66,HUMANA CHOICE PLUS,MGD,12.66,,,,,,,case rate,12.66,12.66,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,AETNA,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,BCBS,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,CIGNA,COM,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,TRICARE,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,UNITED HEALTHCARE,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,UNITED HEALTHCARE,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,VA,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,VA TRICARE,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,WELLMED,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,HUMANA,MGD,345.59,,,,,,,per diem,345.59,345.59,"Per diem rate, code is bundled with other services"
SULFACETAMIDE NA S 10%-5% LOT ,92212125,CDM,250,RC,,,,,,Inpatient,1,EA,345.59,345.59,HUMANA CHOICE PLUS,MGD,345.59,,,,,,,case rate,345.59,345.59,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 20MG TAB      ,92212126,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ALMACONE CTB                  ,92212127,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 2MG TAB            ,92212128,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENYTOIN NA 125MG/5ML SUS    ,92212129,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,AETNA,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,BCBS,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,CIGNA,COM,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,TRICARE,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,UNITED HEALTHCARE,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,UNITED HEALTHCARE,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,VA,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,VA TRICARE,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,WELLMED,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,HUMANA,MGD,38.15,,,,,,,per diem,38.15,38.15,"Per diem rate, code is bundled with other services"
SODIUM CL 5% EYE OIN          ,92212130,CDM,250,RC,,,,,,Inpatient,1,EA,38.15,38.15,HUMANA CHOICE PLUS,MGD,38.15,,,,,,,case rate,38.15,38.15,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ATENOLOL 25MG TAB             ,92212131,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,AETNA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,BCBS,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,CIGNA,COM,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,UNITED HEALTHCARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,VA,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,VA TRICARE,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,WELLMED,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,HUMANA,MGD,7.97,,,,,,,per diem,7.97,7.97,"Per diem rate, code is bundled with other services"
VERAPAMIL HCL 240MG TER       ,92212132,CDM,250,RC,,,,,,Inpatient,1,EA,7.97,7.97,HUMANA CHOICE PLUS,MGD,7.97,,,,,,,case rate,7.97,7.97,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,AETNA,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,BCBS,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,CIGNA,COM,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,TRICARE,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,UNITED HEALTHCARE,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,UNITED HEALTHCARE,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,VA,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,VA TRICARE,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,WELLMED,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,HUMANA,MGD,6.55,,,,,,,per diem,6.55,6.55,"Per diem rate, code is bundled with other services"
GLIPIZIDE 10MG TER            ,92212133,CDM,250,RC,,,,,,Inpatient,1,EA,6.55,6.55,HUMANA CHOICE PLUS,MGD,6.55,,,,,,,case rate,6.55,6.55,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 6.25MG/5ML SY,92212134,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISOSORBIDE DN 10MG TAB        ,92212135,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 75MG CAP          ,92212136,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,AETNA,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,BCBS,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,CIGNA,COM,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,TRICARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,UNITED HEALTHCARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,UNITED HEALTHCARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,VA,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,VA TRICARE,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,WELLMED,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,HUMANA,MGD,57.33,,,,,,,per diem,57.33,57.33,"Per diem rate, code is bundled with other services"
ESTRADIOL 0.05MG/DAY TDM      ,92212137,CDM,250,RC,,,,,,Inpatient,1,EA,57.33,57.33,HUMANA CHOICE PLUS,MGD,57.33,,,,,,,case rate,57.33,57.33,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 500MG TAB      ,92212138,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 1.25MG TAB          ,92212139,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 120MG SUP       ,92212140,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,AETNA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,BCBS,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,CIGNA,COM,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,UNITED HEALTHCARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,VA TRICARE,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,WELLMED,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA,MGD,19.85,,,,,,,per diem,19.85,19.85,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212141,CDM,250,RC,,,,,,Inpatient,1,EA,19.85,19.85,HUMANA CHOICE PLUS,MGD,19.85,,,,,,,case rate,19.85,19.85,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG TAB     ,92212142,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,AETNA,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,BCBS,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,CIGNA,COM,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,TRICARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,UNITED HEALTHCARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,UNITED HEALTHCARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,VA,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,VA TRICARE,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,WELLMED,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,HUMANA,MGD,19.91,,,,,,,per diem,19.91,19.91,"Per diem rate, code is bundled with other services"
ERYTHROMYCIN 250MG ECC        ,92212143,CDM,250,RC,,,,,,Inpatient,1,EA,19.91,19.91,HUMANA CHOICE PLUS,MGD,19.91,,,,,,,case rate,19.91,19.91,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,AETNA,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,BCBS,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,CIGNA,COM,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,TRICARE,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,UNITED HEALTHCARE,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,UNITED HEALTHCARE,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,VA,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,VA TRICARE,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,WELLMED,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,HUMANA,MGD,684.65,,,,,,,per diem,684.65,684.65,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212144,CDM,250,RC,,,,,,Inpatient,1,EA,684.65,684.65,HUMANA CHOICE PLUS,MGD,684.65,,,,,,,case rate,684.65,684.65,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORZOXAZONE 500MG TAB       ,92212145,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,AETNA,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,BCBS,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,CIGNA,COM,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,TRICARE,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,UNITED HEALTHCARE,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,UNITED HEALTHCARE,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,VA,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,VA TRICARE,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,WELLMED,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,HUMANA,MGD,136.21,,,,,,,per diem,136.21,136.21,"Per diem rate, code is bundled with other services"
ADENOSINE 3MG/ML INJ          ,92212146,CDM,250,RC,,,,,,Inpatient,1,EA,136.21,136.21,HUMANA CHOICE PLUS,MGD,136.21,,,,,,,case rate,136.21,136.21,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,AETNA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,BCBS,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,CIGNA,COM,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,UNITED HEALTHCARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,VA TRICARE,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,WELLMED,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA,MGD,8.76,,,,,,,per diem,8.76,8.76,"Per diem rate, code is bundled with other services"
SOTALOL HCL 80MG TAB          ,92212147,CDM,250,RC,,,,,,Inpatient,1,EA,8.76,8.76,HUMANA CHOICE PLUS,MGD,8.76,,,,,,,case rate,8.76,8.76,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,AETNA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,BCBS,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,CIGNA,COM,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,UNITED HEALTHCARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,VA,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,VA TRICARE,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,WELLMED,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,HUMANA,MGD,8.44,,,,,,,per diem,8.44,8.44,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 300MG C24       ,92212148,CDM,250,RC,,,,,,Inpatient,1,EA,8.44,8.44,HUMANA CHOICE PLUS,MGD,8.44,,,,,,,case rate,8.44,8.44,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,AETNA,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,BCBS,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,CIGNA,COM,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,TRICARE,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,UNITED HEALTHCARE,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,UNITED HEALTHCARE,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,VA,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,VA TRICARE,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,WELLMED,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,HUMANA,MGD,750.36,,,,,,,per diem,750.36,750.36,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% GEL        ,92212149,CDM,250,RC,,,,,,Inpatient,1,EA,750.36,750.36,HUMANA CHOICE PLUS,MGD,750.36,,,,,,,case rate,750.36,750.36,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,AETNA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,BCBS,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,CIGNA,COM,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,UNITED HEALTHCARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,VA,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,VA TRICARE,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,WELLMED,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,HUMANA,MGD,22.71,,,,,,,per diem,22.71,22.71,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 25MG TAB   ,92212150,CDM,250,RC,,,,,,Inpatient,1,EA,22.71,22.71,HUMANA CHOICE PLUS,MGD,22.71,,,,,,,case rate,22.71,22.71,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212151,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,AETNA,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,BCBS,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,CIGNA,COM,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,TRICARE,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,UNITED HEALTHCARE,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,UNITED HEALTHCARE,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,VA,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,VA TRICARE,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,WELLMED,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,HUMANA,MGD,523.22,,,,,,,per diem,523.22,523.22,"Per diem rate, code is bundled with other services"
INSULIN HUM ISOP 100U/ML INJ  ,92212152,CDM,250,RC,,,,,,Inpatient,1,EA,523.22,523.22,HUMANA CHOICE PLUS,MGD,523.22,,,,,,,case rate,523.22,523.22,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LORATADINE 10MG TAB           ,92212153,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,AETNA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,BCBS,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,CIGNA,COM,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,UNITED HEALTHCARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,VA TRICARE,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,WELLMED,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA,MGD,5.89,,,,,,,per diem,5.89,5.89,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% SOL            ,92212154,CDM,250,RC,,,,,,Inpatient,1,EA,5.89,5.89,HUMANA CHOICE PLUS,MGD,5.89,,,,,,,case rate,5.89,5.89,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLORPROMAZINE HCL 200MG TAB  ,92212155,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
METOPROLOL TART 50MG TAB      ,92212156,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,AETNA,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,BCBS,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,CIGNA,COM,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,TRICARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,UNITED HEALTHCARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,UNITED HEALTHCARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,VA,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,VA TRICARE,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,WELLMED,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,HUMANA,MGD,140.49,,,,,,,per diem,140.49,140.49,"Per diem rate, code is bundled with other services"
HYDROCORTISONE VAL 0.2% OIN   ,92212157,CDM,250,RC,,,,,,Inpatient,1,EA,140.49,140.49,HUMANA CHOICE PLUS,MGD,140.49,,,,,,,case rate,140.49,140.49,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,AETNA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,BCBS,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,CIGNA,COM,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,UNITED HEALTHCARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,VA TRICARE,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,WELLMED,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA,MGD,8.82,,,,,,,per diem,8.82,8.82,"Per diem rate, code is bundled with other services"
KETOPROFEN 200MG CER          ,92212158,CDM,250,RC,,,,,,Inpatient,1,EA,8.82,8.82,HUMANA CHOICE PLUS,MGD,8.82,,,,,,,case rate,8.82,8.82,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NIACIN TD 250MG CER           ,92212159,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PREDNISONE 10MG TAB           ,92212160,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,AETNA,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,BCBS,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,CIGNA,COM,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,TRICARE,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,UNITED HEALTHCARE,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,UNITED HEALTHCARE,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,VA,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,VA TRICARE,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,WELLMED,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,HUMANA,MGD,72.67,,,,,,,per diem,72.67,72.67,"Per diem rate, code is bundled with other services"
LETROZOLE 2.5MG TAB           ,92212161,CDM,250,RC,,,,,,Inpatient,1,EA,72.67,72.67,HUMANA CHOICE PLUS,MGD,72.67,,,,,,,case rate,72.67,72.67,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
OXYCODONE HCL                 ,92212162,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BUSPIRONE HCL 10MG TAB        ,92212163,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,AETNA,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,BCBS,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,CIGNA,COM,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,TRICARE,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,UNITED HEALTHCARE,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,UNITED HEALTHCARE,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,VA,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,VA TRICARE,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,WELLMED,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,HUMANA,MGD,177.03,,,,,,,per diem,177.03,177.03,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE BETAMETH 1-0.05 C,92212164,CDM,250,RC,,,,,,Inpatient,1,EA,177.03,177.03,HUMANA CHOICE PLUS,MGD,177.03,,,,,,,case rate,177.03,177.03,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,AETNA,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,BCBS,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,CIGNA,COM,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,TRICARE,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,UNITED HEALTHCARE,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,UNITED HEALTHCARE,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,VA,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,VA TRICARE,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,WELLMED,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,HUMANA,MGD,251.87,,,,,,,per diem,251.87,251.87,"Per diem rate, code is bundled with other services"
AZTREONAM 2GM/50ML INJ        ,92212165,CDM,250,RC,,,,,,Inpatient,1,EA,251.87,251.87,HUMANA CHOICE PLUS,MGD,251.87,,,,,,,case rate,251.87,251.87,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,AETNA,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,BCBS,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,CIGNA,COM,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,TRICARE,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,UNITED HEALTHCARE,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,UNITED HEALTHCARE,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,VA,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,VA TRICARE,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,WELLMED,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,HUMANA,MGD,19.62,,,,,,,per diem,19.62,19.62,"Per diem rate, code is bundled with other services"
"LIDOCAINE 1%/EPI 1:100,000 INJ",92212166,CDM,250,RC,,,,,,Inpatient,1,EA,19.62,19.62,HUMANA CHOICE PLUS,MGD,19.62,,,,,,,case rate,19.62,19.62,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 500MG CAP         ,92212167,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SALSALATE 750MG TAB           ,92212168,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CALCIUM GLUBIONATE 1.8GM/5ML S,92212169,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM GLUCONATE 500MG TAB ,92212170,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,AETNA,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,BCBS,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,CIGNA,COM,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,TRICARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,UNITED HEALTHCARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,UNITED HEALTHCARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,VA,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,VA TRICARE,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,WELLMED,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,HUMANA,MGD,55.98,,,,,,,per diem,55.98,55.98,"Per diem rate, code is bundled with other services"
AMPICILLIN-SULBACTAM 3GM INJ  ,92212171,CDM,250,RC,,,,,,Inpatient,1,EA,55.98,55.98,HUMANA CHOICE PLUS,MGD,55.98,,,,,,,case rate,55.98,55.98,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,AETNA,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,BCBS,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,CIGNA,COM,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,TRICARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,UNITED HEALTHCARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,UNITED HEALTHCARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,VA,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,VA TRICARE,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,WELLMED,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,HUMANA,MGD,28.57,,,,,,,per diem,28.57,28.57,"Per diem rate, code is bundled with other services"
AZITHROMYCIN 500MG INJ        ,92212172,CDM,250,RC,,,,,,Inpatient,1,EA,28.57,28.57,HUMANA CHOICE PLUS,MGD,28.57,,,,,,,case rate,28.57,28.57,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARBAMAZEPINE 100MG CTB       ,92212173,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,AETNA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,BCBS,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,CIGNA,COM,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,UNITED HEALTHCARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,VA,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,VA TRICARE,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,WELLMED,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,HUMANA,MGD,11.03,,,,,,,per diem,11.03,11.03,"Per diem rate, code is bundled with other services"
ICHTHAMMOL 20% OIN            ,92212174,CDM,250,RC,,,,,,Inpatient,1,EA,11.03,11.03,HUMANA CHOICE PLUS,MGD,11.03,,,,,,,case rate,11.03,11.03,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 300MG TAB           ,92212175,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,AETNA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,BCBS,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,CIGNA,COM,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,UNITED HEALTHCARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,VA TRICARE,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,WELLMED,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA,MGD,16.1,,,,,,,per diem,16.1,16.1,"Per diem rate, code is bundled with other services"
SODIUM CL 2.5MEQ/ML IVS       ,92212176,CDM,258,RC,,,,,,Inpatient,1,EA,16.1,16.1,HUMANA CHOICE PLUS,MGD,16.1,,,,,,,case rate,16.1,16.1,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,AETNA,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,BCBS,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,CIGNA,COM,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,TRICARE,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,UNITED HEALTHCARE,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,UNITED HEALTHCARE,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,VA,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,VA TRICARE,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,WELLMED,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,HUMANA,MGD,10.65,,,,,,,per diem,10.65,10.65,"Per diem rate, code is bundled with other services"
DISOPYRAMIDE PHOS 150MG CAP   ,92212177,CDM,250,RC,,,,,,Inpatient,1,EA,10.65,10.65,HUMANA CHOICE PLUS,MGD,10.65,,,,,,,case rate,10.65,10.65,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,AETNA,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,BCBS,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,CIGNA,COM,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,TRICARE,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,UNITED HEALTHCARE,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,UNITED HEALTHCARE,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,VA,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,VA TRICARE,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,WELLMED,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,HUMANA,MGD,543.19,,,,,,,per diem,543.19,543.19,"Per diem rate, code is bundled with other services"
IODOQUINOL HC 1%-1% CRE       ,92212178,CDM,250,RC,,,,,,Inpatient,1,EA,543.19,543.19,HUMANA CHOICE PLUS,MGD,543.19,,,,,,,case rate,543.19,543.19,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CHLOROTHIAZIDE 250MG TAB      ,92212179,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,AETNA,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,BCBS,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,CIGNA,COM,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,TRICARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,UNITED HEALTHCARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,UNITED HEALTHCARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,VA,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,VA TRICARE,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,WELLMED,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,HUMANA,MGD,23.94,,,,,,,per diem,23.94,23.94,"Per diem rate, code is bundled with other services"
RISPERIDONE 2MG TAB           ,92212180,CDM,250,RC,,,,,,Inpatient,1,EA,23.94,23.94,HUMANA CHOICE PLUS,MGD,23.94,,,,,,,case rate,23.94,23.94,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,AETNA,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,BCBS,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,CIGNA,COM,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,TRICARE,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,UNITED HEALTHCARE,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,UNITED HEALTHCARE,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,VA,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,VA TRICARE,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,WELLMED,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,HUMANA,MGD,577.33,,,,,,,per diem,577.33,577.33,"Per diem rate, code is bundled with other services"
DOXEPIN HCL 5%CRE             ,92212181,CDM,250,RC,,,,,,Inpatient,1,EA,577.33,577.33,HUMANA CHOICE PLUS,MGD,577.33,,,,,,,case rate,577.33,577.33,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,AETNA,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,BCBS,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,CIGNA,COM,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,TRICARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UNITED HEALTHCARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,UNITED HEALTHCARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,VA,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,VA TRICARE,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,WELLMED,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,HUMANA,MGD,17.17,,,,,,,per diem,17.17,17.17,"Per diem rate, code is bundled with other services"
CIPROFLOXACIN 750MG TAB       ,92212182,CDM,250,RC,,,,,,Inpatient,1,EA,17.17,17.17,HUMANA CHOICE PLUS,MGD,17.17,,,,,,,case rate,17.17,17.17,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ISONIAZID 100MG TAB           ,92212183,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MAGNESIUM CL 64MG TER         ,92212184,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 2MG/ML SOL        ,92212185,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,AETNA,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,BCBS,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,CIGNA,COM,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,TRICARE,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,UNITED HEALTHCARE,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,UNITED HEALTHCARE,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,VA,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,VA TRICARE,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,WELLMED,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,HUMANA,MGD,1369.31,,,,,,,per diem,1369.31,1369.31,"Per diem rate, code is bundled with other services"
ECONAZOLE NITRATE 1% CRE      ,92212186,CDM,250,RC,,,,,,Inpatient,1,EA,1369.31,1369.31,HUMANA CHOICE PLUS,MGD,1369.31,,,,,,,case rate,1369.31,1369.31,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,AETNA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,CIGNA,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,WELLMED,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA,MGD,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212187,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA CHOICE PLUS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,AETNA,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,BCBS,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,CIGNA,COM,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,TRICARE,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,UNITED HEALTHCARE,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,UNITED HEALTHCARE,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,VA,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,VA TRICARE,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,WELLMED,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,HUMANA,MGD,1404.27,,,,,,,per diem,1404.27,1404.27,"Per diem rate, code is bundled with other services"
ACYCLOVIR NA 500MG INJ        ,92212188,CDM,250,RC,,,,,,Inpatient,1,EA,1404.27,1404.27,HUMANA CHOICE PLUS,MGD,1404.27,,,,,,,case rate,1404.27,1404.27,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,AETNA,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,BCBS,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,CIGNA,COM,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,TRICARE,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,UNITED HEALTHCARE,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,UNITED HEALTHCARE,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,VA,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,VA TRICARE,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,WELLMED,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,HUMANA,MGD,23.37,,,,,,,per diem,23.37,23.37,"Per diem rate, code is bundled with other services"
NIACIN 750MG TER              ,92212189,CDM,250,RC,,,,,,Inpatient,1,EA,23.37,23.37,HUMANA CHOICE PLUS,MGD,23.37,,,,,,,case rate,23.37,23.37,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,AETNA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,BCBS,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,CIGNA,COM,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,UNITED HEALTHCARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,VA TRICARE,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,WELLMED,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA,MGD,7.53,,,,,,,per diem,7.53,7.53,"Per diem rate, code is bundled with other services"
CARISOPRODOL ASPIRIN 200-325 T,92212190,CDM,250,RC,,,,,,Inpatient,1,EA,7.53,7.53,HUMANA CHOICE PLUS,MGD,7.53,,,,,,,case rate,7.53,7.53,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,AETNA,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,BCBS,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,CIGNA,COM,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,TRICARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,UNITED HEALTHCARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,UNITED HEALTHCARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,VA,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,VA TRICARE,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,WELLMED,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,HUMANA,MGD,51.98,,,,,,,per diem,51.98,51.98,"Per diem rate, code is bundled with other services"
RISPERIDONE 4MG TAB           ,92212191,CDM,250,RC,,,,,,Inpatient,1,EA,51.98,51.98,HUMANA CHOICE PLUS,MGD,51.98,,,,,,,case rate,51.98,51.98,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROPRANOLOL HCL 40MG TAB      ,92212192,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,AETNA,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,BCBS,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,CIGNA,COM,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,TRICARE,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,UNITED HEALTHCARE,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,UNITED HEALTHCARE,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,VA,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,VA TRICARE,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,WELLMED,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,HUMANA,MGD,40.76,,,,,,,per diem,40.76,40.76,"Per diem rate, code is bundled with other services"
QUETIAPINE FUMARATE 200MG TAB ,92212193,CDM,250,RC,,,,,,Inpatient,1,EA,40.76,40.76,HUMANA CHOICE PLUS,MGD,40.76,,,,,,,case rate,40.76,40.76,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ACETAMINOPHEN 325MG SUP       ,92212194,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,AETNA,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,BCBS,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,CIGNA,COM,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,TRICARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,UNITED HEALTHCARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,UNITED HEALTHCARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,VA,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,VA TRICARE,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,WELLMED,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,HUMANA,MGD,19.06,,,,,,,per diem,19.06,19.06,"Per diem rate, code is bundled with other services"
SIMVASTATIN 20MG TAB          ,92212195,CDM,250,RC,,,,,,Inpatient,1,EA,19.06,19.06,HUMANA CHOICE PLUS,MGD,19.06,,,,,,,case rate,19.06,19.06,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,AETNA,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,BCBS,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,CIGNA,COM,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,TRICARE,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,UNITED HEALTHCARE,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,UNITED HEALTHCARE,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,VA,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,VA TRICARE,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,WELLMED,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,HUMANA,MGD,72.51,,,,,,,per diem,72.51,72.51,"Per diem rate, code is bundled with other services"
SUCCINYLCHOLINE CL 20MG/ML INJ,92212196,CDM,250,RC,,,,,,Inpatient,1,EA,72.51,72.51,HUMANA CHOICE PLUS,MGD,72.51,,,,,,,case rate,72.51,72.51,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,AETNA,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,BCBS,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,CIGNA,COM,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,TRICARE,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,UNITED HEALTHCARE,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,UNITED HEALTHCARE,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,VA,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,VA TRICARE,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,WELLMED,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,HUMANA,MGD,139.8,,,,,,,per diem,139.8,139.8,"Per diem rate, code is bundled with other services"
ACETAZOLAMIDE 500MG INJ       ,92212197,CDM,250,RC,,,,,,Inpatient,1,EA,139.8,139.8,HUMANA CHOICE PLUS,MGD,139.8,,,,,,,case rate,139.8,139.8,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,AETNA,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,BCBS,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,CIGNA,COM,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,TRICARE,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,UNITED HEALTHCARE,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,UNITED HEALTHCARE,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,VA,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,VA TRICARE,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,WELLMED,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,HUMANA,MGD,6.58,,,,,,,per diem,6.58,6.58,"Per diem rate, code is bundled with other services"
CLOTRIMAZOLE 10MG LOZ         ,92212198,CDM,250,RC,,,,,,Inpatient,1,EA,6.58,6.58,HUMANA CHOICE PLUS,MGD,6.58,,,,,,,case rate,6.58,6.58,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
HALOPERIDOL 5MG TAB           ,92212199,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CARISOPRODOL 350MG TAB        ,92212200,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,AETNA,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,BCBS,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,CIGNA,COM,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,TRICARE,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,UNITED HEALTHCARE,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,UNITED HEALTHCARE,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,VA,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,VA TRICARE,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,WELLMED,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,HUMANA,MGD,1113.78,,,,,,,per diem,1113.78,1113.78,"Per diem rate, code is bundled with other services"
PENICILLIN G BENZ 0.6MMU/ML SU,92212201,CDM,250,RC,,,,,,Inpatient,1,EA,1113.78,1113.78,HUMANA CHOICE PLUS,MGD,1113.78,,,,,,,case rate,1113.78,1113.78,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
MULTIVITAMIN TAB              ,92212202,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,AETNA,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,BCBS,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,CIGNA,COM,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,TRICARE,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,UNITED HEALTHCARE,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,UNITED HEALTHCARE,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,VA,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,VA TRICARE,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,WELLMED,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,HUMANA,MGD,41.39,,,,,,,per diem,41.39,41.39,"Per diem rate, code is bundled with other services"
MICONAZOLE NITRATE 2% CRE     ,92212203,CDM,250,RC,,,,,,Inpatient,1,EA,41.39,41.39,HUMANA CHOICE PLUS,MGD,41.39,,,,,,,case rate,41.39,41.39,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,AETNA,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,BCBS,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,CIGNA,COM,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,TRICARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,UNITED HEALTHCARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,UNITED HEALTHCARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,VA,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,VA TRICARE,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,WELLMED,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,HUMANA,MGD,21.99,,,,,,,per diem,21.99,21.99,"Per diem rate, code is bundled with other services"
TAMSULOSIN HCL 0.4MG CAP      ,92212204,CDM,250,RC,,,,,,Inpatient,1,EA,21.99,21.99,HUMANA CHOICE PLUS,MGD,21.99,,,,,,,case rate,21.99,21.99,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,AETNA,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,BCBS,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,CIGNA,COM,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,TRICARE,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,UNITED HEALTHCARE,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,UNITED HEALTHCARE,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,VA,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,VA TRICARE,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,WELLMED,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,HUMANA,MGD,10.93,,,,,,,per diem,10.93,10.93,"Per diem rate, code is bundled with other services"
RISPERIDONE 1MG TAB           ,92212205,CDM,250,RC,,,,,,Inpatient,1,EA,10.93,10.93,HUMANA CHOICE PLUS,MGD,10.93,,,,,,,case rate,10.93,10.93,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,AETNA,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,BCBS,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,CIGNA,COM,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,TRICARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,UNITED HEALTHCARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,UNITED HEALTHCARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,VA,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,VA TRICARE,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,WELLMED,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,HUMANA,MGD,16.44,,,,,,,per diem,16.44,16.44,"Per diem rate, code is bundled with other services"
CARVEDILOL 3.125MG TAB        ,92212206,CDM,250,RC,,,,,,Inpatient,1,EA,16.44,16.44,HUMANA CHOICE PLUS,MGD,16.44,,,,,,,case rate,16.44,16.44,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212207,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,AETNA,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,BCBS,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,CIGNA,COM,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,TRICARE,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,UNITED HEALTHCARE,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,UNITED HEALTHCARE,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,VA,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,VA TRICARE,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,WELLMED,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,HUMANA,MGD,8.54,,,,,,,per diem,8.54,8.54,"Per diem rate, code is bundled with other services"
SERTRALINE HCL 100MG TAB      ,92212208,CDM,250,RC,,,,,,Inpatient,1,EA,8.54,8.54,HUMANA CHOICE PLUS,MGD,8.54,,,,,,,case rate,8.54,8.54,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
AMOXICILLIN 250MG CAP         ,92212209,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,AETNA,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,BCBS,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,CIGNA,COM,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,TRICARE,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,UNITED HEALTHCARE,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,UNITED HEALTHCARE,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,VA,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,VA TRICARE,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,WELLMED,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,HUMANA,MGD,891.45,,,,,,,per diem,891.45,891.45,"Per diem rate, code is bundled with other services"
FLUOCINONIDE 0.05% OIN        ,92212210,CDM,250,RC,,,,,,Inpatient,1,EA,891.45,891.45,HUMANA CHOICE PLUS,MGD,891.45,,,,,,,case rate,891.45,891.45,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,AETNA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,BCBS,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,CIGNA,COM,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,UNITED HEALTHCARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,VA TRICARE,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,WELLMED,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA,MGD,6.74,,,,,,,per diem,6.74,6.74,"Per diem rate, code is bundled with other services"
NICOTINE 21MG/24HR TDM        ,92212211,CDM,250,RC,,,,,,Inpatient,1,EA,6.74,6.74,HUMANA CHOICE PLUS,MGD,6.74,,,,,,,case rate,6.74,6.74,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,AETNA,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,BCBS,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,CIGNA,COM,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,TRICARE,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,UNITED HEALTHCARE,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,UNITED HEALTHCARE,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,VA,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,VA TRICARE,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,WELLMED,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,HUMANA,MGD,70.09,,,,,,,per diem,70.09,70.09,"Per diem rate, code is bundled with other services"
FLUTICASONE PROP 0.05% CRE    ,92212212,CDM,250,RC,,,,,,Inpatient,1,EA,70.09,70.09,HUMANA CHOICE PLUS,MGD,70.09,,,,,,,case rate,70.09,70.09,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,AETNA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,BCBS,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,CIGNA,COM,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,UNITED HEALTHCARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,VA TRICARE,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,WELLMED,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA,MGD,6.24,,,,,,,per diem,6.24,6.24,"Per diem rate, code is bundled with other services"
BUPIVACAINE HCL 0.25% INJ     ,92212213,CDM,250,RC,,,,,,Inpatient,1,EA,6.24,6.24,HUMANA CHOICE PLUS,MGD,6.24,,,,,,,case rate,6.24,6.24,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
TERBUTALINE SULF 2.5MG TAB    ,92212214,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LABETALOL HCL 200MG TAB       ,92212215,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 25MG TAB  ,92212216,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,AETNA,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,BCBS,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,CIGNA,COM,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,TRICARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,UNITED HEALTHCARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,UNITED HEALTHCARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,VA,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,VA TRICARE,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,WELLMED,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,HUMANA,MGD,70.72,,,,,,,per diem,70.72,70.72,"Per diem rate, code is bundled with other services"
OXYCODONE HCL 80MG TER        ,92212217,CDM,250,RC,,,,,,Inpatient,1,EA,70.72,70.72,HUMANA CHOICE PLUS,MGD,70.72,,,,,,,case rate,70.72,70.72,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
ENALAPRIL MALEATE 2.5MG TAB   ,92212218,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,AETNA,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,BCBS,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,CIGNA,COM,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,TRICARE,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,UNITED HEALTHCARE,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,UNITED HEALTHCARE,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,VA,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,VA TRICARE,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,WELLMED,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,HUMANA,MGD,34.4,,,,,,,per diem,34.4,34.4,"Per diem rate, code is bundled with other services"
LAMOTRIGINE 25MG TAB          ,92212219,CDM,250,RC,,,,,,Inpatient,1,EA,34.4,34.4,HUMANA CHOICE PLUS,MGD,34.4,,,,,,,case rate,34.4,34.4,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GLYBURIDE 2.5MG TAB           ,92212220,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
SODIUM CL 0.9% IVS            ,92212221,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,AETNA,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,BCBS,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,CIGNA,COM,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,TRICARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,UNITED HEALTHCARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,UNITED HEALTHCARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,VA,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,VA TRICARE,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,WELLMED,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,HUMANA,MGD,15.47,,,,,,,per diem,15.47,15.47,"Per diem rate, code is bundled with other services"
SIMVASTATIN 40MG TAB          ,92212222,CDM,250,RC,,,,,,Inpatient,1,EA,15.47,15.47,HUMANA CHOICE PLUS,MGD,15.47,,,,,,,case rate,15.47,15.47,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,AETNA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,BCBS,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,CIGNA,COM,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,UNITED HEALTHCARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,VA TRICARE,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,WELLMED,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA,MGD,6.62,,,,,,,per diem,6.62,6.62,"Per diem rate, code is bundled with other services"
FUROSEMIDE 10MG/ML INJ        ,92212223,CDM,250,RC,,,,,,Inpatient,1,EA,6.62,6.62,HUMANA CHOICE PLUS,MGD,6.62,,,,,,,case rate,6.62,6.62,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,AETNA,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,BCBS,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,CIGNA,COM,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,TRICARE,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,UNITED HEALTHCARE,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,UNITED HEALTHCARE,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,VA,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,VA TRICARE,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,WELLMED,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,HUMANA,MGD,214.64,,,,,,,per diem,214.64,214.64,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% EMO     ,92212224,CDM,250,RC,,,,,,Inpatient,1,EA,214.64,214.64,HUMANA CHOICE PLUS,MGD,214.64,,,,,,,case rate,214.64,214.64,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,AETNA,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,BCBS,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,CIGNA,COM,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,TRICARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,UNITED HEALTHCARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,UNITED HEALTHCARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,VA,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,VA TRICARE,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,WELLMED,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,HUMANA,MGD,5.26,,,,,,,per diem,5.26,5.26,"Per diem rate, code is bundled with other services"
FEXOFENADINE HCL 180MG TAB    ,92212225,CDM,250,RC,,,,,,Inpatient,1,EA,5.26,5.26,HUMANA CHOICE PLUS,MGD,5.26,,,,,,,case rate,5.26,5.26,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,AETNA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,BCBS,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,CIGNA,COM,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,UNITED HEALTHCARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,VA TRICARE,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,WELLMED,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA,MGD,7.12,,,,,,,per diem,7.12,7.12,"Per diem rate, code is bundled with other services"
BACLOFEN 10MG TAB             ,92212226,CDM,250,RC,,,,,,Inpatient,1,EA,7.12,7.12,HUMANA CHOICE PLUS,MGD,7.12,,,,,,,case rate,7.12,7.12,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,AETNA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,BCBS,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,CIGNA,COM,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,UNITED HEALTHCARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,VA,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,VA TRICARE,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,WELLMED,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,HUMANA,MGD,14.96,,,,,,,per diem,14.96,14.96,"Per diem rate, code is bundled with other services"
ATORVASTATIN CALCIUM 10MG TAB ,92212227,CDM,250,RC,,,,,,Inpatient,1,EA,14.96,14.96,HUMANA CHOICE PLUS,MGD,14.96,,,,,,,case rate,14.96,14.96,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
NICARDIPINE HCL 20MG CAP      ,92212228,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PROMETHAZINE HCL 25MG/ML INJ  ,92212229,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,AETNA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,BCBS,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,CIGNA,COM,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,UNITED HEALTHCARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,VA TRICARE,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,WELLMED,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA,MGD,12.73,,,,,,,per diem,12.73,12.73,"Per diem rate, code is bundled with other services"
WATER STERILE SOL             ,92212230,CDM,250,RC,,,,,,Inpatient,1,EA,12.73,12.73,HUMANA CHOICE PLUS,MGD,12.73,,,,,,,case rate,12.73,12.73,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,AETNA,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,BCBS,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,CIGNA,COM,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,TRICARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,UNITED HEALTHCARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,UNITED HEALTHCARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,VA,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,VA TRICARE,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,WELLMED,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,HUMANA,MGD,72.01,,,,,,,per diem,72.01,72.01,"Per diem rate, code is bundled with other services"
VASOPRESSIN 20U/ML INJ        ,92212231,CDM,250,RC,,,,,,Inpatient,1,EA,72.01,72.01,HUMANA CHOICE PLUS,MGD,72.01,,,,,,,case rate,72.01,72.01,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,AETNA,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,BCBS,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,CIGNA,COM,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,TRICARE,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,UNITED HEALTHCARE,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,UNITED HEALTHCARE,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,VA,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,VA TRICARE,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,WELLMED,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,HUMANA,MGD,1636.43,,,,,,,per diem,1636.43,1636.43,"Per diem rate, code is bundled with other services"
CLOBETASOL PROP 0.05% OIN     ,92212232,CDM,250,RC,,,,,,Inpatient,1,EA,1636.43,1636.43,HUMANA CHOICE PLUS,MGD,1636.43,,,,,,,case rate,1636.43,1636.43,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
GUAIFENESIN COD 100-10MG/5ML S,92212233,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,AETNA,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,BCBS,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,CIGNA,COM,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,TRICARE,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,UNITED HEALTHCARE,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,UNITED HEALTHCARE,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,VA,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,VA TRICARE,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,WELLMED,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,HUMANA,MGD,85.93,,,,,,,per diem,85.93,85.93,"Per diem rate, code is bundled with other services"
TESTOSTERONE CYPI 200MG/ML OIL,92212234,CDM,250,RC,,,,,,Inpatient,1,EA,85.93,85.93,HUMANA CHOICE PLUS,MGD,85.93,,,,,,,case rate,85.93,85.93,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,AETNA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,BCBS,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,CIGNA,COM,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,UNITED HEALTHCARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,VA TRICARE,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,WELLMED,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA,MGD,9.23,,,,,,,per diem,9.23,9.23,"Per diem rate, code is bundled with other services"
ALENDRONATE NA 10MG TAB       ,92212235,CDM,250,RC,,,,,,Inpatient,1,EA,9.23,9.23,HUMANA CHOICE PLUS,MGD,9.23,,,,,,,case rate,9.23,9.23,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
FLUPHENAZINE HCL 5MG/ML SOL   ,92212236,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG CAP  ,92212237,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
CLONAZEPAM 0.5MG TAB          ,92212238,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,AETNA,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,BCBS,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,CIGNA,COM,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,TRICARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,UNITED HEALTHCARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,UNITED HEALTHCARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,VA,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,VA TRICARE,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,WELLMED,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,HUMANA,MGD,21.77,,,,,,,per diem,21.77,21.77,"Per diem rate, code is bundled with other services"
MEPERIDINE 100MG/ML INJ       ,92212239,CDM,250,RC,,,,,,Inpatient,1,EA,21.77,21.77,HUMANA CHOICE PLUS,MGD,21.77,,,,,,,case rate,21.77,21.77,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,AETNA,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,BCBS,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,CIGNA,COM,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,TRICARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UNITED HEALTHCARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,UNITED HEALTHCARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,VA TRICARE,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,WELLMED,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,HUMANA,MGD,7.62,,,,,,,per diem,7.62,7.62,"Per diem rate, code is bundled with other services"
FLUVOXAMINE MAL 50MG TAB      ,92212240,CDM,250,RC,,,,,,Inpatient,1,EA,7.62,7.62,HUMANA CHOICE PLUS,MGD,7.62,,,,,,,case rate,7.62,7.62,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,AETNA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,BCBS,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,CIGNA,COM,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,UNITED HEALTHCARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,VA TRICARE,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,WELLMED,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA,MGD,8.22,,,,,,,per diem,8.22,8.22,"Per diem rate, code is bundled with other services"
CEFAZOLIN 1GM INJ             ,92212241,CDM,250,RC,,,,,,Inpatient,1,EA,8.22,8.22,HUMANA CHOICE PLUS,MGD,8.22,,,,,,,case rate,8.22,8.22,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
LEVOTHYROXINE NA 200MCG TAB   ,92212242,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DIPHENHYDRAMINE HCL 50MG/ML IN,92212243,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
DILTIAZEM HCL 180MG C24       ,92212244,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,AETNA,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,BCBS,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,CIGNA,COM,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,TRICARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,UNITED HEALTHCARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,UNITED HEALTHCARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,VA,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,VA TRICARE,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,WELLMED,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,HUMANA,MGD,31.82,,,,,,,per diem,31.82,31.82,"Per diem rate, code is bundled with other services"
TRIAMCINOLONE 0.5% OIN        ,92212245,CDM,250,RC,,,,,,Inpatient,1,EA,31.82,31.82,HUMANA CHOICE PLUS,MGD,31.82,,,,,,,case rate,31.82,31.82,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
BELLADONNA/PHENOBARB TAB      ,92212246,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,AETNA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,BCBS,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,CIGNA,COM,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,UNITED HEALTHCARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,VA TRICARE,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,WELLMED,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA,MGD,28.13,,,,,,,per diem,28.13,28.13,"Per diem rate, code is bundled with other services"
RISPERIDONE 3MG TAB           ,92212247,CDM,250,RC,,,,,,Inpatient,1,EA,28.13,28.13,HUMANA CHOICE PLUS,MGD,28.13,,,,,,,case rate,28.13,28.13,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,AETNA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,BCBS,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,CIGNA,COM,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,UNITED HEALTHCARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,VA TRICARE,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,WELLMED,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA,MGD,5.25,,,,,,,per diem,5.25,5.25,"Per diem rate, code is bundled with other services"
PHENAZOPYRIDINE 100MG TAB     ,92212248,CDM,250,RC,,,,,,Inpatient,1,EA,5.25,5.25,HUMANA CHOICE PLUS,MGD,5.25,,,,,,,case rate,5.25,5.25,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,AETNA,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,BCBS,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,CIGNA,COM,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,TRICARE,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,UNITED HEALTHCARE,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,UNITED HEALTHCARE,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,VA,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,VA TRICARE,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,WELLMED,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,HUMANA,MGD,401.72,,,,,,,per diem,401.72,401.72,"Per diem rate, code is bundled with other services"
CORTROSYN 0.25MG INJ          ,92212249,CDM,250,RC,,,,,,Inpatient,1,EA,401.72,401.72,HUMANA CHOICE PLUS,MGD,401.72,,,,,,,case rate,401.72,401.72,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,AETNA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,BCBS,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,CIGNA,COM,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,UNITED HEALTHCARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,VA TRICARE,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,WELLMED,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA,MGD,5.42,,,,,,,per diem,5.42,5.42,"Per diem rate, code is bundled with other services"
HYDROCODONE APAP 10-325MG TAB ,92212250,CDM,250,RC,,,,,,Inpatient,1,EA,5.42,5.42,HUMANA CHOICE PLUS,MGD,5.42,,,,,,,case rate,5.42,5.42,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,AETNA,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,MGD,36.51,,,,,,,case rate,36.51,36.51,"Case rate contract, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem rate, code is bundled with other services"
CR CU MN ZN TRACE ELEMENT INJ ,92212251,CDM,250,RC,,,,,,Inpatient,1,EA,36.51,36.51,BCBS,COM,36.51,,,,,,,per diem,36.51,36.51,"Per diem ra